物联网辅助评估管理肺结节中国专家共识

制定再版物联网辅助评估和管理肺结节中国专家共识,目的为在原基础上通过使"复杂问题简单化、简单问题数字化、数字问题程序化,程序问题体系化"的策略,将肺结节诊治中国共识和亚太指南融入"AI肺结节管理程序"(PNapp 5A)和初评与研判二流程体系,将手工业作坊式诊疗模式提升为达到国家和国际标准的物联网流水作业工程。(1)初...     

高分辨CT表现对孤立性肺结节良恶性鉴别的研究进展

<正>孤立性肺结节(SPN)无肺不张、肺门增大或胸腔积液的表现〔1〕;SPN在胸部X线片中的检出率只有0.09%~0.20%,多数是在不经意间发现〔2〕,随着高分辨率CT(HRCT)的广泛应用,越来越多地被发现并得到重视。同时根据直径,SPN分为直径≤8 mm的亚厘米结节、8 mm结节≤3 cm的典型SPN,再根据CT上是否存在磨玻璃样变结节(GGN),将SPN分为纯磨     

034 FDG-pET在孤立性肺结节诊断及鉴别诊断中的应用

FDD-PET通过测定细胞糖代谢水平判断组织的良恶性,有很高的敏感性和特异性.应用FDG-PET技术对孤立性肺结节进行鉴别能较为准确地判定病变的良恶性,避免患者接受进一步的有创检查,减少了有创检查并发症的发生,并能节省相应的医疗费用.本文就FDG-PET在孤立性肺结节诊断及鉴别诊断中的临床应用作一综述.     

孤立性肺结节的CT诊断与评价

孤立性肺结节(Solitary pnlmonary nodule,SPN)是指肺实质内单发、圆形或类圆形、边界清晰、直径<3cm的不透光影[1],可伴有肺不张或淋巴结肿大。据统计,全世界每年通过筛查可检出约17万例SPN,在检出的SPN中,良性肿瘤占30%~90%不等,其中80%为炎性肉芽肿,8%~10%为错构瘤,但原发恶性肿瘤也约占35%,孤立性转移瘤约占5%~10%。早期肺癌手术切除后的5年生存率高达90%以上,而中晚期的5年生存率低于5%。因此恶性结节能早发现、早诊断、早切除对患者尤为重要,而良性结节则可免于不必要的手术。SPN的病因很多,包括炎症性、感染性、外伤性、血管性…     

孤立性肺结节的研究进展

<正>随着CT技术的快速发展与广泛应用,肺结节检出率越来越高~([1])。多项大型肺癌筛查试验中,肺结节的检出率已经升至8%~51%,而恶性肺结节的比例仅为1.1~12%~([2])。肺结节是被充气肺组织完全包围,边界清晰的单个不透X线阴影,直径≤3 cm;孤立性肺结节是单发的肺结节,没有肺不张、肺门淋巴结肿大或胸腔积液~([3-5])。美国国家肺癌筛查试验(National Lung Screening Trial,NLST)发现采用胸部低剂     

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。     

电视胸腔镜技术在孤立性肺结节诊治中的应用

目的探讨电视胸腔镜（VATS）在孤立性肺部结节（SPN）诊治中的应用价值。方法 55例SPN患者,先在VATS下探查定位,然后行肺叶楔形切除并送快速冰冻病理检查;若为良性,则结束手术;若为恶性则在VATS辅助下行小切口肺叶切除加纵隔淋巴结清扫术。结果本组31例为良性病变,24例为恶性病变;30例行VATS下肺楔形切除,25例行VATS辅助小切口肺叶切除加纵隔淋巴结清扫。均无围手术期死亡,未出现严重手术并发症。结论 VATS在SPN诊治中有重要应用价值,有利于SPN的准确诊断和规范治疗,应做为SPN主要或标准的诊治手段加以明确。     

肺结节定位针与Hookwire在周围型孤立性肺小结节术前定位中的应用比较

目的 比较肺结节定位针与Hookwire在周围型孤立性肺小结节术前定位中的临床应用效果.方法 回顾性分析安徽医科大学附属阜阳医院自2018年7月至2020年4月行胸腔镜下周围型孤立性肺小结节切除的56例患者资料,根据不同定位方法分为两组,其中31例术前在CT引导下使用肺结节定位针穿刺定位,25例使用Hookwrie定位...     

