Exploring the key clinical and computed tomography features for distinguishing high-grade lung cancers from morphologically similar benign tumors - a two-center case-control study

Sep 22, 2026

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High-grade lung cancers (HGLCs) and pulmonary benign tumors (PBTs) can show similar computed tomography (CT) characteristics, increasing diagnostic difficulty and delaying treatment. This two-center retrospective case-control study compared clinical variables and qualitative and quantitative CT indicators in 102 HGLCs and 102 size-matched PBTs. Firth’s penalized logistic regression identified independent predictors, with performance assessed via 5-fold cross-validation. Male sex, heavy smoking, and specific CT patterns—mediastinal/hilar node enlargement, vascular encasement, and bronchial obstruction—supported identifying HGLCs.

LanguageEnglish

CategoryHealthcare

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Pages11

Reading Time28 min

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Abstract

Background

Methods

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Introduction

Zhao et al. BMC Medical Imaging (2026) 26:293 [https://doi.org/10.1186/s12880-026-02375-3](https://doi.org/10.1186/s12880-026-02375-3) BMC Medical Imaging RESEARCH Open Access Exploring the key clinical and computed tomography features for distinguishing highgrade lung cancers from morphologically similar benign tumors: a two-center casecontrol study Min Zhao1†, Hui Gan1,2†, Can Ding1, Wen-tao Zhang1, Fa-jin Lv 1* and Zhi-gang Chu 1* Abstract Background Some high-grade lung cancers (HGLCs) and pulmonary benign tumors (PBTs) exhibit similar computed tomography (CT) features. This study aims to determine the key clinical and CT features for identifying HGLCs. Methods From 2011 to 2025, 102 HGLCs presenting as regular solid nodules (SNs) and 102 size-matched PBTs were retrospectively enrolled. Clinical data and qualitative and quantitative CT indicators of lesions were analyzed and compared. Firth’s penalized logistic regression was used to identify independent predictors, and model performance was evaluated using 5-fold cross-validation. Results Compared to patients with PBTs, those with HGLCs were more likely to be male, older, and symptomatic individuals and smokers, with greater smoking amount (all P < 0. 05) . HGLCs also demonstrated higher rates of mediastinal/hilar lymph node enlargement, vascular encasement, and bronchial obstruction, while calcification was absent (all P < 0. 001) . The male (odds ratio [OR], 42 . 340; 95% confidence interval [CI], 2.283-785. 149; P = 0 . 012), high pack-years (> 27 . 6) (OR, 1. 161; 95%CI, 1.022–1. 321; P = 0 . 022), mediastinal/hilar lymph node enlargement (OR, 208 . 631; 95% CI, 6 .477–6720. 607; P = 0 . 003), bronchial obstruction (OR, 34 . 375; 95% CI, 2 .314–196. 064; P = 0 . 010), and vascular encasement (OR, 39 . 650; 95% CI, 9 .089–67. 752; P = 0 . 002) were revealed as independent predictors of HGLCs. Conclusions In male heavy smokers, SNs with morphological features of PBTs but exhibiting vascular encasement, bronchial obstruction, or mediastinal/hilar lymph node enlargement warrant closer monitoring or further evaluation. Keywords Lung neoplasms, Tomography, X-ray computed, Smokers †Min Zhao and Hui Gan contributed equally to this work. *Correspondence: Fa-jin Lv [fajinlv@163.com](fajinlv@163.com)[ ](fajinlv@163.com)Zhi-gang Chu[chuzg0815@163.com](chuzg0815@163.com) 1Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China 2Department of Radiology, The Second Affiliated Hospital of Army Medical University, Chongqing, China © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/licenses/by-nc-nd/4.0/](vecommons.org/licenses/by-nc-nd/4.0/.)[.](vecommons.org/licenses/by-nc-nd/4.0/.) Introduction Lung cancer remains the most frequently diagnosed malignancy worldwide [1]. High-grade lung cancers (HGLCs), including small cell lung cancer (SCLC), large cell carcinoma (LCC), SMARCA4-deficient undiffe

FAQs

What problem does the study address about high-grade lung cancers and benign tumors?

Some HGLCs and PBTs share similar CT features, which can lead to misdiagnosis and delayed treatment. The study seeks clinical and CT indicators to distinguish them.

How were patients selected in this two-center case-control study?

From 2011 to 2025, 102 HGLCs presenting as regular solid nodules and 102 size-matched PBTs were retrospectively enrolled and compared using clinical and CT variables.

Which factors were identified as independent predictors for HGLCs?

Male sex, high pack-years, mediastinal/hilar lymph node enlargement, bronchial obstruction, and vascular encasement were independent predictors. Calcification was absent in HGLCs.

Sep 22, 2026

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