孤立性肺部结节诊断的近况

孤立性肺部结节的诊断尤其是良、恶性疾病的鉴别临床上十分重要，本文就近年来有关ＣＴ、正电子发射体层扫描、快速增强梯度回波ＭＲＩ、ＣＴ导向下经皮针吸活检和电视辅助胸腔镜检等对本病的诊断情况作一简介。     

242例肺部孤立性结节的性质及影像学分析

目的了解肺部孤立性结节的性质及影像学特点。方法分析242例肺部孤立性结节的性质、影像学特点及两者的关系。结果 242例肺部孤立性结节的疾病谱常见依次为肺癌、肺结核、炎性假瘤。当结节直径为1 cm、1-3 cm、3-5 cm、5-7 cm、≥7 cm时其恶性比分别为9.1%、42.8%、76.9%、91.2%、95.9%。纯磨玻璃样结节、半实质样结节、纯实质样结节,恶性比分别为80.3%、75.4%、62.9%。分叶征、毛刺征、空泡征等多见于恶性病变。结论我科收治的肺部孤立性结节中肺癌最多见,其次为肺结核、炎性假瘤。当结节直径≥5 cm其恶性概率达92.3%,纯磨玻璃样和半实质样结节较纯实质样结节恶性概率高。分叶征、毛刺征、空泡征等多见于恶性病变。     

肺部孤立性小结节的诊断分析

目的探讨肺小结节的临床诊断。方法自2004年1月至2009年6月本院就诊发现的肺小结节73例,通过不同方法最后明确诊断。结果所有患者中最后确诊为肺癌55例,结核11例,炎性假瘤4例,纤维瘤2例,淋巴瘤1例。结论肺小结节恶性率高,早期诊断和治疗至关重要。     

肺内孤立性炎性结节的CT表现

目的 总结分析肺内孤立性炎性结节的CT形态学表现和CT灌注成像图像特征,以提高孤立性炎性结节的CT诊断正确率.方法 选取16例经病理证实或经临床短期随访观察病变消失或明显缩小的肺内孤立性炎性结节的高分辨CT影像资料,计算动态增强曲线参数.全部患者均行16层螺旋CT平扫及动态增强扫描.结果 结节最大者直径约2.9 cm,最小者直径约1 cm.结节形态为圆形或类圆形.结节边缘光滑清晰者6例,边缘模糊者10例;4例有浅分叶,余无分叶.所有结节周围均无卫星灶、血管集束,所有结节内均无钙化灶.15例CT灌注成像图像上时间-密度曲线为速升速降型,1例为缓升缓降型.结论 结合CT形态学和灌注成像图像,可明显提高肺内孤立性炎性结节的CT诊断准确率.     

肺部孤立性结节的评估及诊断策略的选择

随着胸部CT的广泛应用,肺部孤立性结节的发现率越来越高.如何确认发现的肺部孤立性结节的性质成为临床上亟待解决的问题.少数结节的性质可以通过患者的临床特征及胸部CT特点得到确认,但绝大多数的结节的性质需要通过进一步的检查,包括经验性抗感染治疗、胸部CT定期随访观察、PET/CT检查、纤维支气管镜榆查、CT引导下经胸针吸肺...     

54例肺部孤立性圆形病灶临床分析

肺部孤立性圆形病灶（Solid pulmonary nodule）是临床诊断的难题。由于病因甚多治疗各异,故鉴别诊断具有十分重要的意义,影像学检查是发现肺部球形病灶的手段。本组54例患者,男36例,女18例,年龄17～71岁,中位年龄44岁。就诊时症状：无症状体检或因其他疾病行胸片检查时发现34例,咳嗽18例,咳嗽伴胸痛2例,咳嗽伴痰血6例,     

肺部孤立性结节的早期诊断

肺部孤立性结节(solitary pulmonary nodule,SPN)是指肺内直径≤3 cm的单个圆形、类圆形或形态不规则的局限性病灶,边界清楚,外周被含气肺组织包裹的影像学改变。需除外胸腔积液、空洞、肺不张、卫星病灶和肺门淋巴结肿大等。美     

76例肺部结节性病变临床与病理分析

目的分析肺部结节性病变的临床病理特征及其相互关系。方法分析2005年8月~2010年4月之间的76例住院患者的临床病理资料。结果 43例孤立性结节,6例2个以上结节和8例空洞性结节经病理分析后确诊肺癌各为37例,5例和6例;拟诊肺结核15例经病理检查确诊13例,拟诊伴有空洞液平4例肺脓肿经病理确诊1例。肺癌误诊为其他疾病为15.78%;其他疾病误诊为肺癌亦达15.78%,（结核占7.02%）。结论肺部各种类型结节临床误诊率较高,为降低误诊率,应力争做组织病理学分析。     

