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Radiology：临近“间隙”的肺结节分类是良还是恶？

2018-07-14 shaosai MedSci原创

肺结节肿瘤间隙
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本研究旨在研究不同阅片者间对CT图像中外周结节（PFNs）进行不同密度分类，评价放射科医生鉴别PFN与恶性肿瘤的可靠性，并将结果发表在Radiology上。

本研究旨在研究不同阅片者间对CT图像中外周结节（PFNs）进行不同密度分类，评价放射科医生鉴别PFN与恶性肿瘤的可靠性，并将结果发表在Radiology上。

本研究中所分析的结节均为非钙化、实性、大小约为5-10mm且扫描层厚为不高于2mm。由6名放射科医生对359处结节进行分级。当结节被超过3名放射科医生认定为不可判别时将会排除，最后有316处结节进行分析。

结果为，本研究共纳入了22.2%肿瘤(70/316)。PFN结节的中位数比例为45.6% (144/316)。共有17.7% (56 of 316)的结节被6名放射科医生均判定为PFNs。Fleiss κ为0.50。与非PFNs相比，PFNs相对较小，多位于下叶，并与间隙相连(P < .001)。13/70 (18.6%) 肿瘤被误判为PFN21次。个人误判率约为0% (0 /125) -4.9% (8/163)。在13处恶性结节中，11处位于上叶，22处与间隙相连。

本研究表明，对于判定间隙旁结节，阅片者的一致性一般。月有2.5%的间隙旁结节被误判为肺肿瘤（21/865）。当将结节定义为间隙旁结节时将会减少不必要的扫描检查。鉴别上叶间隙旁结节将会降低误判率。

原始出处：

Schreuder A， van Ginneken B， Scholten ET. et al.Classification of CT Pulmonary Opacities as Perifissural Nodules： Reader Variability.Radiology.DOI：10.1148/radiol.2018172771

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    2018-07-24 执着追梦

    学习，谢谢分享

    0

  2. 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    2018-07-20 执着追梦

    学习，谢谢分享

    0

  3. 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    2018-07-18 执着追梦

    学习谢谢分享

    0

  4. 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createdTime=Fri Jul 20 06:29:02 CST 2018, time=2018-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=332478, encodeId=4c963324e807, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Wed Jul 18 12:40:21 CST 2018, time=2018-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=332376, encodeId=6ec83323e69d, content=谢谢了学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=30331616752, createdName=txqjm, createdTime=Wed Jul 18 06:55:51 CST 2018, 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    2018-07-18 txqjm

    谢谢了学习

    0

  5. 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    2018-07-14 邓启付

    间隙旁结节是良性居多吗?好像问题没有说清楚.

    0

  6. 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    2018-07-14 lofter

    学习了感谢分享

    0

  7. 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createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sat Jul 14 05:50:47 CST 2018, time=2018-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=331450, encodeId=9cf933145035, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sat Jul 14 05:50:44 CST 2018, time=2018-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=331449, encodeId=eebf33144930, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sat Jul 14 05:50:41 CST 2018, time=2018-07-14, status=1, ipAttribution=)]
    2018-07-14 yjs木玉

    好好好好好好好好

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=333760, encodeId=c665333e6026, content=学习，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Tue Jul 24 06:55:07 CST 2018, time=2018-07-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=332829, encodeId=bf7133282983, content=学习，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Fri Jul 20 06:29:02 CST 2018, time=2018-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=332478, encodeId=4c963324e807, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Wed Jul 18 12:40:21 CST 2018, time=2018-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=332376, encodeId=6ec83323e69d, content=谢谢了学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=30331616752, createdName=txqjm, createdTime=Wed Jul 18 06:55:51 CST 2018, time=2018-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=331465, encodeId=0036331465fd, content=间隙旁结节是良性居多吗?好像问题没有说清楚., beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Sat Jul 14 07:41:57 CST 2018, time=2018-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=331462, encodeId=00773314626c, content=学习了感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/C20CB8E4EBB36F5B821651C710BCB491/100, createdBy=18de1715848, createdName=lofter, createdTime=Sat Jul 14 06:51:06 CST 2018, time=2018-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=331453, encodeId=6f6833145364, content=好好好好好好好好, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Sat Jul 14 06:00:04 CST 2018, time=2018-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=331451, encodeId=27513314515a, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sat Jul 14 05:50:47 CST 2018, time=2018-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=331450, encodeId=9cf933145035, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sat Jul 14 05:50:44 CST 2018, time=2018-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=331449, encodeId=eebf33144930, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sat Jul 14 05:50:41 CST 2018, time=2018-07-14, status=1, ipAttribution=)]
    2018-07-14 哈哈869

    学了

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=333760, encodeId=c665333e6026, content=学习，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Tue Jul 24 06:55:07 CST 2018, time=2018-07-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=332829, encodeId=bf7133282983, content=学习，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, 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time=2018-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=331465, encodeId=0036331465fd, content=间隙旁结节是良性居多吗?好像问题没有说清楚., beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Sat Jul 14 07:41:57 CST 2018, time=2018-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=331462, encodeId=00773314626c, content=学习了感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/C20CB8E4EBB36F5B821651C710BCB491/100, createdBy=18de1715848, createdName=lofter, 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createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sat Jul 14 05:50:41 CST 2018, time=2018-07-14, status=1, ipAttribution=)]
    2018-07-14 哈哈869

    学了

    0

  10. [GetPortalCommentsPageByObjectIdResponse(id=333760, encodeId=c665333e6026, content=学习，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Tue Jul 24 06:55:07 CST 2018, time=2018-07-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=332829, encodeId=bf7133282983, content=学习，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, 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time=2018-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=331465, encodeId=0036331465fd, content=间隙旁结节是良性居多吗?好像问题没有说清楚., beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Sat Jul 14 07:41:57 CST 2018, time=2018-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=331462, encodeId=00773314626c, content=学习了感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/C20CB8E4EBB36F5B821651C710BCB491/100, createdBy=18de1715848, createdName=lofter, createdTime=Sat Jul 14 06:51:06 CST 2018, time=2018-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=331453, encodeId=6f6833145364, content=好好好好好好好好, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Sat Jul 14 06:00:04 CST 2018, time=2018-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=331451, encodeId=27513314515a, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sat Jul 14 05:50:47 CST 2018, time=2018-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=331450, encodeId=9cf933145035, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sat Jul 14 05:50:44 CST 2018, time=2018-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=331449, encodeId=eebf33144930, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Sat Jul 14 05:50:41 CST 2018, time=2018-07-14, status=1, ipAttribution=)]
    2018-07-14 哈哈869

    学了

    0

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当在非选择的、具有异质性的临床人群中进行验证时，布洛克模型对潜在恶性和良性结节具有高预测性辨别力。

Thorax：低剂量CT肺癌筛查检测到的新实性结节的特征：NELSON研究

与形态学结节特征相反，不依赖于生长的特征会进一步改善基于体积的新结节肺癌预测

Medscape：风险工具可能有助于确定哪些肺结节是恶性结节？

根据 2017年12月20日在JAMA Surgery杂志上在线发表的一项回顾性研究的结果，临床医生“很少”使用可行的工具来量化肺结节为癌症的风险，而主要依赖定性语言，如“可疑”、“非常疑似”和“高预测概率”。

Radiology：数字胸部断层摄影在实性肺结节中的价值有多少？

本研究旨在沿着数字胸部断层摄影（DTS）在检出和显示偶然性实性肺结节的价值，并将结果发表在Radiology上。