Soubani A O
Division of Pulmonary, Allergy, Critical Care and Sleep, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Postgrad Med J. 2008 Sep;84(995):459-66. doi: 10.1136/pgmj.2007.063545.
Solitary pulmonary nodules (SPNs) are increasingly detected with the widespread use of chest computed tomography (CT) scans. The primary goal of the evaluation of these nodules is to determine whether they are malignant or benign. Clinical factors such as older age, tobacco smoking and current or remote history of malignancy increase the pre-test likelihood of malignancy. Radiological features of the SPN based on chest CT with high resolution cuts are critical in differentiating between benign or malignant lesions. These features include size, change in size, the presence and pattern of calcification, edge characteristics, attenuation, and contrast enhancement. SPNs that are stable in size for >2 years and those with benign pattern of calcification do not need further studies. Lesions with clear change in size are malignant until proven otherwise and require tissue diagnosis. Frequently, the aetiology of the SPN following chest CT scan remains indeterminate and requires further evaluation. The approach to the management of indeterminate SPN ranges between observation with repeat chest CT scan, further diagnostic studies such as positron emission tomography (PET) scan, or invasive procedures to obtain tissue diagnosis. These procedures include bronchoscopy, transthoracic needle aspirate, and resection by video assisted thoracoscopy or thoracotomy. Determination of which approach to follow depends on the pre-test probability of malignancy, whether the patient is a surgical candidate, and the patient's informed preferences. This article reviews the radiological features of the SPN and their value in differentiating between benign and malignant lesions. This is followed by discussion of the different approaches to the management of the SPN after initial characterisation by chest CT scan, including the benefits and limitations of the different diagnostic studies.
随着胸部计算机断层扫描（CT）的广泛应用，孤立性肺结节（SPN）的检出率日益增加。评估这些结节的主要目的是确定它们是恶性还是良性。年龄较大、吸烟以及当前或既往恶性肿瘤病史等临床因素会增加恶性肿瘤的检测前可能性。基于高分辨率胸部CT的SPN的放射学特征对于区分良性或恶性病变至关重要。这些特征包括大小、大小变化、钙化的存在及模式、边缘特征、密度以及对比增强。大小稳定超过2年的SPN以及具有良性钙化模式的SPN无需进一步检查。大小有明显变化的病变在未被证明为其他情况之前即为恶性，需要进行组织诊断。通常，胸部CT扫描后SPN的病因仍不明确，需要进一步评估。对于不确定的SPN的处理方法包括通过重复胸部CT扫描进行观察、进一步的诊断性检查如正电子发射断层扫描（PET），或采用侵入性操作获取组织诊断。这些操作包括支气管镜检查、经胸针吸活检，以及通过电视辅助胸腔镜或开胸手术进行切除。决定采用哪种方法取决于恶性肿瘤的检测前概率、患者是否为手术候选者以及患者的知情偏好。本文回顾了SPN的放射学特征及其在区分良性和恶性病变中的价值。随后讨论了在胸部CT扫描初步定性后SPN的不同处理方法，包括不同诊断性检查的益处和局限性。
