Smereka Paul, Doshi Ankur M, Ream Justin M, Rosenkrantz Andrew B
Department of Radiology, NYU Langone Medical Center, New York University School of Medicine, 660 First Avenue, New York, NY 10016.
Department of Radiology, NYU Langone Medical Center, New York University School of Medicine, 660 First Avenue, New York, NY 10016.
Acad Radiol. 2017 May;24(5):603-608. doi: 10.1016/j.acra.2016.12.009. Epub 2017 Feb 3.
To assess the American College of Radiology Incidental Findings Committee's (ACR-IFC) recommendations for defining and following up abnormal incidental abdominopelvic lymph nodes.
A total of 59 lymph nodes satisfying ACR-IFC criteria as incidental (no malignancy or lymphoproliferative disorder) and with sufficient follow-up to classify as benign (biopsy, decreased size, ≥12-month stability) or malignant (biopsy, detection of primary malignancy combined with either fluorodeoxyglucose hyperactivity or increase in size of the node) were included. Two radiologists independently assessed nodes for suspicious features by ACR-IFC criteria (round with indistinct hilum, hypervascularity, necrosis, cluster ≥3 nodes, cluster ≥2 nodes in ≥2 stations, size ≥1 cm in retroperitoneum). Outcomes were assessed with attention to ACR-IFC's recommendation for initial 3-month follow-up.
A total of 8.5% of nodes were malignant; 91.5% were benign. Two of six malignant nodes were stable at 3 to <6-month follow-up before diagnosis; diagnosis of four of five malignant nodes was facilitated by later development of non-nodal sites of tumor. A total of 13, 5, 8, and 9 nodes were deemed benign given a decrease at <3 months, 3-5 months, 6-11 months, or ≥12 months of follow-up. No ACR-IFC feature differentiated benign and malignant nodes (P = 0.164-1.0). A cluster ≥3 nodes was present in 88.1%-93.2% of nodes. A total of 96.6%-98.3% had ≥1 suspicious feature for both readers. Necrosis and hypervascularity were not identified in any node.
ACR-IFC imaging features overwhelmingly classified incidental nodes as abnormal, although did not differentiate benign and malignant nodes. Nodes stable at the ACR-IFC's advised initial 3-month follow-up were occasionally proven malignant or decreased on further imaging. Refinement of imaging criteria to define nodes of particularly high risk, integrated with other clinical criteria, may help optimize the follow-up of incidental abdominopelvic lymph nodes.
评估美国放射学会偶然发现委员会（ACR-IFC）关于定义和随访异常偶然发现的腹盆腔淋巴结的建议。
共纳入59个淋巴结，这些淋巴结符合ACR-IFC偶然发现标准（无恶性肿瘤或淋巴增殖性疾病），且有足够的随访资料以分类为良性（活检、缩小、≥12个月稳定）或恶性（活检、检测到原发性恶性肿瘤并伴有氟脱氧葡萄糖高代谢或淋巴结增大）。两名放射科医生根据ACR-IFC标准（圆形且肾门不清晰、血管增多、坏死、≥3个淋巴结聚集、≥2个区域有≥2个淋巴结聚集、腹膜后淋巴结大小≥1 cm）独立评估淋巴结的可疑特征。根据ACR-IFC关于最初3个月随访的建议评估结果。
共8.5%的淋巴结为恶性；91.5%为良性。6个恶性淋巴结中有2个在诊断前3至<6个月的随访中稳定；5个恶性淋巴结中有4个的诊断因后期出现非淋巴结部位的肿瘤而得以促进。在随访<3个月、3至5个月、6至11个月或≥12个月时，分别有13个、5个、8个和9个淋巴结因缩小而被判定为良性。没有ACR-IFC特征能区分良性和恶性淋巴结（P = 0.164至1.0）。88.1%至93.2%的淋巴结存在≥3个淋巴结聚集。两位读者对96.6%至98.3%的淋巴结均发现≥1个可疑特征。未在任何淋巴结中发现坏死和血管增多。
ACR-IFC成像特征绝大多数将偶然发现的淋巴结分类为异常，尽管不能区分良性和恶性淋巴结。在ACR-IFC建议的最初3个月随访中稳定的淋巴结偶尔被证实为恶性或在进一步成像时缩小。完善成像标准以定义特别高危的淋巴结，并与其他临床标准相结合，可能有助于优化偶然发现的腹盆腔淋巴结的随访。