CT薄层影像特征制定的肺结节分级评估系统区分良恶性肺结节的应用价值

目的探究CT薄层影像特征制定的肺结节分级评估系统区分孤立性肺结节(SPN)良恶性的应用价值。方法回顾性分析我院2018年9月至2020年7月确诊的122例SPN患者的临床资料。采用CT薄层影像特征制定的肺结节分级评估系统进行分级评定,并以病理诊断结果为“金标准”,分析其准确性、敏感度及特异度,并通过Kappa检验分析其与病理诊断结果的一致性。结果病理诊断证实良性SPN 56例,占45.9%(56/122),多为不典型增生及错构瘤,占28.6%(16/56),恶性SPN 66例,占54.1%(66/122),多为腺癌及鳞癌;肺结节分级标准分类2级31例、3级29例、4A级9例、4B级53例;肺恶性结节中,空泡征、宝石征、肿瘤血管征、毛刺征的发生率明显高于肺良性结节(均P<0.05),而病灶周围有卫星病灶的发生率明显低于肺良性结节(P<0.05);将肺结节分级标准中3级及以下归为阴性结节,4级及以上归为阳性结节,诊断准确率为90.2%。肺结节分级标准诊断肺良性结节与病理结果表现出了较好的一致性(Kappa=0.803),以肺结节分级标准诊断肺良性结节的结果与“金标准”(病理诊断结果)比较,得到的敏感度87.9%(58/66)和特异度92.9%(52/56)。结论影像诊断时,合理利用基于CT薄层影像特征制定的肺结节分级评估系统能有效地分类CT筛查出的肺结节,较好区分SPN的良、恶性。     

Futile lobectomies following video-thoracoscopic exploration for indeterminate pulmonary nodules: a retrospective study

BackgroundLung cancer screening is correlated with an increase in detection of small indeterminate pulmonary nodules and these nodules often require operative resection to obtain the diagnosis. In suspected early-stage lung cancer, video-assisted thoracoscopic surgery (VATS) has become the preferred option. In this context of minimally invasive surgery, diagnostic wedge resection is sometimes difficult to perform for small deep impalpable nodules. So, our purpose was to determine whether performing VATS for indeterminate pulmonary nodule increases the risk of lobectomy for benign lesions.MethodsA retrospective analysis was carried out in our center from January 2013 to January 2019 on patients who underwent resection for a solitary pulmonary nodule suspicious for cancer. Resection method, frozen section analysis, post-operative outcomes, operative and pathology reports were reviewed.ResultsSix hundred fifty-one patients underwent surgical exploration for a solitary pulmonary nodule. Thirty hundred and forty-five patients underwent VATS and 306 patients underwent thoracotomy. Patients in the VATS group underwent significantly more wedge resections (P=0.012) and diagnosis of lung cancer was significantly more frequent in the thoracotomy group (P<0.001). One hundred and thirty-two patients (38.3%) in the VATS group and 60 patients (19.6%) in the thoracotomy group underwent lobectomy without frozen section analysis of the pulmonary nodule. There was no significant difference in terms of lobectomy performed for a benign lesion between the two groups.ConclusionsVATS was associated with a higher rate of benign lesion resection but was not associated with a higher rate of lobectomies for benign lesion in our study.     

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...     

孤立性肺结节影像诊断现状及进展

随着CT技术的发展、健康查体的普及,发现孤立性肺结节越来越多,而许多孤立性肺结节是原发性肺癌的早期表现,因此明确诊断尤为重要,临床上以影像学诊断作为孤立性肺结节定性诊断的主要依据,简便易行、辐射暴露低、花费少、准确率高的影像检查方法是未来孤立性肺结节诊断的主要发展前景。     

肺小结节活检方式的研究进展

肺部小结节的良恶性判断以病理活检为准,临床上对肺部小结节的活检方式研究层出不穷。笔者将近年来涌现的肺部小结节活检方式,包括CT、超声等引导下经皮肺穿刺活检术、虚拟导航联合径向超声气管镜穿刺活检术、穿刺标本快速现场评价经支气管肺冷冻活检术及经胸腔镜肺活检术等作一综述,旨在寻找肺小结节活检的适合手段。     

Analysis of pulmonary nodules caused by nontuberculous mycobacteriosis in 101 resected cases: multi-center retrospective study

