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Abstract：
BACKGROUND: Pulmonary solid pleura-attached nodules (SPANs) are not very commonly detected and thus not well studied and understood. This study aimed to identify the clinical and CT characteristics for differentiating benign and malignant SPANs.
RESULTS: From January 2017 to March 2023, a total of 295 patients with 300 SPANs (128 benign and 172 malignant) were retrospectively enrolled. Between benign and malignant SPANs, there were significant differences in patients\' age, smoking history, clinical symptoms, CT features, nodule-pleura interface, adjacent pleural change, peripheral concomitant lesions, and lymph node enlargement. Multivariate analysis revealed that smoking history (odds ratio [OR], 2.016; 95% confidence interval [CI], 1.037-3.919; p = 0.039), abutting the mediastinal pleura (OR, 3.325; 95% CI, 1.235-8.949; p = 0.017), nodule diameter (> 15.6 mm) (OR, 2.266; 95% CI, 1.161-4.423; p = 0.016), lobulation (OR, 8.922; 95% CI, 4.567-17.431; p < 0.001), narrow basement to pleura (OR, 6.035; 95% CI, 2.847-12.795; p < 0.001), and simultaneous hilar and mediastinal lymph nodule enlargement (OR, 4.971; 95% CI, 1.526-16.198; p = 0.008) were independent predictors of malignant SPANs, and the area under the curve (AUC) of this model was 0.890 (sensitivity, 82.0%, specificity, 77.3%) (p < 0.001).
CONCLUSIONS: In patients with a smoking history, SPANs abutting the mediastinal pleura, having larger size (> 15.6 mm in diameter), lobulation, narrow basement, or simultaneous hilar and mediastinal lymph nodule enlargement are more likely to be malignant.
UNASSIGNED: The benign and malignant SPANs have significant differences in clinical and CT features. Understanding the differences between benign and malignant SPANs is helpful for selecting the high-risk ones and avoiding unnecessary surgical resection.
CONCLUSIONS: • The solid pleura-attached nodules (SPANs) are closely related to the pleura. • Relationship between nodule and pleura and pleural changes are important for differentiating SPANs. • Benign SPANs frequently have broad pleural thickening or embed in thickened pleura. • Smoking history and lesions abutting the mediastinal pleura are indicators of malignant SPANs. • Malignant SPANs usually have larger diameters, lobulation signs, narrow basements, and lymphadenopathy.
RESULTS: From January 2017 to March 2023, a total of 295 patients with 300 SPANs (128 benign and 172 malignant) were retrospectively enrolled. Between benign and malignant SPANs, there were significant differences in patients\' age, smoking history, clinical symptoms, CT features, nodule-pleura interface, adjacent pleural change, peripheral concomitant lesions, and lymph node enlargement. Multivariate analysis revealed that smoking history (odds ratio [OR], 2.016; 95% confidence interval [CI], 1.037-3.919; p = 0.039), abutting the mediastinal pleura (OR, 3.325; 95% CI, 1.235-8.949; p = 0.017), nodule diameter (> 15.6 mm) (OR, 2.266; 95% CI, 1.161-4.423; p = 0.016), lobulation (OR, 8.922; 95% CI, 4.567-17.431; p < 0.001), narrow basement to pleura (OR, 6.035; 95% CI, 2.847-12.795; p < 0.001), and simultaneous hilar and mediastinal lymph nodule enlargement (OR, 4.971; 95% CI, 1.526-16.198; p = 0.008) were independent predictors of malignant SPANs, and the area under the curve (AUC) of this model was 0.890 (sensitivity, 82.0%, specificity, 77.3%) (p < 0.001).
CONCLUSIONS: In patients with a smoking history, SPANs abutting the mediastinal pleura, having larger size (> 15.6 mm in diameter), lobulation, narrow basement, or simultaneous hilar and mediastinal lymph nodule enlargement are more likely to be malignant.
UNASSIGNED: The benign and malignant SPANs have significant differences in clinical and CT features. Understanding the differences between benign and malignant SPANs is helpful for selecting the high-risk ones and avoiding unnecessary surgical resection.
