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The Journal of thoracic and cardiovascular surgery 多学科选择肺结节行手术切除: 诊断结果和远期疗效。
影响因子：6.439 DOI：10.1016/j.jtcvs.2019.09.030
作者： Madariaga ML,Lennes IT,Best T,Shepard JO,Fintelmann FJ,Mathisen DJ,Gaissert HA,MGH Pulmonary Nodule Clinic Collaborative. 发表时间：2020-07-10 20:00:40
from：《JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY》
keywords： Madariaga MLLennes ITBest TShepard JOFintelmann FJMathisen DJGaissert HAMGH Pulmonary Nodule Clinic Collaborative.
关键词： 计算机断层扫描 肺叶切除术 肺癌 肺癌筛查 肺结节
Abstract
OBJECTIVE:Pulmonary nodules found incidentally or by lung cancer screening differ in prevalence, risk profile, and diagnostic intervention. The results of surgical intervention for incidental versus screening lung nodules during multidisciplinary Pulmonary Nodule and Lung Cancer Screening Clinic (PNLCSC) follow-up have not been reported. METHODS:All patients evaluated at a PNLCSC from 2012 to 2018 following referral by primary care physicians, specialist physicians, or self-referral after computed tomography (CT) identified nodules on routine diagnostic CT (incidental group) or lung cancer screening CT (screening group) were included. Follow-up interval, invasive intervention, histology, postoperative events, survival, and recurrence were compared. RESULTS:Of 747 patients evaluated in the PNLCSC, 129 (17.2%) underwent surgical intervention. The surgical cohort consisted of 104 (80.6%) incidental and 25 (19.3%) screening patients followed over a mean of 122 and 70 days, respectively. More benign lesions were excised in the incidental group (20.2%, 21/104)-representing 3.3% (21/632) of all incidental nodules evaluated-than in the screening group (4%, 1/25) (P = .038). Operative mortality was zero. Among 99 patients with primary lung cancer, 87% (screening) and 86.8% (incidental) were pathologic stage Ia. Complete follow-up was available in 725 of 747 (97%), and no patient developed progressive disease. Disease-free survival at 5 years was 74.9% (incidental) and 89.3% (screening) (P = .48). CONCLUSIONS:A unique multidisciplinary PNLCSC for incidental and lung cancer screening-detected nodules with individualized risk assessment reliably identifies primary and metastatic tumors while exposing few patients to diagnostic excision for benign disease. Longer-term outcomes, strategies to limit radiation exposure, and cost control need further study.
摘 要
目的: 偶然发现或通过肺癌筛查发现的肺结节在患病率、风险特征和诊断干预方面存在差异。多学科肺结节和肺癌筛查门诊 (PNLCSC) 随访期间偶然筛查肺结节的手术干预结果尚未见报道。 方法: 2012 年至 2018 年在PNLCSC接受初级保健医生、专科医生转诊或计算机断层扫描 (CT) 后自我转诊的所有患者进行评估纳入常规诊断CT (偶发组) 或肺癌筛查CT (筛查组) 上确定的结节。比较随访间隔、侵入性干预、组织学、术后事件、生存率和复发情况。 结果: 在PNLCSC评估的 747 例患者中，129 例 (17.2%) 接受了手术干预。手术队列包括 104 例 (80.6%) 偶然和 25 例 (19.3%) 筛查患者，分别随访平均 122 天和 70 天。偶发组 (20.2%，21/104) 切除的良性病变多于筛查组 (3.3%，21/632)，占所有偶发结节的 4% (1/25) (P = .038)。手术死亡率为零。在 99 例原发性肺癌中，病理分期Ia为 87% (筛查) 和 86.8% (偶发)。725 例中有 747 例 (97%) 获得完整随访，无患者发生疾病进展。5 年无病生存率为 74.9% (偶然) 和 89.3% (筛查) (P = .48)。 结论: 一个独特的多学科PNLCSC用于偶发和肺癌筛查发现的结节，具有个体化风险评估，可靠地识别原发和转移性肿瘤，同时使少数患者暴露于良性病变的诊断性切除。长期结果、限制辐射暴露的策略和成本控制需要进一步研究。
期刊介绍
《JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY》 (点击进入期刊详情)
英文简介 : The Journal presents original, exclusive articles on conditions of the chest, heart, lungs, and great vessels where surgical intervention is indicated. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the journal focuses on techniques and developments in cardiac surgery, pacemaker insertion/removal, lung and esophageal surgeries, heart and lung transplantation, and other procedures. The Journal of Thoracic and Cardiovascular Surgery ranks in the top 3.3% of the 4,779 scientific journals most frequently cited (Science Citation Index). It is also recommended for initial purchase in the Brandon-Hill study, Selected List of Books and Journals for the Small Medical Library (1997/98 Edition).
中文简介 : （来自Google、百度翻译） 该杂志发表了关于胸部、心脏、肺和大血管状况的原创、独家文章，指出需要手术治疗。该杂志是美国胸外科协会和西方胸外科协会的官方出版物，主要关注心脏手术、起搏器插入/移除、肺和食管手术、心肺移植和其他手术的技术和发展。《胸心血管外科杂志》在4779份最常引用的科学期刊（科学引文索引）中排名前3.3%。还建议在布兰登-希尔研究（Brandon Hill Study）中进行首次购买，该研究是小型医学图书馆（1997/98版）书籍和期刊的精选清单。
CIRCULATION RESEARCH 期刊中科院评价数据
新中科院分区
大类(学科) 小类(学科) 学科排名
医学

SURGERY (外科)

CARDIAC & CARDIOVASCULAR SYSTEMS (心脏和心血管系统)

RESPIRATORY SYSTEM (呼吸系统)

28/128
8/60
9/200
新发布的期刊年发文量
年度总发文量 年度论文发表量 年度综述发表量
289 281 8

总被引频次 :29599

特征因子 : 0.036950

影响因子趋势图

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