Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
Diagnostic Image Analysis Group, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Eur Radiol. 2018 Mar;28(3):1095-1101. doi: 10.1007/s00330-017-5055-x. Epub 2017 Oct 6.
Perifissural nodules (PFNs) are a common finding on chest CT, and are thought to represent non-malignant lesions. However, data outside a lung cancer-screening setting are currently lacking.
In a nested case-control design, out of a total cohort of 16,850 patients ≥ 40 years of age who underwent routine chest CT (2004-2012), 186 eligible subjects with incident lung cancer and 511 controls without were investigated. All non-calcified nodules ≥ 4 mm were semi-automatically annotated. Lung cancer location and subject characteristics were recorded.
Cases (56 % male) had a median age of 64 years (IQR 59-70). Controls (60 % male) were slightly younger (p<0.01), median age of 61 years (IQR 51-70). A total of 262/1,278 (21 %) unique non-calcified nodules represented a PFN. None of these were traced to a lung malignancy over a median follow-up of around 4.5 years. PFNs were most often located in the lower lung zones (72 %, p<0.001). Median diameter was 4.6 mm (range: 4.0-8.1), volume 51 mm (range: 32-278). Some showed growth rates < 400 days.
Our data show that incidental PFNs do not represent lung cancer in a routine care, heterogeneous population. This confirms prior screening-based results.
• One-fifth of non-calcified nodules represented a perifissural nodule in our non-screening population. • PFNs fairly often show larger size, and can show interval growth. • When morphologically resembling a PFN, nodules are nearly certainly not a malignancy. • The assumed benign aetiology of PFNs seems valid outside the screening setting.
胸膜周围结节（PFNs）是胸部 CT 的常见表现，被认为代表非恶性病变。然而，目前缺乏肺癌筛查环境之外的数据。
在一项嵌套病例对照设计中，在总共 16850 名年龄≥40 岁接受常规胸部 CT（2004-2012 年）的患者中，共调查了 186 名符合条件的肺癌患者（56%为男性）和 511 名无肺癌的对照组。所有≥4 毫米的非钙化结节均采用半自动方式进行注释。记录肺癌位置和患者特征。
病例组（56%为男性）的中位年龄为 64 岁（IQR 59-70）。对照组（60%为男性）稍年轻（p<0.01），中位年龄为 61 岁（IQR 51-70）。1278 个唯一的非钙化结节中有 262 个为 PFN。在中位随访时间约 4.5 年期间，这些结节均未追踪到肺癌恶性肿瘤。PFNs 最常位于下肺区（72%，p<0.001）。中位直径为 4.6 毫米（范围：4.0-8.1），体积为 51 毫米（范围：32-278）。有些结节的生长速度<400 天。
我们的数据表明，在常规护理、异质性人群中，偶然发现的 PFN 并不代表肺癌。这证实了之前基于筛查的结果。
• 在我们的非筛查人群中，1/5 的非钙化结节为胸膜周围结节。
• PFN 通常较大，可出现间隔生长。
• 当形态上与 PFN 相似时，结节几乎肯定不是恶性肿瘤。
• PFN 被认为是良性病因，这在筛查环境之外是有效的。
