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,*,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，假设无变化无需随访,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，假设无变化无需随访,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，假设无变化在24个月再随访1次，无变化可停止随访,8mm,实性结节随访,pGGN,随访,局部实性结节随访,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,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,局部实性结节: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,局部实性结节:457天,实性结节:149天,参考文献,CHEST 2021;143(5)(Suppl):e93Se120S Diagnosis and Management of Lung Cancer,3rd ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines,Curr Opin Pulm Med 2021,18:304312,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.,