BackgroundSolitary pulmonary nodules caused by nontuberculous mycobacteriosis are included as a category of pulmonary nontuberculous mycobacterium disease. Clinical characteristics, treatments and prognosis are not fully known because there are a few related reports.MethodsThis was a multi-center retrospective study of 101 cases diagnosed as solitary nodular type of nontuberculous mycobacteriosis from January 2000 to March 2017 that underwent resection at 9 related facilities belonging to the Thoracic Surgery Study Group of Osaka.ResultsThe most common pathogen was Mycobacterium avium complex (n=77, 87.5%), followed by Mycobacterium kansasii (n=8, 9.1%). Chest computed tomography results showed subpleural locations that were difficult to distinguish from lung cancer. Fluorodeoxyglucose positron emission tomography/computed tomography was performed in 58 cases and positive results were obtained in 35 (60.3%), with an average maximum standardized uptake value of 3.87. The purpose of resection in most cases was for diagnosis. The surgical procedure was wedge resection in 87, segmentectomy in 3, and lobectomy in 11, while 77 underwent thoracoscopic surgery. Postoperative complications occurred in 7 cases, though no infections caused by nontuberculous mycobacteriosis were noted. The median observation period was 27 months. A worsened condition occurred in 10 (9.9%) with Mycobacterium avium complex, though none had local recurrence.ConclusionsSolitary pulmonary nodules due to nontuberculous mycobacteriosis is difficult to diagnose based on preoperative examination results or distinguish from lung cancer. Among the present cases, none had local complications or recurrence, even in those that underwent a wedge resection, thus postoperative chemotherapy was not considered necessary if a complete resection was performed. On the other hand, some cases showed reinfection after a long period following resection, thus patients should be informed of that future possibility.     

Establishment of a mathematic model for predicting malignancy in solitary pulmonary nodules

Background

The aim of this study was to establish a model for predicting the probability of malignancy in solitary pulmonary nodules (SPNs) and provide guidance for the diagnosis and follow-up intervention of SPNs.

Methods

We retrospectively analyzed the clinical data and computed tomography (CT) images of 294 patients with a clear pathological diagnosis of SPN. Multivariate logistic regression analysis was used to screen independent predictors of the probability of malignancy in the SPN and to establish a model for predicting malignancy in SPNs. Then, another 120 SPN patients who did not participate in the model establishment were chosen as group B and used to verify the accuracy of the prediction model.

Results

Multivariate logistic regression analysis showed that there were significant differences in age, smoking history, maximum diameter of nodules, spiculation, clear borders, and Cyfra21-1 levels between subgroups with benign and malignant SPNs (P<0.05). These factors were identified as independent predictors of malignancy in SPNs. The area under the curve (AUC) was 0.910 [95% confidence interval (CI), 0.857-0.963] in model with Cyfra21-1 significantly better than 0.812 (95% CI, 0.763-0.861) in model without Cyfra21-1 (P=0.008). The area under receiver operating characteristic (ROC) curve of our model is significantly higher than the Mayo model, VA model and Peking University People’s (PKUPH) model. Our model (AUC =0.910) compared with Brock model (AUC =0.878, P=0.350), the difference was not statistically significant.

Conclusions

The model added Cyfra21-1 could improve prediction. The prediction model established in this study can be used to assess the probability of malignancy in SPNs, thereby providing help for the diagnosis of SPNs and the selection of follow-up interventions.     

Perioperative identifications of non-palpable pulmonary nodules: a narrative review

Early detection of lung cancer is the key to improving treatment and prognosis of this disease, and the advent of advances in computed tomography (CT) imaging and national screening programs have improved the detection rate of very small pulmonary lesions. As such, the management of this sub-centimetric and often sub-solid lesions has become quite challenging for clinicians, especially for choosing the most suitable diagnostic method. In clinical practice, to fulfill this diagnostic yield, transthoracic needle biopsy (TTNB) is often the first choice especially for peripheral nodules. For lesions for which TTNB could present technical difficulties or failed, other diagnostic strategies are needed. In this case, video-assisted thoracic surgery (VATS) is the gold standard to reach the diagnosis of lung nodules suspect of being malignant. Nonetheless it’s often not easy the identification of such lesions during VATS because of their little dimensions, non-firm consistency, deep localization. In literature various marking techniques have been described, in order to improve intraoperative nodules detection and to reduce conversion rate to thoracotomy: CT-guided hookwire positioning, methylene blue staining, intra-operative ultrasound and electromagnetic navigation bronchoscopy are the most used. The scientific evidence on this matter is weak because there are no randomized clinical trials but only case series on single techniques with no comparison on efficacy, so there are no guidelines to refer. From this standing, in this article we conducted a narrative review of the existing literature on the subject, with the aim of outlining a framework as complete as possible. We analyzed strengths and weaknesses of the main techniques reported, so as to allow the clinician to orient himself with greater ease.