Department of Internal Medicine, Lillebaelt Hospital Vejle, Vejle, Denmark.
Department of Internal Medicine, Gødstrup Hospital, Herning, Denmark.
Respiration. 2024;103(2):53-59. doi: 10.1159/000535595. Epub 2024 Jan 22.
Lung cancer is the leading cause of cancer-related death globally. Incidental pulmonary nodules represent a golden opportunity for early diagnosis, which is critical for improving survival rates. This study explores the impact of missed pulmonary nodules on the progression of lung cancer.
A total of 4,066 stage IV lung cancer cases from 2019 to 2021 in Danish hospitals were investigated to determine whether a chest computed tomography (CT) had been performed within 2 years before diagnosis. CT reports and images were reviewed to identify nodules that had been missed by radiologists or were not appropriately monitored, despite being mentioned by the radiologist, and to assess whether these nodules had progressed to stage IV lung cancer.
Among stage IV lung cancer patients, 13.6% had undergone a chest CT scan before their diagnosis; of these, 44.4% had nodules mentioned. Radiologists missed a nodule in 7.6% of cases. In total, 45.3% of nodules were not appropriately monitored. An estimated 2.5% of stage IV cases could have been detected earlier with proper surveillance.
This study underlines the significance of monitoring pulmonary nodules and proposes strategies for enhancing detection and surveillance. These strategies include centralized monitoring and the implementation of automated registries to prevent gaps in follow-up.
肺癌是全球癌症相关死亡的主要原因。偶然发现的肺部结节为早期诊断提供了绝佳机会，这对提高生存率至关重要。本研究探讨了肺部结节漏诊对肺癌进展的影响。
本研究调查了 2019 年至 2021 年丹麦医院的 4066 例 IV 期肺癌病例，以确定在诊断前 2 年内是否进行过胸部计算机断层扫描（CT）。对 CT 报告和图像进行了审查，以确定放射科医生漏诊或未适当监测的结节，尽管放射科医生曾提及这些结节，并评估这些结节是否已进展为 IV 期肺癌。
在 IV 期肺癌患者中，13.6%在诊断前接受了胸部 CT 扫描；其中，44.4%的病例提到了结节。放射科医生漏诊了 7.6%的病例中的结节。总的来说，45.3%的结节未得到适当监测。估计有 2.5%的 IV 期病例可以通过适当的监测更早地发现。
本研究强调了监测肺部结节的重要性，并提出了增强检测和监测的策略。这些策略包括集中监测和实施自动登记册，以防止随访中的空白。
