肺結(jié)節(jié)的分類與影像學(xué)診斷

其也可以提示早期肺癌。肺癌作為發(fā)病率和病死率第一的惡性腫瘤[2],其早界一致[1,3],直徑≤5mm的結(jié)節(jié)稱微小結(jié)節(jié)，>5mm而≤10mm的結(jié)節(jié)稱小結(jié)多在3~6個(gè)月內(nèi)縮小或消散，少部分在>12個(gè)月后縮小[3-4]。需要注意的是， 但仍可透過(guò)病變區(qū)域觀察到支氣管和血管紋理的區(qū)域[8],結(jié)節(jié)呈磨玻璃狀或 中[9],在實(shí)性結(jié)節(jié)、部分實(shí)性結(jié)節(jié)、pGGN的基礎(chǔ)上增加了囊腔型結(jié)節(jié)(指結(jié)化[1]。協(xié)會(huì)循證醫(yī)學(xué)指南[11-12]與荷蘭和比利時(shí)2003年啟動(dòng)的NELSON研究，結(jié)節(jié)性概率分別為<1.0%、2.3%~6.0%、15.2%和64.0%~82.0%[13]。根據(jù)美國(guó)2004~10mm惡性概率為1.7%[14]。結(jié)節(jié)具有一些影像特征[12,15-18],如輪廓分葉征、邊緣毛刺征、密度不均CT表現(xiàn)，圖1B個(gè)示右肺癌患者胸部CT表現(xiàn)3.密度：不同密度的肺結(jié)節(jié)惡性概率不同，一般部分實(shí)性idnodule,PSN)>純磨玻璃結(jié)節(jié)>實(shí)性結(jié)節(jié)[11,19]。國(guó)內(nèi)最新的專家共識(shí)[9]指出囊腔型肺結(jié)節(jié)的惡性概率高。此外，肺結(jié)節(jié)的實(shí)性成分占比也與肺結(jié)實(shí)性成分超過(guò)50%常提示惡性可能性大[21],但也有報(bào)道微浸潤(rùn)腺癌(minimallyinvasiveadenocarcinoma,MIA)或浸潤(rùn)性腺癌(inva建議行常規(guī)劑量增強(qiáng)CT檢查明確結(jié)節(jié)性質(zhì)[9]。2021年美國(guó)國(guó)家綜合癌癥網(wǎng)則結(jié)節(jié)惡性可能性大[1]。71.DOI:10.3760/cma.j.issn.1001-0939.2018.10.004.ChineseSociety,ChineseMedicalAssociation,ChineseAllianceAgainstLungentofpulmonarynodules(2018)[J].ChinJTubercRespirDis,2018,4rsin185countries[J].CAchnersociety2017[J].Radiolog8/radiol.2017161659.cer:nonsolidnodulesinbaselineandannualrepeatrounds[J].Radiology,2015,277(2):555-564.DOI:10.1148/radiol.2015142554.agementofpulmonarynodules[J].Chest,2010,137(2):369-375.DOI:1forclassificationofpulmonarynodulesonlow-dosectimagesanseffectonnoduleDOI:10.1148/radiol.2015142700.[7]NairA,BartlettEC,WalshS,eoduleevaluationlrRespirJ,2018,52(6):1801359[pii].DOI:10.1183/13993003.01359-[J].中國(guó)肺癌雜志，2021,24(5):305-322.DOI:10.3779/j.issn.1009-3419.2021.101.14.YeX,WangJ,WeiZG,etermalablationofpulmonarysubsolidnoduleseseJournalofLungCancer,2021,24(5):305-322.DOI:10.37[9]劉寶東，陳海泉，劉倫旭，等.肺結(jié)節(jié)多學(xué)科微創(chuàng)診療中國(guó)專家共識(shí)[J].中國(guó)胸心血管外科臨床雜志，2023,30(8):1061-1074.LiuBD,ChenHQ,LiuLX,etal.ChineseexpertsconsensusonmultidisclyinvasivediagnosisandtreatmentofpulmonaryJournalofClinicalThoracicandCardiovascularSurarcinomafromnon-invasiveoraddedvalueofusingiodinemapping[J].EurRadiol,2016,26(1):43-54.DOI:10.1007/s003[11]WahidiMM,GovertJA,GoudarRK,etal.Evidentofpatientswithpulmonarynodules:whenisitlungcancer?ACCPevidence-basedclinicalp2007,132(3Suppl):94S-107S.DOI:10.1378/chest.07-1[12]GouldMK,DoningtonJ,LynchWR,etswithpulmonarynodules:whenisitlungcancer?idence-basedclinicalpracticeguidelines[J].Chest,2013,143(5pl):e93S-e120S.DOI:10.1378/chest.12-2351.omputedtomographyscreeningforlungcancer:threeSONtrial[J].EurRespirJ,2013,42(6):1659-1667.DOI:10.118[14]MazzonePJ,LamL.Evaluatingthepatientwithapulmonarynodule:areview[J].JAMA,2022,327(3):264-273.DOI:10.1001/jama.2021.nicalpopulation[J].EurRadiol,2017,27(2):689-696.DOI:10.1007/s00330-016-4429-9.ofground-glassnodules:evidencefromtheMILDtrial[J].JThorac0ncol,2012,7(10):1541-1546.DOI:10.1097/JT0.0b013e318264[17]GaoF,SunY,ZhangG,etal.CTcharacterizationofdifferentpathologicaltypesofsubcentimeterpulmonarygrosions[J].BrJRadiol,2019,92(1094):20180204.DOI:10.essindiameter[J].EurRadiol,2017,7/s00330-017-4829-5.rlungcancer:frequencyandsignificanceofpnodules[J].AJRAmJRoentgenol,2002,178(5):105214/ajr.178.5.1781053.ysisofmultiple(fiveormore)atypicaladenomatousHs)ofthelung:evidencefortheAAH-adenocarcinomasequence[J].JThoracOncol,2010,5(4):466-471.DOI:10.1097/JT0.0b013e3181ce3b73[21]OhdeY,NagaiK,YoshidaJ,etal.Theproportionofconsolidatifordistinguishingthepopulationofnon-invarcinoma[J].LungCancer,2003,42(3):303can.2003.07.001.[22]KanedaH,SakaidaN,SaitoT,etal.Appearanceofnocarcinoma[J].GenThoracCardiovascI:10.1007/s11748-008-0345-5.[23]AsamuraH,HishidaT,SuzukiK,etal.Radiographiednoninvasiveadenocarcinomaofthelung:survivaloutcomesofJapan(1):24-30.DOI:10.1016/j.jtcvs.2012.12.047.ogy,2022,303(1):202-212.DOI:10.1148/radiol.210551.[25]IchinoseJ,KawaguchiY,NakaoM,etal.UtilityofmaximumCTalueinpredictingtheinvasivenessofpuregrou