| No matter male or female, lung cancer is the most common lung disease leadingcause of death, there are about175,000new diagnosed cases every year, while157000deaths each year. It is estimated there will be a case of lung cancer occurred in18women and12men in one life, the number died of lung cancer is more than additionalthree malignant diseases, which are breast cancer, colon cancer, prostate cancer. themost common manifestation of lung cancer is imaging solitary pulmonary nodules lessthan3cm nodules or chest X-ray one larger than3cm.The solitary pulmonary nodule is defined as a circular or oval-shaped high-density,diameter is less than3cm and at least2/3is surrounding by normal lung tissue,lymphoma atelectasis and pneumonia need excepted at the same time, but to a largerlesions are generally not included in this definition, because in most cases they aremalignant. Solitary pulmonary nodule is seen in about2%of patients chest imaging,their differential diagnosis often is difficult, many lesions be proved is granuloma orhamartoma finally, so find solitary pulmonary and make sure its nature is veryimportant, if the solitary pulmonary nodule is malignant, the mortality rate can reach85%. So early detection of small solitary pulmonary nodules can reduce the cause ofdeath due to malignant lung lesions, but if solitary pulmonary nodule is benign, thepatients is not only enjoy the benefits of surgery, but also endure unnecessary surgerycomplications.Although we can not draw diagnostic conclusions on the basis of imaging featuressolely, but imaging checks are often play a greater role in the diagnosis of solitarypulmonary nodule, where we will give classification and analysis of imagingcharacteristics to malignant solitary pulmonary nodule.Imaging diagnosis and analysis about solitary pulmonary nodule is a commonclinical problem, the clinical diagnostic process include the patient’s clinical history and imaging nodule size、shape and availability of nodular histological diagnosis. The mostreliable imaging characteristics is benign performance，But they are usually have notexist. Once malignant lesions is suspected highly，we should give a pathologically examat once, our principle is not only to give a timely surgery for identified small malignantnodules, but also to avoid unnecessary surgery for benign lesions, with the clinicalapplication of new technologies, diagnostic tools and level to solitary pulmonary noduleare constantly improved.For select the appropriate imaging checks and reduce the cost of treatment，wehave a meta analysis to published articles of four commonly used imaging diagnosticchecks, they are dynamic enhanced CT, dynamic magnetic resonance, PET, singlephoton emission tomography examination.In the past, the PET check be used for the differential diagnosis to uncertainpulmonary nodule more and more, many patients of pulmonary nodule havepreoperative PET or PET-CT fusion check, which benign or malignant nodules isjudged by18F-FDG uptake in PET checks, but in lung cancer and granulomatousdisease usually have same high metabolic activity, which show same positiveperformance, for avoid misdiagnosis and use PET-CT in clinical better, we have aretrospective study to PET-CT imaging performance. Abstract: PET distinguish between bronchogenic carcinoma and granuloma isdifficult，But positive results may lead operation. We carefully evaluated the CT andPET appearance of resected carcinomas and granulomas to show CT and PET imagingfeatures that could be used to distinguish between disease of bronchogenic carcinomaand granuloma.Objective: We retrospectively identified93consecutive patients between January2005and February2012who had operation of a pulmonary nodule pathologicallydiagnosed as bronchogenic carcinoma or granuloma and preoperative feature with CTand PET. Each nodule was evaluated on CT for size, doubling time, location, margin,shape, internal characteristics, calcification, clustering, air bronchograms, and cavitation.A diagnostic result was got. Bivariate and logistic regression analyses were finished.Pre-PET data about the proportion of operated granulomas and carcinomas betweenJanuary2005and December2009were reviewed.Methods: Sixty-eight percent (65/96) of nodules were carcinomas and32%(31/96)were granulomas. The CT appearance was benign in65%(20/31) of granulomas and5%(3/65) of carcinomas (p <0.0001; negative predictive value [NPV] is87%[20/23]).Specific CT appearance obviously correlation with granuloma were clustering,cavitation, irregular shape, no pleural tags, and solid attenuation. Granulomasrepresented (9/50) of resected masses in1995and2009(p=0.066). Rate ofPET-positive in carcinomas is86%(56/65) and97%(30/31) in granuloma，There is notstatistical differences (p=0.11)。Rate of resected granuloma is increased from18%to32%，All increases is78%。But there is not statistical differences in this study(p=0.066)。Results: CT appearance reduce but cannot avoid the possibility that a nodule ofPET positive is malignant. Among of CT imaging appearance，The most valuable todistinguish is clustering, cavitation, irregular shape, no pleural tags, and solidattenuation，The combination of nonspiculated margin, irregular shape, and solid attenuation had an NPV of86%(12/14). Objective: The aim of this article was to assess the clinical effects of diagnostictests for evaluating malignancy within a solitary pulmonary nodule (SPN), and toestablish a nomogram or table using clinical data and noninvasive radiology (positive)test results to estimate post-test probability of malignancy.Methods: Studies that examined computed tomography (CT), magnetic resonanceimaging (MRI), positron emission tomography (PET) and single photon emissioncomputed tomography (SPECT) for the evaluation of SPN. Two investorsindependently abstracted data and evaluated study quality. Study-specific and overallpositive likelihood ratios (LRs) for each diagnostic test confirming a diagnosis ofmalignancy and negative LR for each diagnostic test excluding a diagnosis ofmalignancy within an SPN were calculated.Result: Forty-four of238articles were included. Positive LRs for diagnostic testswere: CT3.91(95%confidence interval2.42,5.40), MRI4.57(3.03,6.1), PET5.44(3.56,7.32) and SPECT5.16(4.03,6.30). Negative LRs were: CT0.10(0.03,0.16),MRI0.08(0.03,0.12), PET0.06(0.02,0.09) and SPECT0.06(0.04,0.08).Conclusion: Differences in performance for all tests were negligible; Hence, theclinician may confidently use any of the four tests presented in further evaluating anSPN. Given the less cost and prevalence of the technology, SPECT seems to be the firstchoice for additional testing in SPN evaluation. |
PDF Full Text Request