Murrmann Gabriele B, van Vollenhoven Femke H M, Moodley Loven
1 Department of Surgery, 2 Department of Pulmonology, Medisch Centrum Leeuwarden, The Netherlands ; 3 Department of Cardio-Thoracic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa.
J Thorac Dis. 2014 Mar;6(3):237-48. doi: 10.3978/j.issn.2072-1439.2013.11.13.
A new solid solitary pulmonary nodule (SPN) is a common feature in the daily practice of physicians, pulmonologists and thoracic surgeons. The etiology and consequently the diagnostic approach is very different in various parts of the world. Identification of malignant nodules is the universal goal to proceed to a potential curable therapy. In countries with a low incidence of inflammatory disease and a high incidence of lung cancer the diagnostic work up includes a positron emission tomography (PET) scan or PET-computer tomography (CT) as a main pillar. In countries with a high incidence of inflammatory and infectious disease and a low incidence in lung cancer this diagnostic work up needs to be adapted. In these settings a PET scan has a limited role and tissue diagnosis, whether with a trans-thoracic, trans-bronchial biopsy or a video-assisted wedge resection is the most targeted approach to determine or exclude malignancy. The evaluation of a solid SPN in the two different situations is outlined in our algorithm. Recommendations stress the value of clinical judgement in different settings, determination of probabilities of malignancy, cost-effective use of diagnostic tools and evaluation of various management alternatives according to the risk profile and the patients preferences.
新发实性孤立性肺结节（SPN）是内科医生、肺科医生和胸外科医生日常工作中的常见情况。在世界不同地区，其病因以及相应的诊断方法差异很大。识别恶性结节是进行潜在可治愈性治疗的共同目标。在炎症性疾病发病率低、肺癌发病率高的国家，诊断检查主要包括正电子发射断层扫描（PET）或PET计算机断层扫描（CT）。在炎症和感染性疾病发病率高、肺癌发病率低的国家，这种诊断检查需要调整。在这些情况下，PET扫描作用有限，组织诊断，无论是经胸、经支气管活检还是电视辅助楔形切除，都是确定或排除恶性肿瘤的最有针对性的方法。我们的算法概述了在两种不同情况下对实性SPN的评估。建议强调在不同情况下临床判断的价值、恶性概率的确定、诊断工具的成本效益使用以及根据风险状况和患者偏好对各种管理方案的评估。
