Lung RADS 3-4级肺结节的CT诊断

CT diagnosis of lung RADS 3-4 lung nodules

目的:探讨Lung RADS分级在肺癌筛查的价值及恶性结节的特征变化,提高诊断准确率。方法:回顾性分析2 580例肺癌高危人群基线筛查资料,重新按Lung RADS分级标准,实性及部分实性结节≥6 mm、磨玻璃密度结节≥20 mm为筛查阳性界值,观察Lung RADS分级3-4级肺结节的肺癌阳性预测率;并分析随访中结节的细部特征变化。结果:与国际早期肺癌行动计划(I-ELCAP)筛查阳性结果比较,基线筛查总体阳性率从22.9%(591/2 580)降至13.8%(357/2 580),肺癌阳性预测率由6.9%(41/591)上升到11.5%(41/357)。其中3级(246例)手术病理确诊为肺癌8例,4A+4B级(共111例)手术病理确诊为肺癌33例,3+4级(357例)共确诊为肺癌的41例,与I-ELCAP分类统计确诊肺癌数量相同。结论 :Lung RADS分级更合理地分类肺癌筛查结果,减少了低风险患者的随访频率,提升肺癌阳性预测率,结合随访中结节特征变化,对提高肺结节的诊断准确率有很大的帮助。

Objective： To investigate the value of Lung RADS grading in the screening of lung cancer and the character- istics of malignant nodules, and to improve the diagnostic accuracy. Methods： The findings on baseline screening in 2 580 persons at high-risk for lung cancer were retrospectively analyzed. According to the Lung RADS grading standards, solid and part solid nodules ≥6 mm, ground-glass density nodules ≥20 mm served as a positive value for screening to observe lung cancer positive predictive rate of RADS 3-4 pulmonary nodules, and followed-up to analyze nodule in detail characteristics change. Results： Compared with the screening positive results of the international early lung cancer action program（I-ELCAP）, baseline screening overall positive rate was decreased from 22.9%（591/2 580） to 13.8%（357/2 580）, lung cancer-positive predic- tion rate was increased from 6.9%（41/591） to 11.5%（41/357）. 8 cases of lung cancer were confirmed by surgery and pathology among 246 cases（Grade 3）, 33 cases of lung cancer were diagnosed by pathology among 111 cases（Grade 4A＋4B）, 41 cases of lung cancer were diagnosed among 357 cases （Grade 3＋4）, and the number of lung cancer was the same as that of I-ELCAP. Conclusion： Lung RADS grading may be more reasonable to classify the results of lung cancer screening, and reduce the fol- low-up frequency of patients with low risk, improve the positive rate of lung cancer, combined with the characteristics changes of the nodules, the diagnostic accuracy of pulmonary nodules was greatly improved.