ArticleJournal of thoracic disease2026
Systemic immune-inflammatory index is associated with malignancy in Lung-RADS 4 lung nodules.
Article in Journal of thoracic disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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12 authors.
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Abstract
Background: Better stratification of malignancy risk among high-risk pulmonary nodules detected by low-dose computed tomography (LDCT) is needed. The objective of this study is to determine if an association exists between the systemic immune-inflammatory index (SII) and malignancy in patients with Lung CT Screening Reporting and Data System (Lung-RADS) 4 nodules identified on LDCT. Methods: A retrospective review of patients who underwent LDCT at a single institution between March 2015 and December 2024 was performed to identify patients with Lung-RADS 4A/B/X nodules. Exclusion criteria included a missing complete blood count with differential, being lost to follow-up, and a diagnosis of inflammatory nodules, granulomas, or metastases from other primary cancers upon biopsy. Univariate and multivariate analyses were used to examine the association between SII and malignancy in Lung-RADS 4 nodules. Cut-point analysis was performed to determine the SII cutoff most strongly correlated with underlying malignancy. Results: A total of 123 patients met study criteria. Among high-risk nodules, 63.4% (78/123) were diagnosed with lung cancer, and the median SII for the cohort was 589 (interquartile range, 360-819). On multivariable linear regression analysis, after adjusting for age, sex, race, smoking history, medical comorbidities, body mass index, and nodule size, individuals with malignant nodules had a significantly higher SII [+272; 95% confidence interval (CI): 75-470; P=0.007]. Utilizing Youden's index analysis, the optimal SII cutoff was 561. On multivariable logistic regression analysis, individuals with a high SII, using a cutoff of 561, had significantly greater odds of having malignant nodules (odds ratio 3.74; 95% CI: 1.42-9.85; P=0.008). Conclusions: An elevated SII is associated with malignancy in non-inflammatory Lung-RADS 4 nodules identified on LDCT. Incorporating SII calculation may serve as a useful adjunct for risk-stratification and prognostication in patients with high-risk pulmonary nodules.
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