Der Lungenrundherd: Vom Zufallsbefund zur histologischen Diagnosesicherung

Mit der zunehmenden Anzahl von CT-Untersuchungen des Thorax steigt auch die Prävalenz zufällig entdeckter Lungenrundherde. Während das Hauptziel der Abklärung eines inzidentellen Lungenrundherdes darin besteht, die Dignität des Rundherdes zu bestimmen, müssen die Risiken durch unnötige diagnostische Verfahren minimiert werden. Fortschritte und neue Technologien in der Bildgebung sowie bei der histologischen Probengewinnung ermöglichen es, diese Ziele zu erreichen.

Abstract

As the number of CT examinations of the lungs increases, so does the prevalence of incidentally discovered pulmonary nodules. While most lung nodules are benign, the risk of malignancy significantly rises with the presence of risk factors and specific imaging features. Upon encountering an incidental nodule, efforts should focus on achieving an accurate pathological diagnosis, particularly to ascertain malignancy while minimizing the risks associated with unnecessary diagnostic procedures. A comprehensive understanding of the typical characteristics and behavior of malignant lung nodules, along with a detailed patient history and standardized clinical and imaging risk assessment, is crucial for determining the optimal diagnostic approach. Additionally, the decision regarding histologic confirmation should consider the patient's comorbidities, preferences, and the examiner's expertise. Emerging sampling technologies provide methods for addressing peripheral lung nodules with minimal risk of complications.

Kernaussagen

• Lungenrundherde treten häufig auf, insbesondere im fortgeschrittenen Alter.

• Die Mehrheit der zufällig gefundenen Lungenrundherde sind benigne.

• Unter den malignen Rundherden sind langsam wachsende Adenokarzinome die am häufigsten vorkommende Pathologie.

• Die bevorzugte Methode zur Erst-Evaluation des Malignitätsrisikos und zur Verlaufskontrolle ist die Mehrzeilen-Spiral-CT mit einem Dünnschichtprotokoll (1mm).

• Das diagnostische Vorgehen bei einem Lungenrundherd sollte individuell auf den Patienten abgestimmt werden.

• Stabile solide Rundherde über einen Zeitraum von 2 Jahren und subsolide Rundherde über 5 Jahren erfordern keine weitere Diagnostik.

Schlüsselwörter

Lungenrundherd - inzidentell - Lungenkrebs - Malignität - Bildgebung

Keywords

pulmonary nodule - incidental - lung cancer - malignancy - imaging

Publication History

Article published online:
23 September 2024

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