PET/CT used in the evaluation of pulmonary nodules suspicious for lung cancer in regions where infectious lung disease is endemic: to be or not to be?

[Clinical-radiological-pathological Characteristics of 297 Cases of Surgical Pathology Confirmed Benign Pulmonary Lesions in Which Malignancy Could Not Be Excluded in Preoperative Assessment: A Retrospective Cohort Analysis in a Single Chinese Hospital]

背景与目的

随着癌症早筛意识的提高，低剂量计算机断层扫描(low-dose computed tomography, LDCT)用于肺癌筛查在中国广泛开展。尽管有部分胸部LDCT筛查所见的肺部病灶是肿瘤病灶，但大多数的肺部结节是良性病变。如何有效的对肺部病灶进行术前鉴别，如何降低部分可避免手术的良性疾病的手术切除比例，是需要关注的问题。

方法

本研究纳入2017年1月1日-2018年12月31日期间北京协和医院诊治的，术前考虑肺部恶性病变不能除外，经手术病理确认为良性病变的患者，回顾性分析患者临床信息。

结果

297例患者纳入本研究，占我院肺部病灶行肺部手术治疗患者的9.8%。197例(66.3%)患者因体检行LDCT筛查发现肺部病灶。肺部病变胸部CT影像学评估情况，可评估的323个病灶，平均长径为(17.9±12.1)mm，直径≥8 mm的占91.0%，实性最多见(212/323, 65.6%)，此类肺部病灶可有毛刺征(71/323, 22.0%)、分叶征(94/323, 29.1%)、胸膜牵拉征(81/323, 25.1%)、血管集束征(130/323, 40.2%)、空泡征(23/323, 7.1%)等，提示恶性病变的影像学特征。292例(98.3%)行电视辅助胸腔镜手术(video-assisted thoracoscopic surgery, VATS)，232例(78.1%)患者行肺楔形切除术，13例(4.4%)行肺段切除术，51例(17.2%)患者行肺叶切除术。4例(1.3%)患者出现手术并发症。术后病理类型前3位的是感染性疾病98例(33.0%)、炎性结节96例(32.3%)和错构瘤64例(21.5%)。

结论

因术前不能排除恶性而行手术切除的肺部良性病灶，影像学表现以实性病灶多见，但多具有提示恶性的影像学特征。VATS可作为一种明确病原病理的重要活检方式。此类病灶病理结果以感染性疾病和炎性结节最为常见，错构瘤第三。

Pitfalls and artifacts in the interpretation of oncologic PET/CT of the chest

PET/CT is widely used for the evaluation of patients with thoracic malignancies. Although the levels of ¹⁸F-fluorodeoxyglucose (FDG) uptake are usually high in neoplastic diseases, they can also be physiological, due to artifacts. In addition, FDG uptake can occur in benign conditions such as infectious, inflammatory, and iatrogenic lesions. Furthermore, some malignant tumors, such as adenocarcinoma in situ (formerly known as bronchoalveolar carcinoma) and carcinoid tumors, may not show FDG uptake. Here, we illustrate the main pitfalls and artifacts in the interpretation of the results of oncologic PET/CT of the chest, outlining strategies for avoiding misinterpretation.