The University of Melbourne, Melbourne Medical School, Royal Melbourne Hospital Clinical School, Melbourne, Victoria, Australia.
Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Intern Med J. 2024 Sep;54(9):1440-1449. doi: 10.1111/imj.16502. Epub 2024 Aug 28.
Pulmonary nodules are common incidental findings requiring surveillance. Follow-up recommendations vary depending on risk factors, size and solid or subsolid characteristics. This review aimed to evaluate the prevalence of clinically significant nodules detected on noncancer-dedicated imaging and the prevalence of part-solid and ground-glass nodules. We conducted a systematic search of literature and screened texts for eligibility. Clinically significant nodules were noncalcified nodules >4-6 mm. Prevalence estimates were calculated for all studies and risk of bias was assessed by one reviewer. Twenty-four studies were included, with a total of 30 887 participants, and 21 studies were cross-sectional in design. Twenty-two studies used computed tomography (CT) imaging with cardiac-related CT being the most frequent. Prevalence of significant nodules was highest in studies with large field of view of the chest and low size thresholds for reporting nodules. The prevalence of part-solid and ground-glass nodules was only described in two cardiac-related CT studies. The overall risk of bias was low in seven studies and moderate in 17 studies. While current literature frequently reports incidental nodules on cardiovascular-related CT, there is minimal reporting of subsolid characteristics. Unclear quantification of smoking history and heterogeneity of imaging protocol also limits reliable evaluation of nodule prevalence in nonscreening cohorts.
肺部结节是常见的偶然发现，需要进行监测。随访建议因危险因素、大小以及实性或部分实性特征而异。本综述旨在评估非癌症专用影像学检查中检测到的有临床意义的结节的发生率，以及部分实性和磨玻璃结节的发生率。我们进行了系统的文献检索，并对符合条件的文献进行了筛选。有临床意义的结节是指非钙化结节>4-6mm。对所有研究进行了发生率估计，并由一名评审员评估了偏倚风险。共纳入 24 项研究，总计 30887 名参与者，其中 21 项为横断面设计。22 项研究使用了计算机断层扫描（CT）成像，其中与心脏相关的 CT 最常见。在使用大视野胸部和低结节报告大小阈值的研究中，有临床意义的结节发生率最高。仅在两项与心脏相关的 CT 研究中描述了部分实性和磨玻璃结节的发生率。7 项研究的总体偏倚风险较低，17 项研究的偏倚风险为中度。虽然目前的文献经常报告心血管相关 CT 上的偶然结节，但对亚实性特征的报告很少。吸烟史的量化不明确以及成像方案的异质性也限制了对非筛查队列中结节发生率的可靠评估。
