Hanley Kathryn Sullivan, Rubins Jeffrey B
Yale Primary Care Residency Program, St Mary's Hospital, Waterbury, Connecticut, USA.
Postgrad Med. 2003 Aug;114(2):29-35; quiz 16. doi: 10.3810/pgm.2003.08.1472.
Physicians often are faced with determining benignity or malignancy in solitary pulmonary nodules in order to refer patients appropriately for curative resection of early-stage malignant nodules and to avoid the morbidity and mortality of a surgical procedure for benign nodules. Nodules are easily deemed benign when they are unchanged on chest radiographs over 2 years or have symmetrical patterns of calcification or central fat on chest CT. Similarly, growing, spiculated lesions in older patients with an extensive smoking history or other risk factors for cancer are easily recognized as likely to be malignant. However, solitary pulmonary nodules classified as indeterminate after consideration of radiologic characteristics and patient risk factors have traditionally posed a diagnostic dilemma. The use of newer imaging modalities, including contrast-enhanced chest CT, fluorodeoxyglucose PET, and technetium Tc 99m SPECT, can help distinguish benign nodules from those that are malignant.
医生常常面临确定孤立性肺结节是良性还是恶性的问题，以便将患者适当地转诊进行早期恶性结节的根治性切除，并避免对良性结节进行手术带来的发病率和死亡率。当结节在2年以上的胸部X线片上没有变化，或者在胸部CT上有对称的钙化模式或中央脂肪时，很容易被认为是良性的。同样，在有广泛吸烟史或其他癌症风险因素的老年患者中，生长的、有毛刺的病变很容易被认为可能是恶性的。然而，在考虑了放射学特征和患者风险因素后被归类为不确定的孤立性肺结节，传统上一直是一个诊断难题。使用更新的成像方式，包括对比增强胸部CT、氟脱氧葡萄糖PET和锝Tc 99m SPECT，可以帮助区分良性结节和恶性结节。