CONCLUSIONS: • The solid pleura-attached nodules (SPANs) are closely related to the pleura. • Relationship between nodule and pleura and pleural changes are important for differentiating SPANs. • Benign SPANs frequently have broad pleural thickening or embed in thickened pleura. • Smoking history and lesions abutting the mediastinal pleura are indicators of malignant SPANs. • Malignant SPANs usually have larger diameters, lobulation signs, narrow basements, and lymphadenopathy.
摘要：
背景：肺实性胸膜附着结节（SPAN）不是很常见，因此没有得到很好的研究和理解。本研究旨在确定鉴别良恶性SPAN的临床和CT特征。
结果：从2017年1月至2023年3月，回顾性纳入了295例300个SPAN患者（128个良性和172个恶性）。在良性和恶性SPAN之间，患者年龄有显著差异，吸烟史,临床症状,CT特征,结节-胸膜界面,相邻胸膜改变，周围伴随病变，淋巴结肿大.多因素分析显示吸烟史(比值比[OR]，2.016；95%置信区间[CI]，1.037-3.919；p=0.039），邻接纵隔胸膜（或，3.325；95%CI，1.235-8.949；p=0.017），结节直径(>15.6mm)(OR，2.266；95%CI，1.161-4.423；p=0.016），分叶(或,8.922；95%CI，4.567-17.431；p<0.001），狭窄的基底到胸膜（或，6.035；95%CI，2.847-12.795；p<0.001），同时肺门和纵隔淋巴结肿大（OR，4.971;95%CI,1.526-16.198;p=0.008)是恶性SPAN的独立预测因子,该模型的曲线下面积（AUC）为0.890（灵敏度，82.0%,特异性，77.3%)(p<0.001)。
结论：在有吸烟史的患者中，邻近纵隔胸膜的SPAN,具有更大的尺寸（直径>15.6mm），分叶,狭窄的地下室,或同时肺门和纵隔淋巴结肿大更可能是恶性的。
■良性和恶性SPAN在临床和CT表现上有显著差异。了解良性和恶性SPAN之间的差异有助于选择高危患者并避免不必要的手术切除。
结论：•实性胸膜附着结节（SPAN）与胸膜密切相关。•结节与胸膜和胸膜改变之间的关系对于区分SPAN很重要。•良性SPAN通常具有广泛的胸膜增厚或嵌入增厚的胸膜中。•吸烟史和邻近纵隔胸膜的病变是恶性SPAN的指标。•恶性SPAN通常具有较大的直径，分叶征象,狭窄的地下室,和淋巴结病。
结果：从2017年1月至2023年3月，回顾性纳入了295例300个SPAN患者（128个良性和172个恶性）。在良性和恶性SPAN之间，患者年龄有显著差异，吸烟史,临床症状,CT特征,结节-胸膜界面,相邻胸膜改变，周围伴随病变，淋巴结肿大.多因素分析显示吸烟史(比值比[OR]，2.016；95%置信区间[CI]，1.037-3.919；p=0.039），邻接纵隔胸膜（或，3.325；95%CI，1.235-8.949；p=0.017），结节直径(>15.6mm)(OR，2.266；95%CI，1.161-4.423；p=0.016），分叶(或,8.922；95%CI，4.567-17.431；p<0.001），狭窄的基底到胸膜（或，6.035；95%CI，2.847-12.795；p<0.001），同时肺门和纵隔淋巴结肿大（OR，4.971;95%CI,1.526-16.198;p=0.008)是恶性SPAN的独立预测因子,该模型的曲线下面积（AUC）为0.890（灵敏度，82.0%,特异性，77.3%)(p<0.001)。
结论：在有吸烟史的患者中，邻近纵隔胸膜的SPAN,具有更大的尺寸（直径>15.6mm），分叶,狭窄的地下室,或同时肺门和纵隔淋巴结肿大更可能是恶性的。
■良性和恶性SPAN在临床和CT表现上有显著差异。了解良性和恶性SPAN之间的差异有助于选择高危患者并避免不必要的手术切除。
结论：•实性胸膜附着结节（SPAN）与胸膜密切相关。•结节与胸膜和胸膜改变之间的关系对于区分SPAN很重要。•良性SPAN通常具有广泛的胸膜增厚或嵌入增厚的胸膜中。•吸烟史和邻近纵隔胸膜的病变是恶性SPAN的指标。•恶性SPAN通常具有较大的直径，分叶征象,狭窄的地下室,和淋巴结病。
