Clinical and Computed Tomography Characteristics for Early Diagnosis of Peripheral Small-cell Lung Cancer

PURPOSE: To investigate the clinical and computed tomography (CT) characteristics of peripheral small-cell lung cancer (pSCLC) to improve its early diagnosis. PATIENTS AND METHODS: In total, 70, 132, 69, and 95 patients with pathological confirmed nodular (≤3 cm) pSCLC, peripheral non-small cell lung cancer (pNSCLC), benign lung tumor (pBLT), and inflammatory lesion (pIL) were enrolled in this study retrospectively. The clinical and CT data of studied patients with different lesions were analyzed and compared by univariate analysis. Multivariate analysis was used to reveal the key features to distinguish pSCLC from pNSCLC, pBLT, and pIL, respectively. RESULTS: Univariate and multivariate analysis of the clinical and CT characteristics of studied patients indicated that 1) compared with pNSCLC and pIL, vessel convergence, spiculation, and peripheral ground-glass opacity were less common in pSCLC; 2) density homogeneity (OR = 38.84–120.21, P < 0.05), bronchial cutoff sign (OR = 10.00–60.13, P = 0.001), hilar lymph node enlargement (OR = 22.81–95.08, P < 0.0001) (pSCLC vs pNSCLC, pBLT, and pIL), male sex (OR = 5.53–10.92, P < 0.05) (pSCLC vs pNSCLC and pBLT), and emphysema (OR = 36.57–56.63, P < 0.05) (pSCLC vs pBLT and pIL) were significantly and independently associated with pSCLC. Type I and II bronchial cutoff sign, especially type I, were closely related to pSCLC. CONCLUSION: Peripheral solid nodules with homogeneous density, bronchial cutoff sign, hilar lymph node enlargement, but without spiculation or vessel convergence in male patients with emphysema should be highly suspected of pSCLC.