旨在确定接触或靠近胸膜的小肺部结节的肺癌风险和观察者间的一致性。结节来自两个队列：来自国家肺部筛查试验的患者，其实性结节尺寸为 6-9.5 毫米；来自国家肺部筛查试验的患者，其实性结节尺寸为 6-9.5 毫米；以及我们的医疗系统中偶发肺部结节且直径为 1-8 毫米的实性结节的患者。仅评估每位患者的主要结节。包括所有恶性结节以及每个队列中随机抽取的 200 个良性结节样本。两名接受过专科培训的胸部放射科医生独立审查每个病例，记录结节形态（是否与淋巴结相容）和结节位置（基于胸膜、与胸膜有间隔连接或两者都不连接）。一名放射科医生测量了到胸膜的距离。应用排除标准后，总共包含 434 个结节，其中 45 个为肺癌。考虑到所有具有淋巴结形态的胸膜结节均为良性，0-7% 的癌症被错误分类为良性，特异性为 33%，κ = 0.69。考虑到胸膜下结节和与胸膜有间隔连接的结节，7-11% 的癌症被错误分类（与基于胸膜的结节相比，p = 0.16-0.25），特异性为 40-52% (p < .0001)，κ = 0.60。考虑到淋巴结形态距胸膜 ≤ 2 毫米的结节，2-7% 的癌症被错误分类（p = 1 与基于胸膜的癌症相比），特异性为 41-36% (p < .0001)，κ = 0.78。考虑结节具有间隔连接的淋巴结形态，或距胸膜 ≤ 2 毫米的淋巴结，作为良性不会导致肺癌明显错误分类为良性。版权所有 © 2024 大学放射科医生协会。由爱思唯尔公司出版。保留所有权利。

To determine the risk of lung cancer and inter-observer agreement for small pulmonary nodules either touching or near the pleura.Nodules were derived from two cohorts: patients from the National Lung Screening Trial with a solid nodule measuring 6-9.5 mm; and patients with incidental pulmonary nodules in our healthcare system with a solid nodule measuring 1-8 mm. Only the dominant nodule was evaluated for each patient. All malignant nodules as well as a random sample of 200 benign nodules from each cohort were included. Two fellowship-trained thoracic radiologists independently reviewed each case to record nodule morphology (compatible with lymph node or not) and nodule location (pleural-based, septal connection to the pleura, or neither). One radiologist measured the distance to the pleura.After exclusion criteria were applied, a total of 434 nodules were included, of which 45 were lung cancers. Considering all pleural-based nodules with lymph node morphology as benign, 0-7% of cancers were misclassified as benign, specificity 33%, and κ = 0.69. Considering subpleural nodules and those with septal connection to the pleura, 7-11% of cancers were misclassified (p = 0.16-0.25 versus pleural-based), specificity 40-52% (p < .0001), and κ = 0.60. Considering nodules with lymph node morphology ≤ 2 mm from the pleura, 2-7% of cancers were misclassified (p = 1 versus pleural-based), specificity 41-36% (p < .0001), and κ = 0.78.Considering nodules with lymph node morphology with septal connection, or those ≤ 2 mm from the pleura, as benign does not lead to significant misclassification of lung cancers as benign.Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.