肺结节随访介绍

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,肺结节,CT,随访策略,复旦大学附属华山医院放射科,张家文,Case 1,女，,66,岁,pGGN,Case 2,Case 3,肺结节,（,pulmonary nodule,）,定义：指肺实质内单发或多发的圆形或类圆形、直径,3 cm,，不伴有肺不张、无淋巴结肿大或肺内其他异常的病变,分类,纯磨玻璃密度（,pGGN,pGGO,）,混合性结节（,partial solid GGN),实性结节（,Solid Nodule),实性结节,无肺癌危险因素,排除吸烟史；年龄,60,岁；有肺癌史或肺外其他癌病史,4mm,，无须随访，但患者必须完全知情随访的利与弊,4 mm-6 mm,，隔,12,个月随访,1,次，若无变化无需随访,6 mm-8 mm,，,612,、,1824,个月各随访,1,次，无变化者可停止随访,实性结节,具有,1,项肺癌危险因素,4 mm,，隔,12,个月随访,1,次，若无变化无需随访,4 mm-6 mm,的结节，,612,、,1824,个月各随访,1,次，无变化的可停止随访,6 mm-8 mm,的结节，,36,、,912,个月各随访,1,次，若无变化在,24,个月再随访,1,次，无变化可停止随访,8mm,实性结节随访,36,、,912,、,1224,个月各随访,1,次，无变化可停止随访,如果有恶性可能证据,建议活检或外科手术,pGGN,随访,5mm,，单发，无须随访；,(,可能为,AAH),5mm,，多发，吸烟或其它肺癌危险因素，至少隔,12,个月随访,1,次,5mm,，,3,个月随访,1,次，无变化者可每年随访一次，至少,3-5,年,pGGN,增大或演变实性结节，常常恶性结节，需立即进一步评估或手术切除,10mm,3,个月随访,1,次,病灶仍然存在，外科切除或活检,部分实性结节随访,单发：,8 mm,，,3,12,24,个月各随访一次，然后每年随访一次，至少,1-3,年,部分实性结节演变成实性结节或增长，常常恶性结节，需手术切除,单发：,8mm,，,3,个月随访，接着,PET-CT,，外科活检,单发：,15mm,，直接,PET-CT,、活检或外科切除,多发：,3,个月随访，长期低剂量,CT,监测,结节大小与良恶性关系,3 mm,，,0.2%,恶性,4,7 mm,，,0.9%,恶性,8,20 mm,，,18%,恶性,20 mm,，,50%,恶性,推荐,CT,扫描技术,高分辨,低剂量,(80mA),薄层,(2.5mm),良性结节,男，,39,岁；,a-GGN,b-3,个月后随访,肺腺癌,女，,59,岁；,a-GGN,b-5,个月后随访，,c-9,个月后随访；有卵巢癌病史。,肺癌新分类与,CT,特征相关性,不典型腺瘤样增生（,AAH,）,5mm,部分实性结节,:71%,实性结节,pGGN:7%,腺癌,女，,66,岁,(a)pGGN,(b)2,年后 随访,(c)CT,引导楔形切除,粘液腺癌,（,Invasive mucinous adenocarcinomas,）,实性结节,实性为主结节,分叶,多发（,BAC,）,CASE,女，,57,岁,AIS,A,：,CT,B,：,18,月后,C,：,PET,（,-,）,CASE,男，,66,岁,A,：左肺上叶,pGGN,B,：,2,年后随访,CT,病理：鳞状上皮腺癌,CASE,女，,70,岁,鳞状上皮腺癌,图示每年一次随访,平均倍增时间,pGGN,：,813,天,部分实性结节,:457,天,实性结节,:149,天,参考文献,CHEST 2013;143(5)(Suppl):e93S,e120S Diagnosis and Management of Lung Cancer,3rd ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines,Curr Opin Pulm Med 2012,18:304,312,Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans:A Statement from the Fleischner Society,（,The American College of Chest Physicians,，,ACCP),，,2005,谢 谢！,非实性结节随访策略,纯磨玻璃密度（,pure ground-glass nodules,pGGNs,）,混合性结节（,part-solid GGNs,）,The rate of malignancy in subsolid nodules(SSNs)is higher than in solid nodules.,There is close but imperfect correlation between the computed tomography(CT)features of SSNs and the spectrum of lung adenocarcinoma.,In the presence of extrapulmonary malignancy,SSNs are more likely to represent a primary lung malignancy rather than metastatic disease.,Serial CT imaging has shown stepwise progression in a subset of SSNs,characterized by increase in size and density of pure ground-glass nodules and development of solid component,the latter usually indicating invasive adenocarcinoma.,The percentage of ground-glass attenuation in SSNs on CT correspond to the percentage of lepidic pattern on histology and is directely related to the prognosis.,人有了知识，就会具备各种分析能力，,明辨是非的能力。,所以我们要勤恳读书，广泛阅读，,古人说“书中自有黄金屋。,”通过阅读科技书籍，我们能丰富知识，,培养逻辑思维能力；,通过阅读文学作品，我们能提高文学鉴赏水平，,培养文学情趣；,通过阅读报刊，我们能增长见识，扩大自己的知识面。,有许多书籍还能培养我们的道德情操，,给我们巨大的精神力量，,鼓舞我们前进,。,