Abstract
BackgroundOur study was designed to improve the accuracy of determining whether pulmonary nodules are benign or malignant.MethodsWe evaluated the clinical and imaging features and serum markers: neuron specific enolase (NSE), carcino-embryonic antigen (CEA), cytokeratin fragment antigen 21–1 (CYFRA 21–1), miRNA-21-5p, and miR-574-5pof in 39 patients with pathology information. Factors that differed significantly between those with benign versus malignant pulmonary nodules were used to establish a prediction model for identifying malignant nodules.ResultsThe studied nodules were 51.3% malignant and 48.7% benign. Age, smoking status, nodule diameter, history of emphysema, vascular sign, burr sign, CYFRA21-1, CEA, miRNA-21-5p, and miRNA-574-5p differed significantly between the benign and malignant nodule groups. Serum levels of CYRFA21-1 and CEA could be used to distinguish between malignant and benign nodules with a positive predictive value (PPV) of 80.0%, a negative predictive value (NPV) of 84.2%, and an area under the receiver operating characteristics curve (AUC) of 0.863. Using the serum levels of miRNA-21-5p and miRNA-574-5p, the PPV was 55%, the NPV was 84.2%, and the AUC was 0.797. When all four serum markers were combined, the PPV was 80%, the NPV was 89.5%, and the AUC was 0.921. We established a prediction model for malignant nodules, including clinical features, imaging features, and serum markers. In cross-validation, the ratio of discriminant conformance was 95%.ConclusionsSerum levels of miRNA-21-5p and miRNA-574-5p are significantly higher in patients with malignant nodules than in patients with benign nodules and are potential serum biomarkers. Our prediction model could improve malignant nodule diagnosis.
Highlights
Our study was designed to improve the accuracy of determining whether pulmonary nodules are benign or malignant
Clinical features help differentiate benign and malignant nodules For the 39 patients with pulmonary nodules included in this study, pathology results were available from material obtained by surgery or bronchoscopic biopsy
Emphysema was present in 25% of those with malignant nodules, while none of those with benign nodules had emphysema (P = 0.04)
Summary
Our study was designed to improve the accuracy of determining whether pulmonary nodules are benign or malignant. We found that lung nodules were detected in 39.1% of patients at high risk of lung cancer screened with low-dose computed tomography (CT) scanning, of which 96.4% were benign [4]. A biopsy of lung tissue obtained through bronchoscopy, CT-guided percutaneous approaches, or open surgical procedures is required to distinguish benign and malignant pulmonary nodules pathologically. These procedures are invasive and high risk, are costly, and sometimes patients cannot tolerate them. It is important to develop less invasive and expensive techniques to aid in monitoring patients with lung nodules for either benign conditions or early-stage cancer
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