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Management subsolider pulmonaler Rundherde

Management of subsolid pulmonary nodules

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Zusammenfassung

Der Nachweis subsolider intrapulmonaler Rundherde stellt ein häufiges Problem in der täglichen klinisch-radiologischen Routine dar. Das biologische Verhalten subsolider Rundherde unterscheidet sich wesentlich von soliden intrapulmonalen Rundherden. Das Risiko für Malignität ist für subsolide Rundherde deutlich höher im Vergleich zu soliden oder reinen Milchglasrundherden. Die Empfehlungen für das diagnostische Management subsolider Rundherde wurden entsprechend der Wachstumstendenz sowie des Malignitätsrisikos adaptiert. Eine benigne Ätiologie ist bei subsoliden Rundherden ebenfalls oft zu finden. Diese weisen häufig in der Verlaufsuntersuchung eine Größenreduktion auf oder bilden sich spontan zurück. Daher wird für viele subsolide Rundherde primär eine kurzfristige Verlaufskontrolle empfohlen. Da sowohl benigne als auch maligne Veränderungen über einen langen Zeitraum stabil bleiben können, wird in weiterer Folge eine jährliche Kontrolle über einen längeren, derzeit noch unklaren Zeitraum empfohlen. Subsolide Veränderungen, welche an Größe und/oder Dichte zunehmen bzw. einen soliden Anteil innerhalb eines Milchglasrundherdes entwickeln, sind bis zum Beweis des Gegenteils als malignomsuspekt zu werten und müssen weiter abgeklärt werden.

Abstract

The finding of subsolid pulmonary nodules poses a frequent problem in the daily routine of the radiologist. The biological behavior of such subsolid lesions differs significantly from solid nodules. The risk of malignancy is significantly higher in subsolid nodules as compared to solid or purely ground glass opacities or nodules. The recommendations regarding the diagnostic management of subsolid nodules have been adapted according to the tendency of growth and the risk of malignancy. A benign etiology is also seen quite often in subsolid lesions and in this case they will show a reduction of size or disappear completely by the follow-up examination. Therefore, in many cases a short-term follow-up examination is primarily recommended. As the findings will often show no changes for a long period of time, further annual follow-up examinations over a longer, not yet specified period of time are recommended. Subsolid lesions that grow in size and/or show an increase in density or develop a solid part within a ground glass lesion should remain as suspected malignancies until proven otherwise.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. E. Eisenhuber, G. Mostbeck, H. Prosch, C. Schaefer-Prokop geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Institut für Röntgendiagnostik, Krankenhaus Göttlicher Heiland, Dornbacher Str. 20–28, 1170, Wien, Österreich

    E. Eisenhuber

  2. Institut für Röntgendiagnostik, Institut für diagnostische und interventionelle Radiologie, Otto-Wagner-Spital, Wilhelminenspital, Wien, Österreich

    G. Mostbeck

  3. Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Wien, Österreich

    H. Prosch

  4. Radiologie, Meander Medical Center, Amersfoort und Radboud University, Nijmegen, Niederlande

    C. Schaefer-Prokop

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  1. E. Eisenhuber
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  2. G. Mostbeck
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  3. H. Prosch
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  4. C. Schaefer-Prokop
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Correspondence to E. Eisenhuber.

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Eisenhuber, E., Mostbeck, G., Prosch, H. et al. Management subsolider pulmonaler Rundherde. Radiologe 54, 427–435 (2014). https://doi.org/10.1007/s00117-013-2602-6

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  • DOI: https://doi.org/10.1007/s00117-013-2602-6

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