Inzidentelle Lungenrundherde – aktuelle Leitlinien und Management

Zusammenfassung

Hintergrund Aufgrund der immer häufiger durchgeführten hochaufgelösten Schnittbildgebung steigt die Anzahl der jährlich detektierten inzidentellen Lungenrundherde. Obwohl die allermeisten inzidentellen Lungenrundherde gutartig sind, ließen sich durch eine konsequente Nachverfolgung viele frühe Lungenkarzinome diagnostizieren. Aus vielfältigen Gründen werden die existierenden Handlungsempfehlungen jedoch häufig nicht korrekt umgesetzt. Daher werden Verbesserungspotenziale auf den Ebenen der Kompetenz, Kommunikation, Struktur und des Prozesses beschrieben.

Methode In diesem Artikel werden die Handlungsempfehlungen für inzidentelle Lungenrundherde aus der aktuellen S3-Leitlinie des Lungenkarzinoms (Juli 2023) vorgestellt. Die international etablierten Handlungsempfehlungen (BTS-Guidelines und Fleischner-Kriterien) werden verglichen und weitere Studien zum optimierten Management wurden nach systematischer Literaturrecherche auf PubMed eingeschlossen.

Ergebnisse und Schussfolgerung Insbesondere KI-basierte Softwarelösungen sind vielversprechend, da sie gleich auf mehreren Ebenen unterstützend eingesetzt werden und zu einem einfacheren und automatisierten Management führen können. Um allerdings auch in der klinischen Routine anwendbar zu sein, muss sich Software gut in den radiologischen Arbeitsablauf einfügen und miteinander integriert werden. Darüber hinaus haben sich in den USA sogenannte „Lung Nodule Management“-Programme bzw. -Kliniken etabliert, die einen standardisierten Ablauf auf hohem Qualitätsniveau für Patienten mit inzidentell oder in der Früherkennung detektierten Lungenrundherden bieten. Gegebenenfalls könnten auch in Deutschland in einem zukünftigen Früherkennungsprogramm Strukturen geschaffen werden, in die auch Patienten mit inzidentellen Lungenrundherden eingebunden werden könnten.

Kernaussagen 

• Inzidentelle Lungenrundherde sind häufig, aber werden oft nicht leitliniengerecht aufgearbeitet

• Die aktualisierte S3-Leitlinie des Lungenkarzinoms umfasst nun auch Handlungsempfehlungen für inzidentelle Lungenrundherde

• Kompetenz-, Kommunikations-, Struktur- und Prozessebene bieten zahlreiche Verbesserungspotenziale für das Rundherdmanagement der IPNs

Zitierweise

• Glandorf J, Vogel-Claussen J, . Incidental pulmonary nodules – current guidelines and management. Fortschr Röntgenstr 2024; 196: 582 – 590

Schlüsselwörter

Inzidentelle Lungenrundherde - Lungenkrebs - Früherkennung - Handlungsempfehlungen - Nachverfolgung

Publication History

Received: 06 July 2023

Accepted: 20 September 2023

Article published online:
08 December 2023

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