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背景与目的计算机断层扫描(computed tomography,CT)随访评估肺内结节的生长特性是临床判断结节良恶性的常用策略。不同生物学行为的肺结节可能具有不同的生长速度和生长模式。本研究的目的是绘制不同类型肺结节的体积生长曲线,了解其生长方式,为判断结节性质并制定肺结节随访方案提供依据。方法应用三维分析软件对111例接受2次及以上CT检查的肺结节(实性结节54例、亚实性结节57例)的影像资料进行回顾性分析。35例恶性及5例良性结节经病理或组织学确认,其余71例经两年随访无显著生长,经专家会诊确认为肺癌低危结节。所有结节按密度及性质分组:实性良性/低危结节、实性恶性结节、亚实性良性/低危结节、亚实性恶性结节。以随访间隔时间(d)为X轴,以随访结节的三维体积(mm3)和三维体积对数为Y轴,绘制体积线性及指数性生长曲线,由研究者主观观察曲线的形态。应用卡方检验比较不同性质肺结节的生长曲线的差异。结果实性恶性结节中12例(66.7%)生长曲线快速上升,3例(16.7%)先平缓-后上升,2例(11.1%)缓慢上升,1例(5.56%)平直。亚实性恶性结节中8例(47.1%)呈快速上升型,4例(23.5%)缓慢上升,3例(17.6%)平直,2例(11.8%)为先下降-后上升型。实性良性/低危结节中5例(13.9%)呈下降型,17例(47.2%)平直,8例(21.6%)缓慢上升,6例(16.7%)呈波浪型。亚实性良性/低危结节中4例(10%)呈下降型,21例(52.5%)平直,9例(22.5%)缓慢上升,6例(15%)呈波浪型。良性/低危结节与恶性结节生长曲线分布存在显著性差异(χ2=42.4,P<0.01)。结论肺癌生长曲线具有异质性,快速上升是恶性肺结节的特征性生长曲线,但部分可在一定时期内表现为平直、缓慢上升甚至下降。缓慢生长不能排除肺癌可能,尤其是亚实性结节。
BACKGROUND & OBJECTIVE: Follow-up of computed tomography (CT) to evaluate the growth characteristics of pulmonary nodules is a common strategy for judging benign and malignant nodules. Pulmonary nodules of different biological behavior may have different growth rates and growth patterns. The purpose of this study is to draw the volume growth curve of different types of pulmonary nodules, to understand the growth pattern, to provide a basis for judging the nodule properties and the development of pulmonary nodule follow-up programs. Methods The imaging data of 111 pulmonary nodules (54 cases of solid nodules and 57 cases of subsolid nodules) undergoing CT examination of 2 times or more were retrospectively analyzed by 3D software. 35 cases of malignant and 5 cases of benign nodules were confirmed by pathology or histology, and the remaining 71 cases showed no significant growth after two years’ follow-up. The expert consultation confirmed lung cancer low-risk nodules. All nodules are grouped by density and nature: solid benign / low-risk nodules, solid malignant nodules, sub-solid benign / low-risk nodules, sub-solid malignant nodules. At intervals of follow-up (d), the X-axis was taken and the volume linear and exponential growth curves were plotted using the three-dimensional volume (mm3) of the followed nodules and the three-dimensional volume logarithm. The morphology of the curve was subjectively observed by the investigators. The chi-square test was used to compare the differences in the growth curves of different nodules of lung. Results The growth curve of 12 cases (66.7%) of solid malignant nodules increased rapidly. Three cases (16.7%) first increased slowly and then increased. Two cases (11.1%) slowly increased and one case (5.56%) straightened. Among the subacute malignant nodules, 8 cases (47.1%) showed rapid increase, 4 cases (23.5%) increased slowly, 3 cases (17.6%) were straight and 2 cases (11.8%) first descended. Among the benign / low-risk nodules, 5 cases (13.9%) showed a descending type, 17 cases (47.2%) were straight, 8 cases (21.6%) were slowly increased and 6 cases (16.7%) were waved. Among the benign / low-risk nodules, 4 cases (10%) showed a descending type, 21 cases (52.5%) were straight, 9 cases (22.5%) were slowly increased and 6 cases (15%) were waved. There was a significant difference in the distribution of benign / low-risk nodules and malignant nodules (χ2 = 42.4, P <0.01). Conclusions The growth curve of lung cancer is heterogeneous. The rapid increase is a characteristic growth curve of malignant pulmonary nodules, but some of them may be straight, slowly rising or even falling within a certain period of time. Slow growth can not rule out the possibility of lung cancer, especially sub-solid nodules.