Oncology Frontier: How to improve diagnostic accuracy of small pulmonary nodules?

　　《肿瘤瞭望》：如何提高肺小结节的诊断准确性？

　　Dr. Veronesi: Diagnostic accuracy of small pulmonary nodules among screening studies is a really important objective. In our screening court， we had a nice sensitivity to detect lung cancer， and a specificity which was very good compared to other studies. However， not optimal in the sense that we had around 14% of nodules that had received surgical action that were benign. So compared to， for example， what has been obtained in other screening courts like NLST (the national lung screening trial)， it is a good result because NLST had more than 20-25% of false positives at surgery—so it’s not that good. But our objective is to reduce the false positive rate to the minimum. What we have found in our ten year annual screening， in which it is obviously important to have the diagnostic algorithm that takes into consideration different parameters like VDT (volume doubling time) of nodules， the CT， PET result， the size， the shape of the nodules， and so on. In our court， we take into consideration all these parameters among precise diagnostic algorithms. We can see that this false positive detection rate was reduced over the years with increased experience， so it’s also important that any positive case is discussed in an inter- and multi-disciplinary team meeting to obtain the maximum accuracy for these nodules.

　　Veronesi:博士：提高肺小结节诊断的准确性是肺癌筛查的重要目标。在我们的肺癌筛查研究项目中，肺癌检测的敏感性和特异性较高，虽然还称不上最佳，研究中14%接受手术的患者为良性结节。相比其他的肺癌筛查研究比如NLST（国家肺癌筛查试验），这个结果还算不错，在NLST试验中，手术发现20~25%检出结节为假阳性。但我们的目的将假阳性率减至最低。我们的诊断流程考虑了各种相关参数以求诊断精确，如体积倍增时间(VDT)、CT和PET检测结果，结节大小，结节形状等。随着经验的增加，假阳性检出率不断降低。如果肺小结节诊断阳性，则组织跨多学科小组进行讨论，以最大程度地提高诊断准确性。