Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur Radiol. 2017 Nov;27(11):4672-4679. doi: 10.1007/s00330-017-4842-8. Epub 2017 Apr 24.
Lung-RADS proposes malignancy probabilities for categories 2 (<1%) and 4B (>15%). The purpose of this study was to quantify and compare malignancy rates for Lung-RADS 2 and 4B subsolid nodules (SSNs) on a nodule base.
We identified all baseline SSNs eligible for Lung-RADS 2 and 4B in the National Lung Screening Trial (NLST) database. Solid cores and nodule locations were annotated using in-house software. Malignant SSNs were identified by an experienced radiologist using NLST information. Malignancy rates and percentages of persistence were calculated.
Of the Lung-RADS 2SSNs, 94.3% (1790/1897) could be located on chest CTs. Likewise, 95.1% (331/348) of part-solid nodules ≥6 mm in diameter could be located. Of these, 120 had a solid core ≥8 mm, corresponding to category 4B. Category 2 SSNs showed a malignancy rate of 2.5%, exceeding slightly the proposed rate of <1%. Category 4B SSNs showed a malignancy rate of 23.9%. In both categories one third of benign lesions were transient.
Malignancy probabilities for Lung-RADS 2 and 4B generally match malignancy rates in SSNs. An option to include also category 2 SSNs for upgrade to 4X designed for suspicious nodules might be useful in the future. Integration of short-term follow-up to confirm persistence would prevent unnecessary invasive work-up in 4B SSNs.
• Malignancy probabilities for Lung-RADS 2/4B generally match malignancy risks in SSNs. • Transient rate between low-risk Lung-RADS 2 and high-risk 4B lesions were similar. • Upgrade of highly suspicious Lung-RADS 2 SSNs to Lung-RADS 4X might be useful. • Up to one third of the benign high-risk Lung-RADS 4B lesions were transient. • Short-term follow-up confirming persistence would avoid unnecessary invasive work-up of 4B lesions.
Lung-RADS 为类别 2（<1%）和 4B（>15%）提出了恶性肿瘤概率。本研究的目的是定量比较 Lung-RADS 2 和 4B 亚实性结节（SSN）在结节基础上的恶性肿瘤发生率。
我们从国家肺癌筛查试验（NLST）数据库中确定了所有符合 Lung-RADS 2 和 4B 标准的基线 SSN。使用内部软件对实性核心和结节位置进行注释。由一位经验丰富的放射科医生使用 NLST 信息识别恶性 SSN。计算恶性肿瘤发生率和持续存在的百分比。
在 Lung-RADS 2 SSN 中，94.3%（1790/1897）可在胸部 CT 上定位。同样，直径≥6mm 的部分实性结节中，95.1%（331/348）可定位。其中，120 个有≥8mm 的实性核心，对应于 4B 类别。2 类 SSN 的恶性肿瘤发生率为 2.5%，略高于<1%的建议率。4B 类 SSN 的恶性肿瘤发生率为 23.9%。在这两个类别中，三分之一的良性病变是短暂的。
Lung-RADS 2 和 4B 的恶性肿瘤概率通常与 SSN 的恶性肿瘤率相匹配。将来，将类别 2 SSN 纳入专为可疑结节设计的 4X 升级类别可能会很有用。通过短期随访确认持续性，可以防止 4B SSN 不必要的侵入性检查。
Lung-RADS 2/4B 的恶性肿瘤概率通常与 SSN 的恶性肿瘤风险相匹配。
低风险 Lung-RADS 2 和高风险 4B 病变之间的短暂率相似。
将高度可疑的 Lung-RADS 2 SSN 升级为 Lung-RADS 4X 可能会很有用。
三分之一的良性高危 Lung-RADS 4B 病变是短暂的。
短期随访确认持续性可避免对 4B 病变进行不必要的侵入性检查。
