Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California, USA.
Division of Pediatric Respiratory Medicine, Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California, USA.
Pediatr Pulmonol. 2021 Jan;56(1):203-210. doi: 10.1002/ppul.25146. Epub 2020 Nov 19.
The management of children found to have pulmonary nodules is not well established. We determined how often diagnostic testing was pursued, the outcome of diagnostic testing, and how often pulmonary nodules were given a definitive diagnosis.
A retrospective review of patients found to have pulmonary nodules. Patients with oncologic diagnoses were excluded. Data collected included number of nodules, presence of pre-existing systemic disease, laboratory testing, presence of respiratory symptoms, repeat imaging, biopsy result, and final diagnosis.
We identified 88 patients, of which 56 (64%) had a single nodule, 21 (24%) had a pre-existing nononcologic systemic disease, and four patients (5%) had a new systemic disease identified at the same time the nodule(s) was found. In otherwise healthy patients presenting with a solitary nodule, 94% did not have a definitive diagnosis and none went on to be diagnosed with systemic disease. Serum infectious work-up result for tuberculosis, coccidioidomycosis, histoplasmosis, or aspergillosis was not significantly different between single and multiple nodule/systemic illness groups. No previously healthy patients presenting with a solitary nodule were later diagnosed with malignancy.
Diagnostic workup for a solitary pulmonary nodule was often inconclusive, especially if the patient did not have symptoms at presentation. Pulmonary nodules were not the sole presenting sign of systemic disease for any subjects. We suggest that in an otherwise healthy pediatric patient found to have an asymptomatic single pulmonary nodule, observation without laboratory work-up or repeat imaging is a reasonable option.
儿童肺部结节的管理尚未得到很好的确立。我们确定了诊断性检查的实施频率、诊断性检查的结果以及肺部结节获得明确诊断的频率。
对发现肺部结节的患者进行回顾性研究。排除患有肿瘤的患者。收集的数据包括结节数量、是否存在预先存在的系统性疾病、实验室检查、是否存在呼吸道症状、重复影像学检查、活检结果和最终诊断。
我们共识别出 88 名患者，其中 56 名（64%）患者有单个结节，21 名（24%）患者有预先存在的非肿瘤性系统性疾病，4 名（5%）患者在发现结节的同时还发现了新的系统性疾病。在没有其他系统性疾病且仅有孤立性结节的健康患者中，94%的患者未获得明确诊断，且均未被诊断为系统性疾病。结核病、球孢子菌病、组织胞浆菌病或曲霉菌病的血清感染性检查结果在单发和多发结节/系统性疾病组之间无显著差异。没有任何健康患者最初只有孤立性结节，后来被诊断为恶性肿瘤。
孤立性肺结节的诊断性检查通常无法得出明确结论，特别是在患者无临床表现时。肺部结节并不是任何患者出现系统性疾病的唯一表现。我们建议，对于健康的儿科患者发现无症状的孤立性肺结节，可选择不进行实验室检查或重复影像学检查而进行观察。
