Department of Radiology, New York University-Langone Medical Center, 560 First Ave, IRM 236, New York, NY 10016, USA.
Radiology. 2009 Dec;253(3):606-22. doi: 10.1148/radiol.2533090179.
Pulmonary nodule characterization is currently being redefined as new clinical, radiologic, and pathologic data are reported, necessitating a reevaluation of the clinical management, especially of subsolid nodules. These are now known to frequently, although not invariably, fall into the spectrum of peripheral adenocarcinomas of the lung. Strong correlation between the Noguchi histologic classification and computed tomographic (CT) appearances of these lesions, in particular, has been reported. Serial CT findings have further documented that stepwise progression of lesions with ground-glass opacity, manifested as an increase in size or the appearance and/or subsequent increase of solid components, does occur in a select subset of patients. As a consequence, recognition of the potential association between subsolid nodules and peripheral adenocarcinomas requires a review of current guidelines for the management of these lesions, further necessitated by a differential diagnosis that includes benign lesions such as focal inflammation, focal fibrosis, and organizing pneumonia. Specific issues that need to be addressed are the need for consensus regarding an appropriate CT classification, methods for precise measurement of subsolid nodules, including the extent of both ground-glass and solid components, as well as accurate assessment of the growth rates as means for predicting malignancy and prognosis. It is anticipated that interim guidelines may serve to standardize our current management of these lesions, pending further clarification of their natural history.
肺结节的特征目前正在重新定义，因为新的临床、放射和病理数据正在被报道，这需要重新评估临床管理，特别是亚实性结节的管理。现在已经知道，这些结节通常（尽管不是一成不变）属于肺外周腺癌的范畴。这些病变的 Noguchi 组织学分类与计算机断层扫描（CT）表现之间存在很强的相关性，特别是在 Noguchi 组织学分类与 CT 表现之间存在很强的相关性。连续的 CT 发现进一步证明，在一部分特定的患者中，具有磨玻璃密度的病变会逐步进展，表现为大小增加或实性成分的出现和/或随后增加。因此，认识到亚实性结节与外周腺癌之间的潜在关联需要对这些病变的管理指南进行审查，这进一步需要对包括局灶性炎症、局灶性纤维化和机化性肺炎等良性病变在内的鉴别诊断进行审查。需要解决的具体问题包括需要就适当的 CT 分类达成共识，以及用于精确测量亚实性结节的方法，包括磨玻璃和实性成分的范围，以及准确评估生长速度以预测恶性肿瘤和预后的方法。预计临时指南可能有助于标准化我们目前对这些病变的管理，等待进一步明确其自然史。
