[Progress in diagnosis and treatment of lung adenocarcinomas imaging manifesting as radiological part-solid nodule]

Zhonghua Zhong Liu Za Zhi. 2021 Jul 23;43(7):743-750. doi: 10.3760/cma.j.cn112152-20200710-00646.
[Article in Chinese]

Abstract

The incidence and mortality of lung cancer ranked the first in China. China had 787, 000 new cases of lung cancer in 2015, and a majority of these patients with advanced lung cancer. With the development and popularization of high-resolution computed tomography, more and more early-stage lung adenocarcinomas are found in screening. The imaging finding of early-stage lung adenocarcinomas often manifests as part solid nodule (PSN) containing ground glass opacity (GGO). Although the imaging manifestation of the nodules can't accurately predict the pathologic type of nodules, the parts of solid nodule and GGO still have some pathologic indications, and the prognostic evaluation effect of the maximum diameter of PSN is superior to that of the whole nodule. With the development of the molecular radiography and molecular pathology, the relationship of imaging manifestation of the PSN and metastasis were focused on. Some PSNs with special nature are more active and rapidly progressed than the pure GGOs. While compared to the pure solid nodules, the aggressiveness of PSNs are insufficient, with lower metastatic rates of lymph node and better prognoses. Currently, international acknowledge recommends to take active intervention measure for PSNs which are highly suspected to be malignant. We focus on the diagnosis and treatment of PSNs, systemically depict their staging, follow-up, surgical treatment, gene detection and immunotherapy.

中国肺癌的发病率和死亡率居所有恶性肿瘤之首,2015年中国新发肺癌病例约为78.7万例,其中大部分肺癌于发现时就已处于中晚期。随着高分辨率计算机断层扫描的发展和普及,越来越多的早期肺腺癌在筛查中被发现。早期肺腺癌的影像学常表现为含有磨玻璃成分的部分实性结节。结节的影像学表现虽然并不能精准的预测结节的病理类型,但实性成分和磨玻璃成分仍然对病理有一定的提示作用,部分实性结节实性成分的最大径比整个结节的最大径能更好的区分预后。随着分子影像学和分子病理学的发展,部分实性结节的影像学表现与侵袭性关系越来越受关注。部分实性结节性质特殊,相较于纯磨玻璃结节其性质活跃,易进展迅速;而相较于纯实性结节,其侵袭性不足,淋巴结转移率低且预后较好。目前,国际上推荐对高度怀疑恶性的部分实性结节采取主动干预的措施。文章聚焦于部分实性结节的诊断和治疗,从结节的分期、随访、手术治疗、基因检测和免疫治疗方面作一系统阐述。.

Keywords: Diagnosis; Lung neoplasms; Part solid nodule; Treatment.

MeSH terms

  • Adenocarcinoma of Lung* / diagnostic imaging
  • Adenocarcinoma of Lung* / drug therapy
  • Adenocarcinoma of Lung* / pathology
  • China
  • Humans
  • Lung Neoplasms* / diagnostic imaging
  • Lung Neoplasms* / pathology
  • Lymph Nodes / pathology
  • Neoplasm Staging
  • Retrospective Studies
  • Solitary Pulmonary Nodule* / diagnostic imaging
  • Tomography, X-Ray Computed