Zhang Lichen, Ma Xiaohui, Wu Zhigang, Liu Jiacong, Gu Chen, Zhu Ziyue, Wang Jiachuan, Shu Wenbo, Li Kai, Hu Jian, Lv Xiayi
Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Medical Imaging, the Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Transl Pediatr. 2022 Nov;11(11):1796-1803. doi: 10.21037/tp-22-465.
Following increased screening efforts and the use of thin-slice computed tomography (CT), there has been a considerable increase in the incidence of ground-glass nodules (GGNs) in adults. As a result, we have more and more treatments for ground-glass nodules in adults, but few in children. Most think development pattern of pulmonary GGNs is lung inflammation, tumor, or tuberculosis that are more related to acquired or environmental factors. By studying the incidence of pulmonary GGNs in preschool children, we sought to determine whether we had ground glass nodules in the lung before we were teenagers, but we didn't pay attention to them until later. If the hypothesis holds, we may change the cognition and treatment strategies of ground glass nodules. Even not, there are few epidemiological studies with big data that can fill this gap.
We retrospectively collected the data of all preschool children who had undergone CT at the Children's Hospital of Zhejiang University School of Medicine from 2013 to 2020. These data were filtered according to the following exclusion criteria: severe artifacts, data with identical names to the original data; and patients without follow-up records (≥3 months). Inclusion criteria: must have undergone thin-slice CT (≤1.25 mm) at the first and last follow-up. Two thoracic radiologists with 5 years of experience and another senior one assessed the images.
There were a total of 13,361 cases after relevant exclusions, 311 patients were finally enrolled. Clinical features: age at diagnosis (year): 3.56±1.84, female: 147, male: 164, follow-up interval (month): 6.90±4.74, leukemia: 99, pneumonia: 21, lung cyst: 8, space-occupying lesions outside the lungs: 69, foreign body in respiratory tract: 6. After manual screening and reading, only 1 patient meets all requirements. The results showed that between 2013 and 2020, the incidence of GGNs that could be basically determined in the Children's Hospital of Zhejiang University School of Medicine was 0.32%.
There have been few previous studies of GGNs in children, and based on our study, we found that there is still some associated morbidity for preschool children, it is rarely found when they are young.
随着筛查力度的加大以及薄层计算机断层扫描(CT)的应用,成人磨玻璃结节(GGN)的发病率显著上升。因此,成人磨玻璃结节的治疗方法越来越多,但儿童的相关治疗却很少。大多数人认为肺部磨玻璃结节的发展模式是肺部炎症、肿瘤或肺结核,这些与后天或环境因素关系更大。通过研究学龄前儿童肺部磨玻璃结节的发病率,我们试图确定在青少年之前肺部是否就已经存在磨玻璃结节,只是后来才引起关注。如果该假设成立,我们可能会改变对磨玻璃结节的认知和治疗策略。即便不成立,也鲜有能填补这一空白的大数据流行病学研究。
我们回顾性收集了2013年至2020年在浙江大学医学院附属儿童医院接受CT检查的所有学龄前儿童的数据。这些数据根据以下排除标准进行筛选:严重伪影、与原始数据同名的数据;以及无随访记录(≥3个月)的患者。纳入标准:首次和末次随访时必须接受薄层CT(≤1.25mm)检查。两名具有5年经验的胸科放射科医生和另一名资深医生对图像进行评估。
经过相关排除后,共有13361例病例,最终纳入311例患者。临床特征:诊断时年龄(岁):3.56±1.84,女性:147例,男性:164例,随访间隔(月):6.90±4.74,白血病:99例,肺炎:2l例,肺囊肿:8例,肺部外占位性病变:69例,呼吸道异物:6例。经过人工筛查和阅片,仅1例患者符合所有要求。结果显示,2013年至2020年期间,浙江大学医学院附属儿童医院基本可确定的磨玻璃结节发病率为0.32%。
此前关于儿童磨玻璃结节的研究较少,基于我们的研究,我们发现学龄前儿童仍存在一定的相关发病率,在他们年幼时很少被发现。