Research Advances In Diagnosis And Teratment Strategy Of Solitary Pulnobary Nodule

Solitary pulmonary nodule(SPN) is defined as arounded opacity ≤3 cm in diameter surrounded by lung parenchyma without atelectasis, hilar enlargement or pleural effusion performance. With the development of LDCT, more and more SPNs have been founded.Most smokers have SPN, but most of them are less than 7 mm in diameter. The early diagnostic methods of SPN often have chest radiography, computed tomography, magnetic resonance imaging, positron emission tomography, serology, bronchoscopy, percutaneous lung biopsy or needle biopsy, video-assisted thoracoscopic surgery. Characteristics of nodules, such as size, growth rate, edge, internal structure, location have no relationship in distinguishing benign and malignant. When SPN is not determined to be benign or malignant, it should be evaluated in patients who with cancer risk, including the patient’s age and smoking history. Fleischner guidelines pointed out that the nodules with 4 mm or smaller diameter 99% are benign clearly; when the nodules with zhe diameter of 4-9 mm, the best way to deal with is follow-up. And the frequency of follow-up depends on the size of the nodule(4-6, or 6-8 mm), the level of risk of malignancy in patients with cancer. Non calcified nodules which are larger than 8mm in diameter should be considered in more ways, such as lthin-section CT, positron emission computed tomography(PET), percutaneous lung biopsy, fine-needle aspiration biopsy and video-assisted thoracoscopic surgery. ACCP guidelines suggest that the diameter of SPN is 8mm or less followed up the same way as Fleischner guidelines. For nodules which have the diameter more than 8mm, ACCP guidelines suggest to use Mayo Clinic model to assess the risk of malignant nodules, malignant probability <5%, 5%-65%,> 65% are referred to as low-grade, low to moderate, height, nodule size and malignancy probability to develop follow-up programs or treatment measures; NCCN guidelines suggest that the solid or mixed type SPN have a diameter less than 8mm should be followed up by two years and the frequency depends on the diameter of nodules, which is 3 years for Fleischner and ACCP guidelines. solid nodules which have the diameter more than 8mm, more methods such as PET, percutaneous lung biopsy, and thoracoscopic resection are needed.