肺癌筛查中生长的实性小结节：200毫米(3)最小体积阈值的安全性和有效性

SCI 9 December 2022

Growing small solid nodules in lung cancer screening: safety and efficacy of a 200 mm(3) minimum size threshold for multidisciplinary team referral  

(Thorax, IF: 9.102)

Creamer AW, Horst C, Dickson JL, et al. Growing small solid nodules in lung cancer screening: safety and efficacy of a 200 mm(3) minimum size threshold for multidisciplinary team referral. Thorax 2022.

The optimal management of small but growing nodules remains unclear. The SUMMIT study nodule management algorithm uses a specific threshold volume of 200 mm(3) before referral of growing solid nodules to the multidisciplinary team for further investigation is advised, with growing nodules below this threshold kept under observation within the screening programme. Malignancy risk of growing solid nodules of size >200 mm(3) at initial 3-month interval scan was 58.3% at a per-nodule level, compared with 13.3% in growing nodules of size </=200 mm(3) (relative risk 4.4, 95% CI 2.17 to 8.83). The positive predictive value of a combination of nodule growth (defined as percentage volume change of >/=25%), and size >200 mm(3) was 65.9% (29/44) at a cancer-per-nodule basis, or 60.5% (23/38) on a cancer-per-participant basis. False negative rate of the protocol was 1.9% (95% CI 0.33% to 9.94%). These findings support the use of a 200 mm(3) minimum volume threshold for referral as effective at reducing unnecessary multidisciplinary team referrals for small growing nodules, while maintaining early-stage lung cancer diagnosis.

生长的小结节的最佳治疗方法尚不清楚。SUMMIT研究结节管理算法使用特定的阈值体积为200mm(3)，然后将生长的实性结节转到多学科团队进行进一步研究，建议在筛选方案中观察低于此阈值的生长结节。在最初的3个月间隔扫描中，大小为>200 mm(3)的生长实体结节的恶性风险为58.3%，而大小</=200 mm(3)的生长结节的恶性风险为13.3%(相对风险为4.4, 95% CI 2.17-8.83)。结节生长(定义为>/=25%的体积变化百分比)和>200 mm(3)大小的组合阳性预测值为65.9%(29/44)，或60.5%(23/38)。方案假阴性率为1.9% (95% CI 0.33%-9.94%)。这些发现支持使用200mm(3)的最小容积阈值进行转诊，可以有效减少不必要的多学科团队转诊生长的小结节，同时保持早期肺癌诊断。

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