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孤立性肺结节(SPN)定义为被肺实质包绕的直径≤3 cm的圆形/类圆形不透明影。大多数吸烟者的薄层CT扫描均可以发现SPN,其中大部分直径小于7 mm。在过去,如偶然发现此类结节临床采用2年以上随访,包括3个月、6个月、12个月、18个月、24个月的CT随访。该方案使随访者接受的辐射量增加。结节形态特性,如形状、边缘特征、空洞、位置等难以准确鉴别良恶性结节。当首次检查中的SPN不能定性时,应评估包括患者年龄和吸烟史等危险因素。Fleischner学会2005年指南指明所有4 mm或更小的结节中至少99%为良性;当结节直径为5~9 mm时,最佳策略是随访。随访检查的时间点依据结节大小(4~6 mm或6~8 mm)和患者病史而不一,特别是是否存在恶性肿瘤低危/高危因素。直径>8 mm的非钙化结节高度提示恶性肿瘤,此时应考虑额外检查如造影剂增强CT,正电子发射断层扫描(PET),经皮肺穿刺活检,胸腔镜切除术或电视辅助胸腔镜切除术。
Isolated pulmonary nodules (SPNs) are defined as round / round opaque circles with a diameter of ≤3 cm surrounded by parenchymal lungs. SPNs are found in thin-slice CT scans of most smokers, most of which are less than 7 mm in diameter. In the past, when such nodules were found incidentally, they were followed up for more than 2 years, including 3 months, 6 months, 12 months, 18 months and 24 months. The program increased the amount of radiation received by respondents. Nodule morphology, such as shape, edge features, voids, location, etc. is difficult to accurately identify benign and malignant nodules. When the SPN in the initial exam can not be characterized, risk factors including patient age and smoking history should be assessed. The Fleischner Society 2005 Guidelines indicate that at least 99% of all nodules 4 mm or smaller are benign and that when nodules are 5 to 9 mm in diameter, the best strategy is follow-up. Follow-up examination of the time point based on the size of the nodules (4 ~ 6 mm or 6 ~ 8 mm) and the patient’s history and different, in particular, whether there is a low risk / high risk of malignancy. Non-calcified nodules> 8 mm in diameter are highly suggestive of malignancy and should be considered for additional examinations such as contrast-enhanced CT, positron emission tomography (PET), percutaneous lung biopsy, thoracoscopic resection, or video-assisted thoracoscopy cut.