Subsolid Pulmonary Nodules and the Spectrum of Peripheral Adenocarcinomas of the Lung: Recommended Interim Guidelines for Assessment and Management
Subsolid Pulmonary Nodules and the Spectrum of Peripheral Adenocarcinomas of the Lung: Recommended Interim Guidelines for Assessment and Management
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DOI：
10.1148/radiol.2533090179
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发表时间：
2009-12-01
期刊：
影响因子：
19.7
通讯作者：
Naidich, David P.
中科院分区：
文献类型：
--
作者：
Godoy, Myrna C. B.;Naidich, David P.
随着新的临床、影像学和病理学数据的报道，肺结节的特征正在被重新定义，需要重新评估临床治疗，特别是亚实性结节。现在已知这些经常，虽然不是总是，落入肺周围腺癌的频谱。特别是，这些病变的Noguchi组织学分类和计算机断层扫描（CT）表现之间有很强的相关性。系列CT结果进一步证明，磨玻璃样阴影病变的逐步进展，表现为大小或外观增加和/或随后的实性成分增加，确实发生在选定的患者亚组中。因此，认识到亚实性结节和外周腺癌之间的潜在关联需要审查目前的指南，这些病变的管理，进一步需要的鉴别诊断，包括良性病变，如局灶性炎症，局灶性纤维化，和机化性肺炎。需要解决的具体问题是需要就适当的CT分类达成共识，精确测量亚实性结节的方法，包括毛玻璃和实性成分的范围，以及准确评估生长速度作为预测恶性程度和预后的手段。在进一步阐明这些病变的自然史之前，我们预计临时指南可能有助于规范我们目前对这些病变的处理。(C)RSNA，2009年
Pulmonary nodule characterization is currently being redefined as new clinical, radiologic, and pathologic data are reported, necessitating a reevaluation of the clinical management, especially of subsolid nodules. These are now known to frequently, although not invariably, fall into the spectrum of peripheral adenocarcinomas of the lung. Strong correlation between the Noguchi histologic classification and computed tomographic (CT) appearances of these lesions, in particular, has been reported. Serial CT findings have further documented that stepwise progression of lesions with ground-glass opacity, manifested as an increase in size or the appearance and/or subsequent increase of solid components, does occur in a select subset of patients. As a consequence, recognition of the potential association between subsolid nodules and peripheral adenocarcinomas requires a review of current guidelines for the management of these lesions, further necessitated by a differential diagnosis that includes benign lesions such as focal inflammation, focal fibrosis, and organizing pneumonia. Specific issues that need to be addressed are the need for consensus regarding an appropriate CT classification, methods for precise measurement of subsolid nodules, including the extent of both ground-glass and solid components, as well as accurate assessment of the growth rates as means for predicting malignancy and prognosis. It is anticipated that interim guidelines may serve to standardize our current management of these lesions, pending further clarification of their natural history. (C) RSNA, 2009