Henschke Claudia I, Shaham Dorith, Farooqi Ali, Yankelevitz David F
New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY 10021, USA.
Semin Thorac Cardiovasc Surg. 2003 Oct;15(4):397-404. doi: 10.1053/s1043-0679(03)00095-9.
On computerized tomography (CT) screening for lung cancer within the Early Lung Cancer Action Project, both at baseline and repeat screening, we found not only solid but also subsolid nodules, which unlike solid ones do not completely obscure the lung parenchyma. We established that subsolid nodules represent approximately 20% of the nodules shown on screening and that they have a higher frequency of malignancy than solid nodules. Although we found growth of solid nodules to be a reliable indicator of malignancy, growth of subsolid nodules was more difficult to assess. On review of our results to date in screening, we have continued to refine our definition of a positive result of screening from that given in our initial publication on screening. We have also provided an updated screening regimen. It starts with the initial, low-dose CT test and for all those with positive results on this initial test, the regimen continues by specifying the work-up needed to rule-in a diagnosis of malignancy. In this regimen, we found growth assessed by high-resolution CT to be a useful indicator of malignancy and have developed image-processing tools to help in this assessment. Once growth is ascertained, we recommend fine-needle aspiration for confirmation of malignancy. It may be that once criteria for definitive growth are established and validated, fine-needle aspiration may become optional. However, in the meantime, in the context of screening, a more cautious approach is warranted.
在早期肺癌行动项目中，利用计算机断层扫描（CT）进行肺癌筛查时，无论是在基线筛查还是重复筛查中，我们不仅发现了实性结节，还发现了亚实性结节。与实性结节不同，亚实性结节不会完全遮蔽肺实质。我们确定亚实性结节约占筛查发现结节的20%，且其恶性频率高于实性结节。尽管我们发现实性结节的生长是恶性的可靠指标，但亚实性结节的生长更难评估。在回顾我们迄今为止的筛查结果时，我们不断完善了筛查阳性结果的定义，该定义与我们最初关于筛查的出版物中给出的定义有所不同。我们还提供了更新的筛查方案。该方案从最初的低剂量CT检查开始，对于所有在初次检查中结果呈阳性的患者，该方案通过指定排除恶性诊断所需的检查来继续进行。在这个方案中，我们发现通过高分辨率CT评估的生长是恶性的一个有用指标，并开发了图像处理工具来辅助这一评估。一旦确定有生长，我们建议进行细针穿刺以确认恶性。也许一旦确定并验证了明确生长的标准，细针穿刺可能会变得可选择。然而，与此同时，在筛查的背景下，更谨慎的方法是必要的。