支气管肺泡灌洗液端粒酶活性测定对113例肺外周孤立结节诊断的临床研究

目的通过检测支气管肺泡灌洗液(BALF)中端粒酶的活性,探讨BALF端粒酶活性在肺外周孤立性结节诊断中的应用价值。方法采用TRAPeze-ELISA法,检测113例经螺旋CT扫描发现的肺外周孤立性结节患者支气管镜下取得的BALF中脱落细胞端粒酶活性,并将检测结果与细胞学等结果相比较。结果54例肺癌组中端粒酶活性的阳性率为68.5%(37/54),而59例肺良性疾病组的阳性率为6.8%(4/59),肺癌组检出的敏感性为68.5%,特异性为93.2%。结论BALF中端粒酶活性测定有利于肺外周孤立性结节的定性诊断,为其中肺癌的早期诊断提供依据,同时也有利于肺癌与肺部良性疾病的鉴别诊断。     

孤立性肺结节的临床分析

目的研究孤立性肺结节(SPN)的临床特征,探讨SPN诊断与治疗。方法胸腔镜手术治疗肺结节64例,分析年龄、性别、症状、吸烟史、肺内结节的影像学表现、手术情况、术后病理等因素。结果 SPN的恶性病变与吸烟史,肿瘤直径,肿瘤的边界,肿瘤钙化有关。64例患者中诊断为恶性病变36(56.25%)例。28(43.75%)例术中快速病理诊断为良性病变,其中错构瘤4例,结核球14例,炎性假瘤10例。结论 SPN的良恶性与吸烟史,结节大小,肿瘤边界,是否钙化有关;胸腔镜手术有助于SPN病理诊断与治疗。     

肺内孤立结节病变术前CT误诊原因分析

目的分析CT误诊肺内孤立性结节病变性质的原因。方法对50例有术前CT诊断(误诊5例)并经手术病理证实的肺内孤立结节病变(SPN)进行分析。结果术前5例,2例术前诊断良性肿块,术后病理诊断为恶性。3例术前诊断为恶性肿块,术后病理分别诊断为隐球菌病、硬化性血管瘤、以及支气管囊肿并发感染。结论肺内肿块的术前CT诊断,可交错重叠,出现“同病异影”或“异病同影”使鉴别诊断出现困难。因此在肺内孤立性结节的CT诊断中必须密切结合临床,尽可能避免术前误诊。     

肺内恶性孤立性小结节的CT征像特征分析与诊断

目的通过对肺内恶性孤立性小结节CT影像特征的分析,不断提高CT对恶性孤立性肺结节的检出率。方法全面、系统地回顾、分析134例肺内孤立性小结节患者的临床资料。结果 134例肺内孤立性小结节患者中,病检恶性80例(59.70%);病检和CT均诊断为恶性者78例,CT与病检符合率为97.5%,病检确诊为恶性而CT征像不支持者2例(2.50%),CT诊断为恶性,而首次病检不支持,再次病检支持者1例(1.25%);81例结节≥2.0 cm者,恶性75例(92.59%);53例结节2 cm者,恶性3例(5.66%);右肺结节恶性率为73.21%,明显高于左肺的43.59%(P0.05);恶性结节CT影像表现中胸膜凹陷征、引流线征、血管集束征、毛刺征、棘突征、分叶征、空泡和细支气管充气征,征像所占比例明显高于良性结节(P0.05);85.90%的恶性结节病例表现为3种以上基本影像征像并存。结论肺内孤立性结节恶性率高,其发病的部位和影像表现均具有其一定的特征性,CT诊断具有较高的检出率,在CT诊断过程中,要紧紧围绕结节的部位和影像征像进行仔细分析鉴别,对一时难以定论的结节要积极开展动态观察,以提高恶性孤立性肺结节的检出率,减少误诊和漏诊。     

纤维支气管镜对孤立性肺肿块的诊断价值

目的　评价纤维支气管镜 (纤支镜)检查对原因不明孤立性肺肿块诊断价值。方法 回顾性分析行纤支管镜检查54例孤立性肺肿块。结果 54例经纤支镜检确诊37例 (68.5%)，其中23例恶性 (42.6%)，纤支镜诊断孤立肿块阳性直接与病灶大小相关 (P＜0.025)如果按病灶大小及所处部位看，无显著差异，而病灶＜2cm时位于肺部外带1/3时阳性率3.4% (1/29)，对比病灶位于肺部内2/3占68.0% (17/25)，中叶和下叶基底段的诊断阳性率更高些。结论 纤支镜能提高肺内肿块病灶诊断阳性率，刷片，灌洗，检查后痰检可互相补充以提高诊断的阳性率。纤支镜检查阳性率主要取决病灶大小及部位，当肿块＜2cm，位于肺部外围1/3时阳性率低的，可采用其它方法提高其阳性率。     

