Background and objective: Solitary pulmonary nodules (SPN) is a knotty problem in clinical work. The clinical manifestation and pathological features of SPN in sizes may be obviously different. The aim of this study is to analyze the relationship between the diameters and clinicopathologic characteristics of SPN.
Methods: 390 patients (212 male, 178 female, ranging from 17 years to 86 years, median age 57.1 years) with SPN who were postoperatively diagnosed by pathology between Jan. 2000 and Jun. 2009 are enrolled to this study. In these cases, the number of SPN diameters which are smaller than 0.5 cm (including 0.5 cm) (group A) is 16, between 0.5 cm and 1 cm (including 1 cm, not including 0.5 cm) (group B) is 58, between 1 cm and 2 cm (group C) is 163, and between 2 cm and 3 cm (group D) is 153. The clinical manifestation, and postoperative pathological characters are analyzed in various diameter ranges.
Results: All procedures were carried out securely, including tumor enucleation (n = 20), wedge resection (n = 153), lobectomy (n = 217). There are 130 benign cases (33.3%) and 260 malignant cases (66.7%). 58.5% SPN are detected incidently with no symptoms. There is an increasing incidence of clinical symptoms as the increasing diameter of SPN. All the cases are divided into 4 groups, the prevalence of malignant are separated 43.7% (group A), 50.0% (group B), 63.2% (group C), 79.1% (group D). The diameter of SPN is positively correlated with incidence of malignancy (chi2 = 22.535, P < 0.001). Single factor analysis and Logistic regression analysis show the diameter of SPN is an independent risk factor of malignant pathology (OR = 1.922, P < 0.001). Fourteen patients in all of the SPN were followed up by 2 years or more before operation, and 10 of them turn out to be malignant at last. In the 14 patients, 7 cases were found not enlarged by CT scan, and 3 of them (42.9%) were malignant.
Conclusion: The diameter of SPN is highly associated with clinical symptoms, and is a significant risk factor to predict pathology. Early diagnosis and treatment is so important for patients with SPN.
背景与目的: 孤立性肺结节（solitary pulmonary nodules, SPN）是临床诊治的难题之一，不同直径大小SPN的临床及病例特点可能各不相同。本研究旨在探讨SPN直径大小与临床及病理之间的关系。
方法: 收集2000年1月-2009年7月在北京大学人民医院胸外科经手术切除明确病理诊断的SPN患者共390例。其中男性212例，女性178例。平均年龄57.1岁；结节最大径平均2.02 cm。按SPN最大径进行分组，其中最大径≤0.5 cm 16例（A组），0.5 cm-1 cm 58例（B组），1 cm-2 cm 163例（C组），2 cm-3 cm 153例（D组），比较各组的临床表现及病理特点。
结果: 肿瘤剜除术20例，楔形切除153例，肺叶切除217例。术后病理：良性病变130例（33.3%），恶性病变260例（66.7%）。58.5%的SPN不伴有临床症状，随着结节直径增大，出现临床症状的比率有逐渐增高趋势。A、B、C、D四组的恶性比率分别为43.7%、50.0%、63.2%、79.1%，随着结节直径增大，恶性肿瘤机率显著增加，差异有统计学意义（χ2=22.535, P < 0.001）。单因素及多因素Logistic回归分析结果显示，SPN直径大小是良恶性判断的独立危险因素（OR=1.922, P < 0.001）。本组14例患者术前观察时间达到或超过2年，其中10例术后为恶性，观察期间无增大者7例，3例证实为恶性（42.9%）。
结论: SPN直径大小与患者是否伴有临床症状相关，是病理性质判断的重要危险因素。临床发现的SPN应早期诊断，及时治疗。