327 Ch 326. Solitary Pulmonary Nodule (SPN) and Pulmonary Nodule Management

Solitary pulmonary nodule (SPN) = 單一肺野內病灶 ≤ 3 cm，圓形或類圓形，周圍肺實質正常；> 3 cm 稱 “mass”，自動 high suspicion for malignancy；etiology：(1) benign — granulomas (TB, NTM, fungal — calcification + central/popcorn/laminated)、hamartoma (popcorn calcification + fat)、arteriovenous malformation、infectious/inflammatory；(2) malignant — primary NSCLC + carcinoid + metastases；risk stratification：age + smoking + size + morphology (spiculation, lobulation) + location (upper lobe higher risk) + growth rate；probability calculators：Brock + Mayo + VA Cooperative；Fleischner Society guidelines 2017 for incidental SPN follow-up (依 size + risk + solid/sub-solid)；LDCT screening Lung-RADS + 4X categories；diagnostic options：CT follow-up surveillance、PET-CT (SUVmax > 2.5 concerning)、image-guided percutaneous biopsy、navigational/robotic bronchoscopy、surgical biopsy；2024 trends：AI nodule detection + radiomics + ctDNA detection enhance workup。