Predictors of malignancy in patients with solitary pulmonary nodules undergoing pulmonary resection

BackgroundThe management of a solitary pulmonary nodule is a challenging issue in pulmonary disease. Although many factors have been defined as predictors for malignancy in solitary pulmonary nodules, the accurate diagnosis can only be established with the permanent histological diagnosis.ObjectiveWe tried to clarify the possible predictors of malignancy in solitary pulmonary nodules in patients who had definitive histological diagnosis.MethodsWe made a retrospective study to collect the data of patients with solitary pulmonary nodules who had histological diagnosis either before or after surgery. We made a statistical analysis of both the clinic and radiological features of these nodules with respect to malignancy both in contingency tables and with logistic regression analysis.ResultsWe had a total of 223 patients with a radiological diagnosis of solitary pulmonary nodule. Age, smoking status and pack years of smoking, maximum standardized uptake value (SUVmax), and radiological features such as solid component, spiculation, pleural tag, lobulation, calcification, and higher density were significant predictors of malignancy in contingency tables. Age, smoking status and smoking (pack/year), SUVmax, and radiological features including spiculation, pleural tag, lobulation, calcification, and higher density were the significant predictors in univariate analysis. However, multivariate analysis revealed only SUVmax greater than 2.5 (p < 0.0001), spiculation (p = 0.009), and age older than 61 years (p = 0.015) as the significant predictors for malignancy.ConclusionAge, SUVmax, and spiculation are the independent predictors of malignancy in patients with solitary pulmonary nodules.     

Development and validation of diagnostic prediction model for solitary pulmonary nodules

BACKGROUND AND OBJECTIVE: The aim of this study was to develop a simple prediction model for the underlying diagnosis of solitary pulmonary nodules (SPN) based on clinical characteristics and thin-section CT findings. METHODS: Retrospective analysis was carried out on 452 patients with SPN (113 benign and 339 malignant) smaller than 30 mm, who underwent thin-section CT followed by surgical resection and histological diagnosis. The clinical characteristics were collected from medical records, and radiographic characteristics from thin-section CT findings. The prediction model was determined using multivariate logistic analysis. The prediction model was validated in 148 consecutive patients with undiagnosed SPN, and the diagnostic accuracy of the model was compared with that of an experienced chest radiologist. RESULTS: The prediction model comprised the level of serum CRP, the level of carcinoembryonic antigen, the presence or absence of calcification, spiculation and CT bronchus sign. The areas under the receiver-operating characteristic curve in training and validation sets were 0.966 and 0.840, respectively. The diagnostic accuracies of the prediction model and the experienced chest radiologist for the validation set were 0.858 and 0.905, respectively. CONCLUSION: The simple prediction model consisted of two biochemical and three radiographic characteristics. The diagnostic accuracy of an experienced chest radiologist was higher compared with the prediction model.     

恶性肿瘤患者腹部CT检查偶然发现的肺结节的临床意义

目的分析在恶性肿瘤患者腹部CT检查中偶然发现的肺结节及其临床意义。方法在医院PACS系统以“占位”、“结节”或“肿块”为关键词搜索,对1年内的腹部CT报告进行搜索并评估。排除之前有胸部或腹部CT检查且/或非癌患者。结果9159次腹部CT检查中有1889例报道了肺部的“占位”,“结节”或“肿块”(1889/9159,20.6%),这其中只有252名为初诊患者,在这252名患者中,43名随访了胸部CT、腹部CT或胸腹部CT,且确诊为恶性肿瘤。既往没有接受过胸部或腹部CT,而1324名(1324/1576,84.0%)既往接受过CT检查,既被排除在研究之外。在剩余的252名患者中,有43名患者(43/252,17.1%)诊断为恶性肿瘤且接受了以胸部CT(n=16),腹部CT(n=13)或胸腹部(n=14)形式的随访CT。恶性肿瘤包括:原发性肝癌(n=21,其中肝细胞肝癌19例,肝内胆管细胞癌2例),结、直肠癌(n=8),胰腺癌(n=5),胃癌(n=5),膀胱癌(n=2),子宫颈癌(n=2)。43名患者中有21名(48.9%)患者的肺结节诊断为恶性。转移的肺结节多为类圆形、边界清楚的实性结节,常位于肺外围。结论在恶性肿瘤患者腹部CT上同时观察肺部情况是有必要的。胸部CT肺结节的良恶性特征鉴别可能也适用于恶性肿瘤患者腹部CT上偶然发现的肺结节。     

