Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep.
School of Public Health, Division of Biostatistics, University of Minnesota.
J Thorac Imaging. 2020 Mar;35(2):108-114. doi: 10.1097/RTI.0000000000000465.
Pulmonary nodules, found either incidentally or on lung cancer screening, are common. Evaluating the benign or malignant nature of these nodules is costly in terms of patient risk and expense. The presence of both global and regional emphysema has been linked to increased lung cancer risk. We sought to determine whether the measurement of emphysema directly adjacent to a lung nodule could inform the likelihood of a nodule being malignant.
Within a population of Veterans at high risk for lung cancer, 58 subjects with malignant nodules found on computerized tomographic chest scans were matched by lobe and nodule size to 58 controls. Lung densitometry was measured via determination of the low attenuation area percentage at -950 Hounsfield units (LAA950) and the Hounsfield unit (HU) value at which 15% of lung voxels have a lower lung density (Perc15), at predefined lung volumes that encompassed the nodule to evaluate both perinodular and regional lung fields. The association between measured lung density and malignancy was investigated using conditional logistic regression models, with densitometry measurements used as the primary predictor, adjusting for age alone, or age and computerized tomographic scan characteristics.
No significant differences in emphysema measurements between malignant and benign nodules were identified at lung volumes encompassing both perinodular and regional emphysema. Furthermore, emphysema quantification remained stable across lung volumes within individuals.
In this study, quantifying the degree of perinodular or regional emphysema did not offer any benefit in the risk stratification of lung nodules.
偶然发现或在肺癌筛查中发现的肺结节很常见。评估这些结节的良性或恶性性质，无论是从患者风险还是费用方面来说，代价都很高。全球和区域性肺气肿的存在与肺癌风险的增加有关。我们试图确定紧邻肺结节的肺气肿程度是否可以提示结节恶性的可能性。
在一个肺癌高危的退伍军人人群中，对计算机断层扫描胸部扫描发现的 58 例恶性结节患者进行了研究，这些患者按叶和结节大小与 58 例对照患者相匹配。通过确定 -950 豪斯菲尔德单位（LAA950）的低衰减区域百分比和肺密度降低 15%的肺体素的豪斯菲尔德单位（HU）值（Perc15）来测量肺密度，在预设的肺体积内测量，这些体积包含结节，以评估结节周围和区域肺区域。使用条件逻辑回归模型研究了测量的肺密度与恶性肿瘤之间的相关性，使用密度测量值作为主要预测因子，仅调整年龄，或年龄和计算机断层扫描特征。
在包含结节周围和区域肺气肿的肺体积中，恶性和良性结节之间的肺气肿测量值没有显著差异。此外，个体内的肺气肿定量在肺体积内保持稳定。
在这项研究中，量化结节周围或区域肺气肿的程度并不能为肺结节的风险分层提供任何益处。
