良性肺结节误诊为恶性肺结节临床分析

Clinical Analysis of Benign Pulmonary Nodules Misdiagnosed as Malignant Nodules

目的 探讨良性肺结节误诊为恶性肺结节的原因及防范措施。方法 回顾性分析2018年1月—2021年12月术前误诊的良性肺结节31例的临床资料。结果 31例均因体检发现肺结节而行手术切除治疗,术后病理检查证实为良性肺结节。病理学类型依次为结核性肉芽肿10例,错构瘤6例,炎性结节4例,纤维增生或瘢痕3例,非结核性肉芽肿、硬化性肺细胞瘤各2例,肺隐球菌病、肺曲霉菌病、机化性肺炎、炎性假瘤各1例。被误诊的良性肺结节以实性结节为主,有29例(93.5%);多分布于上叶,有17例(54.8%);大部分肺结节直径≥10 mm,有23例(74.2%);且形态不规则23例(74.2%)。结论 对于怀疑为恶性肺结节的患者术前可完善PET/CT检查和结核筛查,必要时可行肺穿刺活检,同时加强多学科联合诊治,有助于降低误诊率。

Objective To investigate the causes and preventive measures of misdiagnosis of benign pulmonary nodules as malignant nodules.Methods The clinical data of patients with benign pulmonary nodules who had been misdiagnosed as malignant nodules in preoperative assessment from January 2018 to December 2021 were retrospectively analyzed.Results There were 31 cases of benign pulmonary nodules,which were detected in routine check-up,surgically resected and confirmed by postoperative pathology.According to the pathological types,there were 10 cases of tuberculous granuloma,6 cases of hamartoma,4 cases of inflammatory nodules,3 cases of fibroplasis or scar,2 cases of non-tuberculous granuloma,2 cases of pulmonary sclerosing pneumocytoma,1 case of pulmonary cryptococcosis,1 case of pulmonary aspergillosis,1 case of organizing pneumonia,and 1 case of inflammatory pseudotumor.The majority of misdiagnosed pulmonary nodules were solid nodules(29 cases,93.5%),and 17 cases(54.8%)of benign nodules were located in the upper lobe.Most of benign nodules were≥10 mm in diameter(23 cases,74.2%)and had irregular shape(23 cases,74.2%).Conclusion Preoperative PET/CT examination and tuberculosis screening are recommended to patients suspected of malignant pulmonary nodules.If necessary,biopsy should be performed to confirm the diagnosis.Meanwhile,multi-disciplinary team meeting should be introduced into the management of pulmonary nodules,thereby reducing misdiagnosis rate.