Factors associated with overdiagnosis of benign pulmonary nodules as malignancy: a retrospective cohort study

• Published in: BMC pulmonary medicine 2023-11, Vol.23 (1), p.454-11, Article 454
• Main Authors: Duan, Xirui, Ouyang, Zhiqiang, Bao, Shasha, Yang, Lu, Deng, Ailin, Zheng, Guangrong, Zhu, Yu, Li, Guochen, Chu, Jixiang, Liao, Chengde
• Format: Article
• Language: English
• Subjects: Benign; Benign pulmonary nodules; Biomarkers; Biopsy; Cancer; Care and treatment; Computed tomography; Convergence; CT imaging; Diagnosis; Diagnosis, Differential; Differential diagnosis; Family medical history; Graduate students; Histopathology; Humans; Imaging features; Lung cancer; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Lung nodules; Lung tumors; Malignancy; Malignant pulmonary nodules; Medical imaging; Medical research; Medical screening; Medicine, Experimental; Methods; Middle Aged; Mortality; Multiple Pulmonary Nodules - diagnostic imaging; Multiple Pulmonary Nodules - pathology; Overdiagnosis; Patients; Preoperative model; Pulmonology; Regression analysis; Retrospective Studies; Risk factors; Statistical analysis; Surgery
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/s12890-023-02727-7

To establish a preoperative model for the differential diagnosis of benign and malignant pulmonary nodules (PNs), and to evaluate the related factors of overdiagnosis of benign PNs at the time of imaging assessments. In this retrospective study, 357 patients (median age, 52 years; interquartile range, 46-59 years) with 407 PNs were included, who underwent surgical histopathologic evaluation between January 2020 and December 2020. Patients were divided into a training set (n = 285) and a validation set (n = 122) to develop a preoperative model to identify benign PNs. CT scan features were reviewed by two chest radiologists, and imaging findings were categorized. The overdiagnosis rate of benign PNs was calculated, and bivariate and multivariable logistic regression analyses were used to evaluate factors associated with benign PNs that were over-diagnosed as malignant PNs. The preoperative model identified features such as the absence of part-solid and non-solid nodules, absence of spiculation, absence of vascular convergence, larger lesion size, and CYFRA21-1 positivity as features for identifying benign PNs on imaging, with a high area under the receiver operating characteristic curve of 0.88 in the validation set. The overdiagnosis rate of benign PNs was found to be 50%. Independent risk factors for overdiagnosis included diagnosis as non-solid nodules, pleural retraction, vascular convergence, and larger lesion size at imaging. We developed a preoperative model for identifying benign and malignant PNs and evaluating factors that led to the overdiagnosis of benign PNs. This preoperative model and result may help clinicians and imaging physicians reduce unnecessary surgery.