DIFFERENTIATION OF BENIGN AND MALIGNANT PULMONARY NODULES BY GROWTH RATE
DIFFERENTIATION OF BENIGN AND MALIGNANT PULMONARY NODULES BY GROWTH RATE
复制标题
DOI：
10.1148/79.2.221
复制
发表时间：
1962-01-01
期刊：
影响因子：
19.7
通讯作者：
ADAMS, RA
中科院分区：
文献类型：
--
作者：
NATHAN, MH;COLLINS, VP;ADAMS, RA
许多研究者（11、13、15、16、17、31、33、38、43）已经对孤立性肺结节进行了分析，寻找表明其病因学的体征，主要努力方向是区分良性和恶性病变。在提到的所有体征中，包括大小、形状、密度、边缘清晰度、脐、卫星结节、空洞、延伸到门和/或胸膜的密度、生长和钙化，只有最后一个被认为是鉴别的可靠辅助手段。尽管人们认识到，在恶性病变中偶尔会发现微小的中央钙化，但肺部病变中任何钙化的存在都使得恶性肿瘤的可能性极小。环形、层状和大的中央“爆米花”钙化是良性的可靠标志 (16, 31)。一般来说，大多数人认为，以前正常的肺部出现结节或肺结节增大（有一些例外）表明恶性病变。由于难以区分良性结节和恶性结节，过去几年，特别是自 1945 年左右以来，普遍态度已经改变建议立即切除所有孤立性肺结节，除非钙化的存在表明其良性。很少有人对这一程序提出反对意见。加兰 (Garland)（13 岁）是抗议者之一，他建议：“不要像麦克白夫人那样。不要说‘滚出去，该死的斑点！’我想你会正确诊断大部分结节。”癌症以恒定速率呈指数增长的概念，由莫特拉姆 (Mottram) 于 1935 年提出 (29)，后来由科林塞特 (Collinset) 等人提出。 1956年(5)，得到了几位独立调查员(1、2、10、21、22、25、34、41、42)工作的支持。 Collins 收集了 177 例恶性肺结节病例，连续胸片显示肿瘤结节的生长。测量结节并将生长速率表示为“倍增时间”。值范围为 7 至 465 天 (5-9)。非肿瘤性增大。结节也可能发生，但其机制与肿瘤不同，并且预计不一定会导致以恒定速率呈指数增长。尽管肉芽肿、肺炎、脓肿、梗塞、血肿、积液等可能会增大，但它们不会通过细胞分裂而增大。然而，观察大小的变化（或没有变化）可以证明生长模式不是恶性肿瘤的生长模式。因此，这可能是一种有用的诊断测试。如果可以发现肿瘤生长速率和良性病变扩大速率之间存在差异，那么将可以使用一种有用的诊断工具来添加少数放射学和临床体征以进行鉴别诊断。
Solitarypulmonary nodules have been analyzed by many investigators (11, 13, 15, 16, 17, 31, 33, 38, 43) for signs indicative of their etiology, the main effort having been directed toward separation of benign and malignant lesions. Of all the signs mentioned, including size, shape, density, sharpness of margin, umbilication, satellite nodules, cavitation, densities extending into the hilus and/or pleura, growth, and calcification, only the last has been considered to be a reliable aid in differentiation. The presence of any calcification in a pulmonary lesion makes malignancy extremely unlikely, although it is recognized that minute central calcification can on rare occasions be found in malignant lesions. Ring-shaped, laminated, and large central “popcorn” calcifications are reliable signs of benignity (16, 31).In general, the appearance of a nodule in a lung which was previously normal or enlargement of a pulmonary nodule, with the reservation that there are some exceptions, is thought by most to indicate a malignant lesion.Because of the difficulty in differentiating benign from malignant nodules, the general attitude in the last few years, particularly since about 1945, has been to recommend the immediate removal of all solitary pulmonary nodules except those in which the presence of calcification indicates their benign nature. Few objections have been raised against this procedure. One of those who protests is Garland (13) who advised: “Don't be like Lady Macbeth. Don't say ‘Out, damned spot!’ and I think you will diagnose most of these nodules correctly. ”The concept of exponential growth of cancer at a constant rate, advanced by Mottram in 1935 (29) and later by Collinset al. in 1956 (5), has received support in the work of several independent investigators (1, 2, 10, 21, 22, 25, 34, 41, 42). Collins collected a series of 177 cases of malignant pulmonary nodules with serial chest films showing the growth of neoplastic nodules. The nodules were measured and growth rate was expressed as “doubling time.” Values ranged from 7 to 465 days (5–9).Enlargement of non-neoplastic. nodules also may occur, but the mechanisms are not the same as for neoplasms and would not be expected to result necessarily in exponential growth at a constant rate. Although granulomas, pneumonitis, abscesses, infarcts, hematomas, fluid collections, etc., may enlarge, they do not do so by cell division. Nevertheless, observation of change (or lack of change) in size may demonstrate that the pattern of growth is not that of a malignant tumor. This may therefore be a useful diagnostic test.If differences could be found to exist between the rate of tumor growth and the rate of enlargement of benign lesions, then a useful diagnostic tool would become available to add to the few radiographic and clinical signs for differential diagnosis.