低剂量CT动态监测孤立性肺结节调查研究

目的探讨低剂量CT(LDCT)检出孤立性肺结节(SPN)的临床特点和动态变化。方法采用回顾性研究方法,收集2013年1月至2014年12月在首都医科大学附属北京友谊医院体检中心经LDCT检出年龄≥40岁的SPN患者217例。按照《2012年美国国家综合癌症网肺癌筛查指南》标准分为高危组41例、中危组83例、低危组93例,分析患者的一般资料、影像学特点和病理结果,并每年复查1次LDCT,且连续3次动态监测SPN变化。结果高危组男性比率和肺基础疾病比率最高(P<0.05),SPN直径最大(P<0.05);中危组被动吸烟者比率最高(P<0.05);低危组最年轻(P<0.05),吸烟比率最低(P<0.05)。SPN中位直径4 mm(2~23 mm);实性结节80例(36.9%),亚实性结节137例(63.1例);上叶96例(44.2%),中叶48例(22.1%),下叶73例(33.7%);伴有毛刺6例(2.8%)。截至随访时间,确诊肺癌11例。肺癌中位直径18 mm(12~32 mm),均为亚实性结节;上叶8例,中叶3例;伴有毛刺8例。11例均为I期,LDCT1时肺癌发病率为2.8%,LDCT2时肺癌发病率为1.4%,LDCT3时肺癌发病率为1.0%,发病率差异无统计学意义(P>0.05)。结论LDCT监测肺结节有助于肺癌患者获得早期诊断、及时处理从而改善预后,但是不会降低或杜绝肺癌的发生。SPN的大小和特征信息对于结节良恶性的判断有着重要的意义。

Investigation of low-dose computed tomography in dynamic monitoring of solitary pulmonary nodules

Objective To investigate the clinical features and dynamic changes of solitary pulmonary nodules(SPN)with low-dose computed tomography(LDCT).Methods The data of 217 cases≥40 years with SPN who underwent chest LDCT scanning in Beijing Friendship Hospital,Capital Medical University,between January 2013 and December 2014 were retrospectively analyzed.According to the National Comprehensive Cancer Network(NCCN)guideline for lung cancer screening(2012),the patients were assigned to three groups:high-risk group(41 cases),moderate-risk group(83 cases)and low-risk group(93 cases).The clinical data,radiologic features and pathological results were analyzed and the SPN changes were dynamic monitored by three-year consecutive LDCT.Results The ratio of male and pulmonary disease in high-risk group were the highest and the SPN diameter was the largest(P<0.05).The ratio of passive smoker in moderate-risk group was the highest(P<0.05).The patients in low-risk group were the youngest and the ratio of smoker was the lowest(P<0.05).The median diameter of all SPN was 4 mm(2~23 mm).80 cases(36.9%)were with solid nodules,137 cases(63.1%)with subsolid nodules;96 cases(44.2%)with SPN in the upper lobe,48(22.1%)in the middle lobe,73(33.7%)in the lower lobe;SPN in 6 cases(2.8%)with burrs.By follow-up time,11 cases were diagnosed with lung cancer.The median diameter of them was 18 mm(12~32 mm)and all were subsolid nodules,with 8 in the upper lobe,3 in the middle lobe and 8 with burrs.All cases were in stage I.There was no significant difference in the incidence of lung cancer among LDCT1,LDCT2 and LDCT3(2.8%vs.1.4%vs.1.0%P>0.05).Conclusion LDCT monitoring of pulmonary nodules can help patients with lung cancer to obtain early diagnosis and timely treatment to improve the prognosis,but it will not reduce or eliminate the occurrence of lung cancer.The size and characteristics of SPN are important for the differential diagnosis of benign and malignant nodules.