实性和亚实性肺结节的长期病程及 CT 随访中间隔生长的预测因素：系统评价和荟萃分析。
The long-term course of subsolid nodules and predictors of interval growth on chest CT: a systematic review and meta-analysis.
机构信息
Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), 54 Youdian Road, Hangzhou, China.
The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, China.
出版信息
Eur Radiol. 2023 Mar;33(3):2075-2088. doi: 10.1007/s00330-022-09138-y. Epub 2022 Sep 22.
OBJECTIVES
To calculate the pooled incidence of interval growth after long-term follow-up and identify predictors of interval growth in subsolid nodules (SSNs) on chest CT.
METHODS
A search of MEDLINE (PubMed), Cochrane Library, Web of Science Core Collection, and Embase was performed on November 08, 2021, for relevant studies. Patient information, CT scanner, and SSN follow-up information were extracted from each included study. A random-effects model was applied along with subgroup and meta-regression analyses. Study quality was assessed by the Newcastle-Ottawa scale, and publication bias was assessed by Egger's test.
RESULTS
Of the 6802 retrieved articles, 16 articles were included and analyzed, providing a total of 2898 available SSNs. The pooled incidence of growth in the 2898 SSNs was 22% (95% confidence interval [CI], 15-29%). The pooled incidence of growth in the subgroup analysis of pure ground-glass nodules was 26% (95% CI: 12-39%). The incidence of SSN growth after 2 or more years of stability was only 5% (95% CI: 3-7%). An initially large SSN size was found to be the most frequent risk factor affecting the incidence of SSN growth and the time of growth.
CONCLUSIONS
The pooled incidence of SSN growth was as high as 22%, with a 26% incidence reported for pure ground-glass nodules. Although the incidence of growth was only 5% after 2 or more years of stability, long-term follow-up is needed in certain cases. Moreover, the initial size of the SSN was the most frequent risk factor for growth.
KEY POINTS
• Based on a meta-analysis of 2898 available subsolid nodules in the literature, the pooled incidence of growth was 22% for all subsolid nodules and 26% for pure ground-glass nodules. • After 2 or more years of stability on follow-up CT, the pooled incidence of subsolid nodule growth was only 5%. • Given the incidence of subsolid nodule growth, management of these lesions with long-term follow-up is preferred.
目的
计算长期随访后间隔生长的汇总发生率，并确定胸部 CT 上亚实性结节（SSN）间隔生长的预测因素。
方法
于 2021 年 11 月 08 日在 MEDLINE（PubMed）、Cochrane 图书馆、Web of Science 核心合集和 Embase 中进行了相关研究的检索。从每个纳入的研究中提取患者信息、CT 扫描仪和 SSN 随访信息。应用随机效应模型进行分析，并进行亚组和荟萃回归分析。使用纽卡斯尔-渥太华量表评估研究质量，使用 Egger 检验评估发表偏倚。
结果
在检索到的 6802 篇文章中，有 16 篇文章被纳入并进行了分析，共提供了 2898 个可用于分析的 SSN。2898 个 SSN 中生长的汇总发生率为 22%（95%置信区间[CI]：15-29%）。纯磨玻璃结节亚组分析中生长的汇总发生率为 26%（95%CI：12-39%）。2 年或以上稳定后 SSN 生长的发生率仅为 5%（95%CI：3-7%）。最初较大的 SSN 大小被发现是影响 SSN 生长发生率和生长时间的最常见危险因素。
结论
SSN 生长的汇总发生率高达 22%，纯磨玻璃结节的发生率为 26%。尽管 2 年或以上稳定后生长的发生率仅为 5%，但某些情况下仍需要长期随访。此外，SSN 的初始大小是生长的最常见危险因素。
重点
基于对文献中 2898 个可用于分析的亚实性结节进行的荟萃分析，所有亚实性结节的汇总生长发生率为 22%，纯磨玻璃结节的发生率为 26%。
在长期随访 CT 上稳定 2 年或以上后，亚实性结节生长的汇总发生率仅为 5%。
鉴于亚实性结节生长的发生率，优选对这些病变进行长期随访管理。
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