Context: Early detection of pulmonary nodules in lung cancer and timely intervention can improve the number of diagnoses at early stages of lung cancer and can reduce mortality. At present, it's not possible to accurately determine the degree of pathological invasion of ground-glass nodules and the probability of regional lymph node metastasis using an imaging examination before surgery.
Objective: The study intended to analyze the clinical, imaging, and pathological characteristics of malignant pulmonary nodules and to explore the high-risk factors for lymph node metastasis, using logistic regression multivariate analysis.
Design: The research team retrospectively analyzed lung-cancer patients' demographic and clinical data.
Setting: The study took place in the Department of Thoracic Surgery at Zhangzhou Municipal Hospital, affiliated with Fujian Medical University, in Zhangzhou, China.
Participants: Participants were 1168 patients with malignant pulmonary nodules at the hospital between January 2018 and December 2020.
Outcome measures: The research team: (1) collected participant's pulmonary nodules after surgical resection, which the hospital had confirmed were primary lung cancer and (2) analyzed the clinical characteristics of the malignant pulmonary nodules using the World Health Organization's (WHO's) 2021 classification standard for lung-cancer tissue. The research team also collected participants' data, including gender, age, smoking status, nodular size, imaging characteristics, pathological type, degree of invasion, and lymph node metastasis, and analyzed the clinical characteristics of the malignant pulmonary nodules and explored the risk factors for lymph node metastasis.
Results: Participants' average age was 56.79 ± 11.53 years, and the study included 675 females (57.79%) and 493 males (42.21%), 932 of whom didn't smoke (79.8%). Imaging indicated that most participants had nodules in the upper lobes of the lungs, 424 participants in the right lung (36.30%) and 303 in the left (25.94%). Imaging also showed that 400 participants had pure ground-glass nodules (34.25%) and 371 had solid nodules(31.76%), 355 had partial solid nodules (30.39%), the other 42 had cavitary nodules (3.60%) , and 1098 participants had adenocarcinoma (94.00%). Regarding the incidence of lymph node metastasis, 67 participants had N1 metastasis (5.74%) and 34 had N2 metastasis (2.91%). The multivariate logistic regression analysis showed that an increase in the nodular size (P < .001); the presence of lower-lobe pulmonary nodules, the nodular site (P = .025); and the amount of solid components in the nodule, the nodule's features (P < .001), were significant adverse factors for N1 lymph node metastasis, while gender, age, and smoking status didn't affect that outcome.
Conclusions: Adenocarcinoma was the most common pathological type, and the probability of lymph node metastasis was low. N1 lymph node metastasis was associated with increased nodular size and solid components and the presence of lower lobe nodules.