评估 Lung-RADS 4 类患者中肺癌的患病率，并阐明临床或影像学特征是否有助于区分良性病变和肺癌。对 1 月份期间单个大学筛查项目的肺癌筛查 (LCS) 研究进行回顾性审查2018 年和 2021 年 12 月确定了所有患有 Lung-RADS 4 类病变的患者。记录患者人口统计数据、前 6 个月内的症状和影像学特征。在规定的时间内，进行了 4819 次基线和年度 LCS 检查； 7.6% (n = 368) 的检查显示 4 类结节，59 名 (1.2%) 患者经活检证实患有肺癌。 Lung-RADS 4 类病变的分布和肺癌诊断如下：4A - 223 个结节，6.3% 恶性； 4B - 114 个结节，20.2% 恶性； 4X - 31 个结节，71.0% 恶性。 9.0% (n = 20) 4A 类（2 例恶性）、15.8% (n = 18) 4B 类（1 例恶性）和 22.6% (n = 7) 4X 类（5 例恶性）报告有症状。与恶性肿瘤相关的影像学特征包括支气管内阻塞伴远端肺不张、胸膜束缚、形状不规则、空洞和异质囊性外观。 24 个结节尺寸增大，但只有 7 个经活检证实。相对于 4A 疾病的风险，多变量逻辑分析显示，4B 和 4X 疾病的恶性肿瘤几率显着增加 3.8 倍（95% CI：1.9, 7.9）和 39.2 倍（95% CI：14.9, 103.0）分别 (p < 0.0001)。仅涉及 4A 类和 4B 类患者的单独分析共同表明，疾病类别（OR = 3.0；95% CI：1.5，6.4）和其他影像学特征（OR = 3.2；95% CI：1.4，7.0）是恶性肿瘤的显着预测因子。临床症状的存在与肺癌没有统计学相关性。7.6%的LCS检查发现Lung-RADS 4结节，其中16%是肺癌。肺癌的概率从 4A 类增加到 4X 类，影像学特征可能有助于区分该 LCS 类中的良性结节和恶性结节。版权所有 © 2023 Elsevier B.V. 保留所有权利。

To assess the prevalence of lung cancer in Lung-RADS category 4 patients, and to elucidate if clinical or imaging features help differentiate benign lesions from lung cancer.A retrospective review of lung cancer screening (LCS) studies at a single university screening program between January 2018 and December 2021 identified all patients with Lung-RADS category 4 lesions. Patient demographics, symptoms within the prior 6 months, and imaging features were recorded.During the defined period, 4819 baseline and annual LCS exams were performed; 7.6 % (n = 368) of exams had category 4 nodules and 59 (1.2 %) patients had biopsy-proven lung cancer. Distribution of Lung-RADS category 4 lesions and lung cancer diagnosis were as follows: 4A - 223 nodules, 6.3 % malignant; 4B - 114 nodules, 20.2 % malignant; and 4X - 31 nodules, 71.0 % malignant. Symptoms were reported in 9.0 % (n = 20) of category 4A (2 were malignant), 15.8 % (n = 18) category 4B (1 was malignant) and 22.6 % (n = 7) category 4X (5 were malignant). Imaging features associated with malignancy included endobronchial obstruction with distal atelectasis, pleural tethering, irregular shape, cavitation, and heterogeneous cystic appearance. Twenty-four nodules increased in size, however, only 7 were biopsy proven. Relative to the risk seen with 4A disease, multivariable logistic analyses showed that the odds of a malignancy increased significantly by 3.8 fold (95 % CI: 1.9, 7.9) and 39.2 fold (95 % CI: 14.9, 103.0) with 4B and 4X disease, respectively (p < 0.0001). A separate analysis involving only category 4A and 4B patients jointly showed that disease category (OR = 3.0; 95 % CI: 1.5, 6.4) and additional imaging features (OR = 3.2; 95 % CI: 1.4, 7.0) were significant predictors of malignancy. The presence of clinical symptoms was not statistically associated with lung cancer.Lung-RADS 4 nodules were found in 7.6% of LCS examinations and 16% of these nodules were lung cancer. The probability of lung cancer increases from category 4A to 4X, and imaging features may help differentiate benign from malignant nodules in this LCS category.Copyright © 2023 Elsevier B.V. All rights reserved.