Lung Cancer |

Histologic Spectrum of Solitary Pulmonary Nodule A Single-Institutional Retrospective Study Based on a Large Cohort of 2,255 Patients FREE TO VIEW

Yiliang Zhang, MS; Yuan Li, MD; Ting Ye, MS; Yang Zhang; Yihua Sun, MD; Jiaqing Xiang, MD; Yawei Zhang, MD; Hecheng Li, MD; Lei Shen, MS; Haiquan Chen, PhD
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Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China

Chest. 2014;145(3_MeetingAbstracts):337A. doi:10.1378/chest.1835824
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SESSION TITLE: Lung Cancer Posters I

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Solitary pulmonary nodule (SPN) is increasingly detected on chest imaging andposes a challenge to clinicians because the differential diagnosis is extensive. This study was aimed to reveal the histologic spectrum of resected SPNs.

METHODS: We performed a retrospective review on all consecutive patients who underwent surgery for SPNat a single institution between 2008 and 2013. SPNs were divided into four groups by their length (3-2cm; 2-1cm; 1-0.5cm; 0.5-0cm).The size was measured in fresh specimen before formalin fixation. Correlations between pathologic data and clinical characteristics were evaluated.

RESULTS: There were totally 2255 SPNs included. For those 3-2 cm, malignant tumors accounted for 85.6%. Adenocarcinoma (54.8%) and squamous cell carcinoma (16.9%) were the main malignant types, while inflammation (11.4%) and hamartoma (1.3%) were the most common causes for benign diseases.When SPN became smaller (2-1cm to 1-0.5cm), the likelihood of malignancy decreased (79.2% to 68.7%). Adenocarcinoma was still the leading form (54.3% to 39.6%) whilemetastatic nodulestook the second place (10.3% to 14.4%). Incidence of Inflammation (15.3% to 20.3%) and hamartoma (3.4% to 10.5%) increased when the nodule got smaller. The likelihood of malignancy dropped to 39.4%when a SPN was smaller than 0.5cm, and adenocarcinoma in situ (22.7%)became the mostcommon etiology.Benign lesions accounted for more than half in this group, with inflammation (36.4%) and atypical adenoma hyperplasia (13.6%) as the top two causes. For the whole cohort, the incidence of malignant SPN increased steadily with aging (OR=.955, 95%CI .944-.966, P<.0001).

CONCLUSIONS: Adenocarcinoma was the main malignantetiology while inflammation the major benign one in all resected SPNs. The probability of malignancy in a SPN increases with the nodule size.Increasing patient age generally correlates with increasing likelihood of malignancy.

CLINICAL IMPLICATIONS: We performed a retrospective study based on a large cohort of resected solitary pulmonary nodules (SPNs). We found that adenocarcinoma was the main malignant etiology while inflammation the major benign one. The probability of malignancy in a SPN increases with the nodule size. Increasing patient age generally correlates with increasing likelihood of malignancy.

DISCLOSURE: The following authors have nothing to disclose: Yiliang Zhang, Yuan Li, Ting Ye, Yang Zhang, Yihua Sun, Jiaqing Xiang, Yawei Zhang, Hecheng Li, Lei Shen, Haiquan Chen

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