肺放射学报告和数据系统（Lung-RADS）版本 1.0 与版本 1.1：基于美国国家肺癌筛查试验中结节数据的类别比较。
Lung-RADS Version 1.0 versus Lung-RADS Version 1.1: Comparison of Categories Using Nodules from the National Lung Screening Trial.
机构信息
From the Department of Diagnostic Radiology, University of Maryland, 22 S Greene St, Baltimore, MD 21136 (J.K., R.H., J.J., F.D., V.M., C.W.); Philips Research North America, Cambridge, Mass (S.D.); and Philips Healthcare, Highland Heights, Ohio (E.D.).
出版信息
Radiology. 2021 Jul;300(1):199-206. doi: 10.1148/radiol.2021203704. Epub 2021 May 4.
Background The American College of Radiology updated Lung Imaging Reporting and Data System (Lung-RADS) version 1.0 to version 1.1 in May 2019, with the two key changes involving perifissural nodules (PFNs) and ground-glass nodules (GGNs) now designated as a negative screening result. This study examines the effects of these changes using National Lung Screening Trial (NLST) data. Purpose To determine the frequency of PFNs and GGNs reclassified from category 3 or 4A to the more benign category 2 in the updated Lung-RADS version 1.1, as compared with Lung-RADS version 1.0, using CT scans from the NLST. Materials and Methods In this secondary analysis of the NLST, the authors studied all noncalcified nodules (NCNs) found on the incident scan. Nodules were evaluated using criteria from both Lung-RADS version 1.0 and version 1.1, which were compared to determine changes in the number of nodules deemed benign. A McNemar test was used to assess statistical significance. Results A total of 2813 patients (mean age ± standard deviation, 62 years ± 5; 1717 men) with 4408 NCNs were studied. Of the largest 1092 solid NCNs measuring at least 6 mm but less than 10 mm, 216 (19.8%) were deemed PFNs (category 2) using Lung-RADS version 1.1. Eleven of the 1092 solid NCNs (1.0%) were malignant, but none were PFNs. Of 161 GGNs, three (1.9%) were category 3 according to Lung-RADS version 1.0, of which two (66.7%) were down-classified to category 2 with version 1.1. One of the three down-categorized GGNs (version 1.1) proved to be malignant (false-negative finding). Statistically significant improvement for Lung-RADS version 1.1 was found for total nodules ( < .01) and PFNs ( < .01), but not GGNs ( = .48). Conclusion This secondary analysis of National Lung Screening Trial data shows that Lung Imaging Reporting and Data System version 1.1 decreased the number of false-positive results. This was related to the down-classification of perifissural nodules in the range of 6 up to 10 mm. The increase in allowable nodule size for ground-glass nodules in category 2 from 20 mm (version 1.0) to 30 mm (version 1.1) showed no benefit. © RSNA, 2021 See also the editorial by Mayo and Lam in this issue.
背景 美国放射学院于 2019 年 5 月将肺影像报告和数据系统（Lung-RADS）版本 1.0 更新为 1.1 版，其中两项关键变更涉及肺周边结节（PFN）和磨玻璃结节（GGN），现在被指定为阴性筛查结果。本研究使用国家肺癌筛查试验（NLST）的数据来检验这些变化的效果。目的 使用 NLST 的 CT 扫描，确定在更新的 Lung-RADS 版本 1.1 中，从 3 类或 4A 类重新分类为更良性的 2 类的 PFN 和 GGN 的频率，与 Lung-RADS 版本 1.0 相比。材料与方法 本研究为 NLST 的二次分析，作者对首次扫描中发现的所有非钙化结节（NCN）进行了研究。使用 Lung-RADS 版本 1.0 和版本 1.1 的标准对结节进行评估，比较以确定被认为良性的结节数量的变化。采用 McNemar 检验评估统计学意义。结果 在这项研究中，对 2813 例（平均年龄±标准差，62 岁±5；1717 例男性）4408 个 NCN 进行了研究。在最大的 1092 个直径至少为 6 但小于 10 毫米的实性 NCN 中，有 216 个（19.8%）根据 Lung-RADS 版本 1.1 被归类为 PFN（2 类）。在这 1092 个实性 NCN 中，有 11 个（1.0%）为恶性，但没有 PFN。在 161 个 GGN 中，有 3 个（1.9%）根据 Lung-RADS 版本 1.0 为 3 类，其中 2 个（66.7%）根据版本 1.1 降为 2 类。在降为 2 类的 3 个 GGN 中，有 1 个（版本 1.1）为恶性（假阴性发现）。Lung-RADS 版本 1.1 在总结节（<.01）和 PFN（<.01）方面有显著改善，但在 GGN 方面无统计学意义（=.48）。结论 对国家肺癌筛查试验数据的二次分析表明，肺影像报告和数据系统版本 1.1 减少了假阳性结果的数量。这与 6 至 10 毫米范围内的肺周边结节降类有关。在 2 类中允许的 GGN 大小从 20 毫米（版本 1.0）增加到 30 毫米（版本 1.1），但没有带来益处。©RSNA，2021 也请参见本期 Mayo 和 Lam 的社论。
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