非小细胞肺癌NCCN指南2017V4：临床表现和风险评估

临床表现和风险评估（DIAG-1）

a Multidisciplinary evaluation including thoracic surgeons, thoracic radiologists, and pulmonologists to determine the likelihood of a cancer diagnosis and the optimal diagnostic or follow-up strategy. 山东省肿瘤医院呼吸肿瘤内科张品良
a 包括胸外科医生、胸部放射学家和肺科专家的多学科评估共同确定癌症诊断的可能性和最的佳诊断或随访策略。

b Risk calculators can be used to quantify individual patient and radiologic factors but do not replace evaluation by a multidisciplinary diagnostic team with substantial experience in the diagnosis of lung cancer.
b 风险计算器可用于量化具体患者和放射因素，但不能代替在肺癌诊断方面有丰富经验的多学科诊断小组的评估。

c See Principles of Diagnostic Evaluation (DIAG-A 1 of 2).
c 见诊断评估原则（DIAG-A 1/2）。

d The most important radiologic factor is change or stability compared with a previous imaging study.
d 最重要的影像因素是与既往影像学检查相比是发生变化还是稳定。

实性肺结节的随访（DIAG-2）

* Lung nodules in asymptomatic, high-risk patients detected during lung cancer screening with LDCT, see the NCCN Guidelines for Lung Cancer Screening.
* 肺癌筛查期间LDCT发现的无症状、高危患者的肺结节，见NCCN肺癌筛查指南。

* For incidentally detected lung nodules, see below.
*对于偶然发现的肺结节，见下文。

c See Principles of Diagnostic Evaluation (DIAG-A 1 of 2).
c 见诊断评估原则（DIAG-A 1/2）。

d The most important radiologic factor is change or stability compared with a previous imaging study.
d 最重要的影像因素是与既往影像学检查相比是发生变化还是稳定。

e Low risk = minimal or absent history of smoking or other known risk factors.
e 低危=几乎不吸烟或无吸烟史或其他已知的危险因素。

f High risk = history of smoking or other known risk factors. Known risk factors include history of lung cancer in a first-degree relative; exposure to asbestos, radon, or uranium.
f 高危=吸烟史或其他已知的危险因素。已知的危险因素包括一级亲属的肺癌史；暴露于石棉、氡或铀。

g Non-solid, partially solid, or ground-glass nodules may require longer follow-up to exclude indolent adenocarcinoma.
g 非实性、部分实性或磨玻璃结节可能需要较长时间的随访以排除进展缓慢的（惰性）腺癌。

h Adapted from Fleischner Society Guidelines: MacMahon H, Austin JH, Gamsu G, et al. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 2005;237:395-400. (C) Radiological Society of North America. Fleischner Society Guidelines do not direct whether or not contrast is necessary or if an LDCT is appropriate. LDCT is preferred unless there is a reason for contrast enhancement for better diagnostic resolution.
h 根据美国弗莱施纳学会指南改编：MacMahon H, Austin JH, Gamsu G，等。CT扫描发现的小的肺结节管理指南：美国弗莱施纳学会综述。放射学2005;237:395-400。©北美国放射学会。美国弗莱施纳学会指南并未规定是否有必要强化或LDCT是合适的。LDCT是首选的，除非有为了更好的诊断分辨率而进行对比剂增强的理由。

i PET/CT performed skull base to knees or whole body. A positive PET result is defined as a standardized uptake value (SUV) in the lung nodule greater than the baseline mediastinal blood pool. A positive PET scan finding can be caused by infection or inflammation, including absence of lung cancer with localized infection, presence of lung cancer with associated (eg, postobstructive) infection, and presence of lung cancer with related inflammation (eg, nodal, parenchymal, pleural). A false-negative PET scan can be caused by a small nodule, low cellular density (nonsolid nodule or ground-glass opacity [GGO]), or low tumor avidity for FDG (eg, adenocarcinoma in situ [previously known as bronchoalveolar carcinoma], carcinoid tumor).
i 从颅底到膝盖或全身PET/CT。阳性PET结果定义为肺结节的标准摄取值（SUV）大于基线纵隔血池。PET扫描阳性发现可以是由感染或炎症所致，包括无肺癌的局部感染、肺癌合并相关的（如阻塞性）感染以及存在肺癌合并相关的炎症（如淋巴结、肺组织、胸膜）。PET扫描假阴性可以是由小结节、低细胞密度（非实性结节或磨玻璃影[GGO]）或肿瘤的FDG亲和力低（如原位腺癌[以前称为细支气管肺泡癌]、类癌）所引起的。

j Patients with a suspicion of lung cancer after PET/CT require histologic confirmation before any nonsurgical therapy. When a biopsy is not possible, a multidisciplinary evaluation should be done including radiation oncology, surgery, and interventional pulmonology.
j 经PET-CT检查后怀疑肺癌的患者，在任何非手术治疗前均需要组织学证实。当不可能活检时，应开展包括放射肿瘤学、外科和肺病介入科的多学科评估。

亚实性肺结节的随访（DIAG-3）

* Lung nodules in asymptomatic, high-risk patients detected during lung cancer screening with LDCT, see the NCCN Guidelines for Lung Cancer Screening.
* 肺癌筛查期间LDCT发现的无症状、高危患者的肺结节，见NCCN肺癌筛查指南。

* For incidentally detected lung nodules, see below.
*对于偶然发现的肺结节，见下文。

c See Principles of Diagnostic Evaluation (DIAG-A 1 of 2).
c 见诊断评估原则（DIAG-A 1/2）。

d The most important radiologic factor is change or stability compared with a previous imaging study.
d 最重要的影像因素是与既往影像学检查相比是发生变化还是稳定。

g Non-solid, partially solid, or ground-glass nodules may require longer follow-up to exclude indolent adenocarcinoma.
g 非实性、部分实性或磨玻璃结节可能需要较长时间的随访以排除进展缓慢的（惰性）腺癌。

k Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected on CT: A statement from the Fleischner Society. Radiology 2013;266:304-317. Guidelines do not direct whether or not contrast is necessary or if an LDCT is appropriate. LDCT is preferred unless there is a reason for contrast enhancement for better diagnostic resolution.
k Naidich DP, Bankier AA, MacMahon H，等。CT检出亚实性肺结节的管理推荐：美国弗莱施纳学会综述。放射学2013;266:304-317。指南并未规定是否有必要强化或LDCT是合适的。LDCT是首选的，除非有为了更好的诊断分辨率而进行对比剂增强的理由。