Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions
Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions
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DOI：
10.1148/radiographics.20.1.g00ja0343
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发表时间：
2000-01-01
期刊：
影响因子：
5.5
通讯作者：
Roggli, VL
中科院分区：
文献类型：
--
作者：
Erasmus, JJ;Connolly, JE;Roggli, VL
孤立性肺结节是一种常见的放射学异常，经常被偶然发现。尽管大多数孤立性肺结节都有良性原因，但许多代表 I 期肺癌，必须以快速且经济有效的方式与良性结节区分开来。使用传统成像技术评估孤立性肺结节的特定形态特征可以帮助区分良性和恶性结节，并避免进一步昂贵的评估。尺寸小且边缘光滑且轮廓分明，提示良性，但不能诊断良性。分叶状轮廓以及不规则或毛刺状边缘以及邻近血管扭曲通常与恶性肿瘤相关。良性和恶性结节的内部特征（例如，衰减、空化、壁厚）有相当大的重叠。结节内脂肪的存在是错构瘤的可靠指标。钙化的存在和模式也可以帮助区分良性结节和恶性结节。计算机断层扫描 (CT)（特别是薄层 CT）比标准放射线照相术敏感 10-20 倍，可以对钙化进行客观、定量的评估。初步评估通常会导致非特异性结果，在这种情况下，结节被分类为不确定，需要进一步评估以排除恶性肿瘤。生长率评估、贝叶斯分析、对比材料增强 CT、正电子发射断层扫描和经胸针吸活检在这方面可能有用。
The solitary pulmonary nodule is a common radiologic abnormality that is often detected incidentally. Although most solitary pulmonary nodules have benign causes, many represent stage I lung cancers and must be distinguished from benign nodules in an expeditious and cost-effective manner. Evaluation of specific morphologic features of a solitary pulmonary nodule with conventional imaging techniques can help differentiate benign from malignant nodules and obviate further costly assessment. Small size and smooth, well-defined margins are suggestive of but not diagnostic for benignity. Lobulated contour as well as an irregular or spiculated margin with distortion of adjacent vessels are typically associated with malignancy. There is considerable overlap in the internal characteristics (eg, attenuation, cavitation, wall thickness) of benign and malignant nodules. The presence of intranodular fat is a reliable indicator of a hamartoma. The presence and pattern of calcification can also help differentiate benign from malignant nodules. Computed tomography (CT) (particularly thin-section CT) is 10-20 times more sensitive than standard radiography and allows objective, quantitative assessment of calcification. Initial evaluation often results in nonspecific findings, in which case nodules are classified as indeterminate and require further evaluation to exclude malignancy. Growth rate assessment, Bayesian analysis, contrast material-enhanced CT, positron emission tomography, and transthoracic needle aspiration biopsy can be useful in this regard.