肺结节的分类与影像学诊断

其也可以提示早期肺癌。肺癌作为发病率和病死率第一的恶性肿瘤[2],其早界一致[1,3],直径≤5mm的结节称微小结节，>5mm而≤10mm的结节称小结多在3~6个月内缩小或消散，少部分在>12个月后缩小[3-4]。需要注意的是， 但仍可透过病变区域观察到支气管和血管纹理的区域[8],结节呈磨玻璃状或 中[9],在实性结节、部分实性结节、pGGN的基础上增加了囊腔型结节(指结化[1]。协会循证医学指南[11-12]与荷兰和比利时2003年启动的NELSON研究，结节性概率分别为<1.0%、2.3%~6.0%、15.2%和64.0%~82.0%[13]。根据美国2004~10mm恶性概率为1.7%[14]。结节具有一些影像特征[12,15-18],如轮廓分叶征、边缘毛刺征、密度不均CT表现，图1B个示右肺癌患者胸部CT表现3.密度：不同密度的肺结节恶性概率不同，一般部分实性idnodule,PSN)>纯磨玻璃结节>实性结节[11,19]。国内最新的专家共识[9]指出囊腔型肺结节的恶性概率高。此外，肺结节的实性成分占比也与肺结实性成分超过50%常提示恶性可能性大[21],但也有报道微浸润腺癌(minimallyinvasiveadenocarcinoma,MIA)或浸润性腺癌(inva建议行常规剂量增强CT检查明确结节性质[9]。2021年美国国家综合癌症网则结节恶性可能性大[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].中国肺癌杂志，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]刘宝东，陈海泉，刘伦旭，等.肺结节多学科微创诊疗中国专家共识[J].中国胸心血管外科临床杂志，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