Viggiano R W, Swensen S J, Rosenow E C
Mayo Medical School, Mayo Clinic, Rochester, Minnesota.
Clin Chest Med. 1992 Mar;13(1):83-95.
The evaluation and management of a patient with an SPN is guided by principles that were derived from earlier surgical studies. Stability or no growth for at least 2 years, the presence of calcium in characteristic patterns, and age less than 35 years without any associated risk factors are reliable indicators of a benign process. Fluoroscopy and localized tomography are helpful in evaluation of an SPN. If the nodule is still considered indeterminate, CT scanning, with the use of thin section cuts through the nodule, is now widely employed. If calcium is present in a characteristic pattern, the nodule is considered benign. If the nodule is very dense or more dense than a phantom reference nodule, the nodule has a high likelihood of being benign. Nodules that are less dense than the phantom nodule are indeterminate, and approximately 25% of these nodules will be benign. Computed tomography scan of the chest and upper abdomen is indicated in patients with a previous history of malignancy or when there is a high suspicion that the nodule is malignant. The further evaluation and management of SPNs that are indeterminate after CT examination are controversial. Some recommend tissue biopsy via transbronchoscopic or transthoracic approach, whereas others recommend immediate thoracotomy. Observation is indicated in certain situations when the chance of malignancy is quite low, the patient is not an operable candidate, or when the patient refuses further invasive evaluation. The physician's role in the management of a patient with an SPN is to educate and advise. The physician must be aware of the patient's anxieties, fears, and attitude and provide an opportunity for active participation by the patient in the decision-making process. Multiple pulmonary nodules are most commonly encountered in patients with metastatic disease to the lungs. Other less commonly encountered diseases that present as multiple pulmonary nodules include infections, arteriovenous malformations, Wegener's granulomatosis, and lymphoma. The evaluation and management of the patient with multiple pulmonary nodules are usually guided by the history, physical examination, and laboratory findings.
孤立性肺结节（SPN）患者的评估与管理遵循源自早期外科研究的原则。至少2年稳定或无生长、特征性模式的钙化存在以及年龄小于35岁且无任何相关危险因素是良性病变的可靠指标。荧光镜检查和局部断层扫描有助于SPN的评估。如果结节仍被认为不确定，目前广泛采用通过结节进行薄层扫描的CT扫描。如果钙化呈特征性模式，该结节被认为是良性的。如果结节非常致密或比模拟参考结节更致密，则该结节极有可能是良性的。比模拟结节密度低的结节不确定，其中约25%的结节将是良性的。有恶性肿瘤病史的患者或高度怀疑结节为恶性时，需进行胸部和上腹部的计算机断层扫描。CT检查后仍不确定的SPN的进一步评估和管理存在争议。一些人建议通过支气管镜或经胸途径进行组织活检，而另一些人则建议立即开胸手术。在恶性可能性很低、患者不适合手术或患者拒绝进一步侵入性评估的某些情况下，可进行观察。医生在SPN患者管理中的作用是教育和提供建议。医生必须了解患者的焦虑、恐惧和态度，并为患者积极参与决策过程提供机会。肺部转移瘤患者最常出现多发肺结节。其他较少见的以多发肺结节形式出现的疾病包括感染、动静脉畸形、韦格纳肉芽肿和淋巴瘤。多发肺结节患者的评估和管理通常由病史、体格检查和实验室检查结果指导。
