Spencer J A
Department of Clinical Radiology, St James's University Hospital, Leeds, UK.
Clin Radiol. 2008 Aug;63(8):843-52. doi: 10.1016/j.crad.2007.11.025. Epub 2008 Apr 14.
Indeterminate lesions are detected on cancer imaging examinations at all points along the patient pathway. Decisions made about indeterminate lesions may have profound impact on patient management, particularly when these may represent solitary sites of metastasis. In this process of decision making the radiologist, having detected a potential metastasis, must attempt to characterize the abnormality and then to make a judgement about its impact on management based on knowledge of the clinical context. Not every abnormality can be confidently characterized using the modality of detection and the indeterminate lesion may require further clarification through discussion in the format of a multidisciplinary meeting, planned further investigation, or intervention. In some circumstances the lesion remains indeterminate and a monitoring approach is appropriate. Uncertainty must not be regarded as a personal weakness of any individual, but may remain even after collective discussion in a multidisciplinary setting. The aim must be to develop a plan of action (or inaction) that is understandable, useful, and acceptable to the patient and clinician. In this review, the principles guiding these decisions are discussed in further detail and practical solutions to some commonly encountered indeterminate lesions are suggested, focusing on those that might represent solitary sites of disease and whose management impact may be profound.
在患者就医过程的各个环节，癌症影像检查中都会发现不确定病变。针对不确定病变所做出的决策可能会对患者的治疗产生深远影响，尤其是当这些病变可能代表孤立转移灶时。在这个决策过程中，放射科医生在检测到潜在转移灶后，必须尝试对异常情况进行特征描述，然后根据临床背景知识对其对治疗的影响做出判断。并非每个异常情况都能通过检测手段得到明确的特征描述，不确定病变可能需要通过多学科会议讨论、计划进一步检查或干预等方式进行进一步明确。在某些情况下，病变仍不确定，采取监测方法是合适的。不确定性不应被视为任何个人的个人弱点，即使在多学科环境中进行集体讨论后，不确定性可能仍然存在。目标必须是制定一个患者和临床医生都能理解、有用且可接受的行动计划（或不采取行动的计划）。在本综述中，将进一步详细讨论指导这些决策的原则，并针对一些常见的不确定病变提出实际解决方案，重点关注那些可能代表孤立病灶且对治疗影响可能很大的病变。
