Henschke Claudia I, Yankelevitz David F, Naidich David P, McCauley Dorothy I, McGuinness Georgeann, Libby Daniel M, Smith James P, Pasmantier Mark W, Miettinen Olli S
Department of Radiology and Medicine, Weill Medical College of Cornell University, 525 E 68th St, New York, NY 10021, USA.
Radiology. 2004 Apr;231(1):164-8. doi: 10.1148/radiol.2311030634. Epub 2004 Feb 27.
To assess the frequency with which a particular, possibly optimal work-up of noncalcified nodules less than 5.0 mm in diameter identified on initial computed tomographic (CT) images at baseline screening leads to a diagnosis of malignancy prior to first annual repeat screening, compared with a possibly optimal work-up of larger nodules.
Two series of baseline CT screenings in high-risk people were retrospectively reviewed. The first series (n = 1,000) was performed in 1993-1998; the second (n = 1,897), in 1999-2002. In each series, cases in which the largest noncalcified nodule detected was less than 5.0 mm in diameter and those in which it was 5.0-9 mm were reviewed to determine whether diagnostic work-up prior to first annual repeat screening showed or would have shown nodule growth and led or would have led to a diagnosis based on biopsy or surgical specimens.
The frequency with which malignancy was or could have been diagnosed when the largest noncalcified nodule was less than 5.0 mm in diameter was 0 of 378, whereas when the largest noncalcified nodule was 5.0-9 mm in diameter, the frequency was 13 or 14 of 238. If persons with only nodules smaller than 5.0 mm had merely been referred for first annual repeat screening without immediate further work-up, the referrals for such work-up would have been reduced by 54% (from 817 [28%] to 385 [13%] of 2,897).
In modern CT screening for lung cancer at baseline, detected noncalcified nodules smaller than 5.0 mm in diameter do not justify immediate work-up but only annual repeat screening to determine whether interim growth has occurred.
评估在基线筛查时，对初次计算机断层扫描（CT）图像上发现的直径小于5.0mm的非钙化结节进行特定的、可能最佳的检查，与对较大结节进行可能最佳的检查相比，在首次年度重复筛查前诊断为恶性肿瘤的频率。
回顾性分析高危人群的两个系列基线CT筛查。第一个系列（n = 1000）于1993 - 1998年进行；第二个系列（n = 1897）于1999 - 2002年进行。在每个系列中，对检测到的最大非钙化结节直径小于5.0mm的病例以及直径为5.0 - 9mm的病例进行评估，以确定首次年度重复筛查前的诊断检查是否显示或可能显示结节生长，并是否基于活检或手术标本导致或可能导致诊断。
当最大非钙化结节直径小于5.0mm时，诊断为恶性肿瘤或可能诊断为恶性肿瘤的频率为378例中0例，而当最大非钙化结节直径为5.0 - 9mm时，频率为238例中的13或14例。如果仅对直径小于5.0mm结节的患者直接进行首次年度重复筛查而不立即进行进一步检查，此类检查的转诊率将降低54%（从2897例中的817例[28%]降至385例[13%]）。
在现代肺癌基线CT筛查中，检测到的直径小于5.0mm的非钙化结节无需立即进行检查，只需进行年度重复筛查以确定是否发生了间期生长。
