Fleischner孤立性肺结节 课件.ppt

patient’s clinical risk factors 当前得出的初步结论（certain tentative conclusionscan be drawn at the present） 1Approximately half of all smokers over 50 years of age have at least one lung nodule at the time of an initial screening examination. In addition, approximately 10% of screening subjects develop a new nodule during a 1-year period (36).） 2. The probability that a given nodule is malignant increases according to its size (4,5). Even in smokers, the percentage of all nodules smaller than 4mmthat will eventually turn into lethal cancers is very low (1%), whereas for those in the 8-mm range the percentage is approximately 10%–20% (4,7,8,37). 3. Cigarette smokers are at greater risk for lethal cancers, and malignant nodules in smokers grow faster, on average, than do those in nonsmokers (19,25,26). Also, the cancer risk for smokers increases in proportion to the degree and duration of exposure to cigarette smoke (38). 1. 约一半50岁以上的吸烟者在最初CT筛查检查时肺部至少发现一个肺结节。约10%的患者一年内又会发生新的结节。 2 结节恶性的概率与其大小相关。即使是吸烟者所有结节最终变成致命癌症的机会也很低（1%），而对于8mm结节的患者，其概率约为10~20%。 3 吸烟是致命性肺癌的主要危险，吸烟者的恶性结节生长较之不吸烟者增快。吸烟的程度和时间长短与患肺癌的危险成比例。 MacMahon H, MB, BCh, BAO. Austin JH, MD Gamsu G, MD Guidelines for Management of Small Pulmonary NodulesDetected on CT Scans: A Statement from the Fleischner Society1Radiology 2005; 237:395–400 4. Certain features of nodules correlate with likelihood of malignancy, cell type, and growth rate. For instance, small purely ground-glass opacity (nonsolid) nodules that have malignant histopathologic features tend to grow very slowly, with a mean volume doubling time on the order of 2 years (19). Solid cancers, on the other hand, tend to grow more rapidly, with a mean volume doubling time on the order of 6 months. The growth rate of partly solid nodules tends to fall between these extremes, and this particular morphologic pattern is highly predictive of adenocarcinoma (39–41). 5. Increasing patient age generally correlates with increasing likelihood of malignancy. Lung cancer