Differentiating benign from malignant pulmonary nodules in the context of bronchiectasis: a retrospective study

BACKGROUND: Pulmonary nodules are common on chest CT in bronchiectasis (BE) patients. This study identifies risk factors for nodule malignancy in BE patients with pulmonary nodules. METHOD: We screened BE patients who underwent chest CT at Second Xiangya Hospital from Jan 1, 2019 to Mar 31, 2025. Only patients with pulmonary nodules and pathological results were enrolled. Univariate and multivariate logistic regression were performed to identify independent predictors of malignancy. RESULTS: , Of 143 patients, 28 had benign nodules and 115 had malignant nodules. Malignant nodules were more often pure ground‑glass/ground glass with a solid component nodule type (73.9% vs 28.6%, p<0.001) and upper lobe located (54.8% vs 32.1%, p=0.032). Benign nodules most commonly showed inflammation (60.7%), while malignant nodules were predominantly invasive adenocarcinoma (86.9%). Pure ground‑glass/ground glass with a solid component nodule type was the only independent predictor of malignancy (adjusted OR 8.53, 95% CI 3.14-25.81). Upper lobe location did not remain significant after adjustment. Reiff score and same‑lobe BE‑nodule coexistence were not significantly associated. CONCLUSION: Among BE patients with pulmonary nodules, pure ground‑glass/ground glass with a solid component nodule type independently predicts malignancy. This may aid clinical decision‑making.