327.2 🩺 國考版

327.2.1 高頻考點

327.2.1.1 Definition

• SPN ≤ 3 cm, mass > 3 cm
• Sub-solid: pure GGN vs part-solid

327.2.1.2 Benign Calcification Patterns

• Central, laminated, popcorn (hamartoma), diffuse
• Eccentric or none: indeterminate

327.2.1.3 Hamartoma

• Most common benign lung tumor
• Popcorn calcification + fat
• No further workup if classic

327.2.1.4 Malignancy Risk Factors

• Age > 40 (especially > 60)
• Smoking (current/prior)
• Size > 8 mm
• Spiculation
• Upper lobe
• Sub-solid (especially part-solid)
• Growth

327.2.1.5 Brock + Mayo Models

• Predict malignancy probability
• Guide management

327.2.1.6 Fleischner Society 2017

• Solid < 6 mm: no follow-up (low risk)
• Solid 6-8 mm: CT 6-12 mo
• Solid > 8 mm: CT/PET/biopsy
• Pure GGN ≥ 6 mm: CT 6-12 mo then q2 yr × 5 yr
• Part-solid ≥ 6 mm: CT 3-6 mo

327.2.1.7 Lung-RADS for LDCT Screening

• Category 1-4X + S
• Guides follow-up

327.2.1.8 PET-CT

• SUVmax > 2.5 concerning
• High NPV
• False neg: < 8 mm, AIS, carcinoid

327.2.1.9 Sub-Solid Nodule

• Higher malignancy risk than solid same size
• Adenocarcinoma spectrum (AAH → AIS → MIA → IA)
• Slower growth often
• Long-term surveillance

327.2.1.10 Diagnostic Biopsy Options

• CT-guided percutaneous (peripheral)
• Bronchoscopy (central)
• Navigational/robotic bronchoscopy (peripheral)
• VATS wedge resection

327.2.2 易混淆比較

Feature	Benign	Malignant
Calcification	Central, laminated, popcorn	None, eccentric
Margins	Smooth	Spiculated, lobulated
Size	Smaller	Larger
Growth	None/slow	Variable
PET	Low SUV	High SUV (> 2.5)
Location	Lower zones	Upper zones
Age	Variable	Older

327.2.3 Special Topics

327.2.3.1 Adenocarcinoma Spectrum (Sub-Solid)

• AAH (atypical adenomatous hyperplasia)
• AIS (adenocarcinoma in situ) — formerly BAC
• MIA (minimally invasive adenocarcinoma)
• IA (invasive adenocarcinoma)
• Progressive solid component on serial imaging

327.2.3.2 Multiple Pulmonary Nodules

• Different from SPN
• Often metastatic
• Mycobacterial / fungal
• Sarcoid
• Septic emboli

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