肺结节专题知识宣讲讲义.pptx

肺结节专题知识宣讲;Diagnosis and Management of Lung Cancer 3rd ed: American College of Chest Physicians(ACCP) Evidence-Based Clinical Practice Guidelines;临床实践指南;循证医学证据的分类;内容：24方面;一、肺结节的诊断;概况;?Rib fracture in a 50-year-old woman with multiple myeloma. (a) Close-up posteroanterior radiograph of the right upper lung shows a poorly marginated nodular area of increased opacity overlying the anterior aspect of the right second rib (arrow). (b) CT scan shows a healed fracture of the right second rib (arrow). ;Figure 2??Pseudonodule in a 50-year-old man. ;概况;病因;Figure 3： (a) Chest radiograph shows an incidental small nodule (arrow) at the left costophrenic angle. (b) Thin-section CT scan shows central fat attenuation (–43 HU) in the nodule. Hamartoma was diagnosed. ;Figure 6a. ??Segmental bronchial atresia in a 17-year-old girl. (a) Close-up posteroanterior radiograph of the right lower lung shows a nodular area of increased opacity in the lower lobe (arrow). (b) Chest CT scans (image on left obtained at a lower level) show a branching tubular area of increased attenuation in the right lower lobe as well as pulmonary parenchyma with lower than expected attenuation. These findings are characteristic of segmental bronchial atresia and obviated further work-up. ;Figure4： A:2006-08左上叶 GGO 8 mm B:2008-01, GGO10 mm,中央区域实变 C:2011-06, GGO 16 mm D:2012-10, GGO 24 mm，周围毛刺;Fleischner Society Guidelines;50岁以上吸烟史51%患者胸部CT发现肺结节 仅一小部分SPN是肺癌 SPN随访2年，稳定基本能排除恶性 不必要的有创检查和外科治疗增加并发症及死亡率 不必要的影像学检查增加相关费用和风险;结节的大小和肺癌的危险因素决定结节的性 5mm 恶性1% 8-20mm 恶性20% 20mm恶性50%;肺癌的危险因素;Fleischner Society Guidelines;1. SPN的患病情况 2. 恶性肺结节的特征（大小、形态、密度） 3.肺结节的倍增时间特征与病理类型的关系 4.诊断SPN的相关检查并发症;肺癌筛查SPN的患病情况;不同大小恶性结节的患病情况;SPN 形态特征;边缘;边缘;??45岁女性1cm肺结节 术后证实膀胱癌肺转移;遗传性出血性毛细血管扩张症导致动静脉瘘;右下肺结节分叶和毛刺---肺腺癌 ;钙化 ;?肺软骨错构瘤 ------爆米花样钙化;80岁男性左上叶2.2cm结节（偏心钙化-----FNAB腺癌）;21岁男性，转移性骨肉瘤 左下叶高密度结节 提示良性钙化 8月病灶明显增大，分叶---手术证实转移性骨肉瘤 ;脂肪密度;无症状错构瘤;结节密度;SPN密度;81岁男性左上叶 2.8cm 不规则部分实性病灶，胸膜凹陷征，FNAB提示腺癌;