MacMahon Heber, Austin John H M, Gamsu Gordon, Herold Christian J, Jett James R, Naidich David P, Patz Edward F, Swensen Stephen J
Radiology. 2005 Nov;237(2):395-400. doi: 10.1148/radiol.2372041887.
Lung nodules are detected very commonly on computed tomographic (CT) scans of the chest, and the ability to detect very small nodules improves with each new generation of CT scanner. In reported studies, up to 51% of smokers aged 50 years or older have pulmonary nodules on CT scans. However, the existing guidelines for follow-up and management of noncalcified nodules detected on nonscreening CT scans were developed before widespread use of multi-detector row CT and still indicate that every indeterminate nodule should be followed with serial CT for a minimum of 2 years. This policy, which requires large numbers of studies to be performed at considerable expense and with substantial radiation exposure for the affected population, has not proved to be beneficial or cost-effective. During the past 5 years, new information regarding prevalence, biologic characteristics, and growth rates of small lung cancers has become available; thus, the authors believe that the time-honored requirement to follow every small indeterminate nodule with serial CT should be revised. In this statement, which has been approved by the Fleischner Society, the pertinent data are reviewed, the authors' conclusions are summarized, and new guidelines are proposed for follow-up and management of small pulmonary nodules detected on CT scans.
在胸部计算机断层扫描（CT）中，肺结节的检出非常常见，并且随着新一代CT扫描仪的出现，检测非常小的结节的能力也在提高。在已报道的研究中，年龄在50岁及以上的吸烟者中，高达51%在CT扫描时有肺结节。然而，目前关于在非筛查CT扫描中发现的非钙化结节的随访和管理指南是在多排探测器CT广泛应用之前制定的，并且仍然表明每个不确定结节都应通过连续CT随访至少2年。这项政策需要对大量人群进行大量研究，费用高昂且会使受影响人群受到大量辐射暴露，但尚未证明是有益的或具有成本效益的。在过去5年中，关于小肺癌的患病率、生物学特征和生长率的新信息已经出现；因此，作者认为，长期以来对每个小的不确定结节进行连续CT随访的要求应该修订。在这份已得到弗莱施纳学会批准的声明中，对相关数据进行了回顾，总结了作者的结论，并提出了关于CT扫描中发现的小肺结节随访和管理的新指南。