High diagnostic yield from transbronchial biopsy of solitary pulmonary nodules using low‐dose CT‐guidance

Background and objective: The diagnostic yield from fluoroscopy‐guided bronchoscopic transbronchial biopsy of small solitary pulmonary nodules is low. The hypothesis tested in the present study was that the diagnostic yield can be significantly increased by combining flexible bronchoscopy with CT‐guidance using a dedicated low‐dose protocol. Methods: CT‐guided transbronchial biopsies were performed in 15 patients with a newly diagnosed solitary peripheral pulmonary nodule and negative conventional bronchoscopic biopsies under fluoroscopic guidance. For imaging, a multi‐detector helical CT unit, adjusted at 120 kV, 15 mAs/slice, 4 × 5 mm collimation, 10 mm reconstructed slice thickness and a maximal scan length of 150 mm, was used. After advancing the biopsy forceps towards the lesion, a CT scan was obtained. When the tip of the forceps reached or penetrated the lesion a biopsy was taken, otherwise the procedure was repeated with a maximum of eight attempts. The effective radiation dose was calculated. Results: The average diameter of the nodules was 23 ± 6 mm (mean ± SD) with a maximum distance to the parietal pleura of 18 mm (mean 6.5 mm). A mean of 4.1 (range 2–8) CT scans was performed to localize the lesion. In four patients, the forceps only reached the periphery of the nodule. In one patient, the nodule was missed in all attempts. Histology was malignant in eight patients and benign in four patients. In three patients, biopsy results were false negative (benign or non‐specific instead of malignant). The overall diagnostic yield was 73%. Complications consisted of two pneumothoraces, one of which necessitated a chest tube. Mean effective radiation dose was 0.55 mSv (range 0.3–1.0). Conclusions: CT‐guided transbronchial biopsy can be a valuable diagnostic tool in evaluating solitary pulmonary nodules. This applies for selected patients when other diagnostic methods are either unavailable or inappropriate. The diagnostic yield is high and, when a low‐dose protocol is used, radiation exposure can be kept at a minimum.     

肺癌孤立性肺结节患者64排螺旋CT扫描影像特点分析

目的 研究64排螺旋CT对肺癌孤立性肺结节(SPN)的诊断价值.方法 选择2015年5月至2019年5月于我院收治的158例经病理证实伴SPN的肺癌患者为对象,按肺癌不同病理类型分为A组(腺癌,112例)、B组(鳞癌,34例)、C组(小细胞癌,12例),均接受64排螺旋CT扫描.比较三组SPN平扫及增强各序列(增强30...     

Development and validation of a prediction model for malignant pulmonary nodules: A cohort study

This study is to develop and validate a preoperative prediction model for malignancy of solitary pulmonary nodules. Data from 409 patients who underwent solitary pulmonary nodule resection at the First Affiliated Hospital of Nanjing Medical University, China between June 2018 and December 2020 were retrospectively collected. Then, the patients were nonrandomly split into a training cohort and a validation cohort. Clinical features, imaging parameters and laboratory data were then collected. Logistic regression analysis was used to develop a prediction model to identify variables significantly associated with malignant pulmonary nodules (MPNs) that were then included in the nomogram. We evaluated the discrimination and calibration ability of the nomogram by concordance index and calibration plot, respectively. MPNs were confirmed in 215 (52.6%) patients by a pathological examination. Multivariate logistic regression analysis identified 6 risk factors independently associated with MPN: gender (female, odds ratio [OR] = 2.487; 95% confidence interval [CI]: 1.313–4.711; P = .005), location of nodule (upper lobe of lung, OR = 1.126; 95%CI: 1.054–1.204; P < .001), density of nodule (pure ground glass, OR = 4.899; 95%CI: 2.572–9.716; P < .001; part-solid nodules, OR = 6.096; 95%CI: 3.153–14.186; P < .001), nodule size (OR = 1.193; 95%CI: 1.107–1.290; P < .001), GAGE7 (OR = 1.954; 95%CI: 1.054–3.624; P = .033), and GBU4–5 (OR = 2.576; 95%CI: 1.380–4.806; P = .003). The concordance index was 0.86 (95%CI: 0.83–0.91) and 0.88 (95%CI: 0.84–0.94) in the training and validation cohorts, respectively. The calibration curves showed good agreement between the predicted risk by the nomogram and real outcomes. We have developed and validated a preoperative prediction model for MPNs. The model could aid physicians in clinical treatment decision making.