Imaging Screening And Rational Disposal Of Pulmonary Nodules

Objective:To analyze the results of lung cancer screening by low-dose CT(LDCT)for asymptomatic physical examiners and to evaluate the CT manifestation of pleural injury after pulmonary nodule thermal ablation and analyze its relationship to post-ablation complications.Methods:From April 1,2015 to April 1,2018,22 351 asymptomatic patients(16-95 years old)underwent lung LDCT examination.They were divided into positive,semi-positive and negative nodules according to the size and type of nodules.The results of LDCT lung nodules and lung cancer screening in different age and sex groups were analyzed.The positive and semi-positive nodules were detected and the size,density and morphology of the nodules were recorded during follow-up.A retrospective analysis of our database was performed between the October 2014 and December 2017,and a total of 59 patients underwent CT guided thermal ablation.Post-ablation CT findings and complications were analyzed.Results:The detection rate of pulmonary nodules was 31.0%.The difference was statistically significant between male and female subjects(?~2=70.47,p<0.001).The detection rate of nodules was positively correlated with age,and the difference was statistically significant(?~2=1032.96,p<0.001).The highest detection rate of nodules was found in 81-95 years old(50.0%).The detection rate of positive nodules was different between the sexes.The detection rate of male was relatively high(10.1%),and the difference was statistically significant(?~2=184.36,p<0.001).The positive rate of different age groups was different,and the difference was statistically significant(?~2=434.89,p<0.001).The detection rate of lung cancer was 0.4%.There was a significant difference between the sexes(?~2=7.52,p=0.006).The detection rate of male lung cancer was higher than that of female lung cancer.The detection rate of lung cancer in different age groups was statistically significant(?~2=62.74,p<0.001).The proportion of positive and semipositive nodules in different density types of nodules was different(?~2=267.06,p<0.0001),and the detection rate of malignant nodules in some solid nodules was higher(?~2=131.77,p<0.001).Thermal ablation was successfully accomplished in all 59 patients.Visceral pleural indentation could be observed on CT scan when the ablation zone was adjacent to pleura.This sign was found in 12 patients,9 of which(75%)had pleural-related complications.Among them,6 patients(50%)underwent thoracic close drainage.Conclusion:LDCT lung cancer screening is especially important for middle-aged and elderly people.Annual review of semi positive nodules is feasible.For continuous mixed glass nodules,it should be treated more actively.The proportion of malignant pulmonary nodules in screened pulmonary nodules is low.A reasonable follow-up or treatment plan should be made according to the size,type and morphological characteristics of the nodules.Visceral pleural indentation might be the sign of pleural injury after pulmonary nodule thermal ablation and revealed high risk of pleural-related complications.