Managing the small pulmonary nodule discovered by CT
Managing the small pulmonary nodule discovered by CT
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DOI：
10.1378/chest.125.4.1522
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发表时间：
2004-04-01
期刊：
影响因子：
9.6
通讯作者：
Henschke, CI
中科院分区：
文献类型：
--
作者：
Libby, DM;Smith, JP;Henschke, CI
目的：回顾1993 - 2003年早期肺癌行动项目中CT检测肺小结节的经验及相关医学文献，以制定肺小结节的管理算法。设计：对既往无恶性肿瘤的吸烟者进行前瞻性非比较研究，并回顾CT筛查肺癌的医学文献。干预措施：胸部CT，适当时CT观察结节生长，抗生素，CT引导下细针穿刺活检，纤维支气管镜检查和视频辅助胸腔镜手术（VATS）。结果：以下因素影响CT检出的非钙化小肺结节的恶性概率：大小、大小变化、年龄、吸烟史、密度、结节数量、性别、CT环境、肺活量测定、职业史和地方性肉芽肿疾病。在评估CT检测到的小的、非钙化的结节时，两种最有用的诊断技术是通过CT短期观察结节生长和CT引导下的FNA。由于结节较小，且经常发现非实性或部分实性结节，因此正电子发射断层扫描、纤维支气管镜检查和VATS不太有用。结论：肺科医生经常被要求评估ct检测到的标准胸片上看不见的小的、非钙化的结节。如果癌症的可能性很高，立即活检是合理的，但如果可能性很低或中等，则需要一段时间的CT观察。ct检查发现的肺小结节很少需要VATS或开胸诊断肺癌。
Objectives: To review the Early Lung Cancer Action Project experience and the medical literature from 1993 to 2003 on detection of the small, noncalcified pulmonary nodule by CT in order to formulate a management algorithm for these nodules.Design: Prospective noncomparative study of smokers without prior malignancy and a review of the medical literature of CT screening of lung cancer.Interventions: Chest CT and, where appropriate, CT observation for nodule growth, antibiotics, CT-guided fine-needle aspiration (FNA) biopsy, fiberoptic bronchoscopy, and video-assisted thoracoscopic surgery (VATS).Results: The following factors influence the probability of malignancy in a CT-detected, small, noncalcified pulmonary nodule: size, change in size, age, smoking history, density, number of nodules, gender, circumstance of the CT, spirometry, occupational history, and endemic granulomatous disease. The two diagnostic techniques most useful in evaluating the CT-detected, small, noncalcified nodule are short-term observation of nodule growth by CT and CT-guided FNA. Due to small nodule size and the frequent finding of nonsolid or part-solid nodules, positron emission tomography, fiberoptic bronchoscopy, and VATS were less useful.Conclusions: Pulmonologists are frequently asked to evaluate the CT-detected, small, noncalcified nodule invisible on standard chest radiography. Immediate biopsy is justified if the likelihood of cancer is high, but if that likelihood is low or intermediate, a period of observation by CT is appropriate. VATS or thoracotomy are rarely necessary for a diagnosis of lung cancer in the CT-detected small pulmonary nodule.