105年:內專

低劑量胸腔CT掃描發現單一肺結節(solitary pulmonary nodule),下列何者為真?

AAbout 70% of incidentally found pulmonary nodules are benign.
BA lobulated and irregular contour is more indicative of malignancy than a smooth one.
CGround-glass nodules should be benign.
DMultiple nodules indicate malignant disease.
EAbsence of growth over a period of 6-12 months is sufficient to determine whether it is benign.

詳細解析

本題觀念:

本題考點為低劑量胸腔 CT 發現的肺結節(solitary pulmonary nodule, SPN)特性,需辨別哪一陳述為「真」(true)。涵蓋:結節良惡性比例、影像形態特徵(輪廓、邊緣)、磨玻璃結節(ground-glass nodule)特性、多發性結節意義,以及觀察期判定良性的標準。

選項分析

(A) About 70% of incidentally found pulmonary nodules are benign. 此陳述方向正確但數字低估。實際上,大多數偶發性肺結節為良性,比例遠高於 70%。依 Cleveland Clinic 及 StatPearls 資料,約 96–99% 的偶發性肺結節為良性(視研究族群而異),在一般人群中惡性率約 1–5%。因此「70% 良性」低估了良性比例,此陳述為不準確/偏低估

(B) A lobulated and irregular contour is more indicative of malignancy than a smooth one. 此陳述為真。依 Fleischner Society 及 ACCP 指引,結節邊緣形態是重要惡性預測因子:**分葉狀(lobulated)、不規則(irregular)、毛刺狀(spiculated)**邊緣與惡

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