PDF(Pubmed)
Abstract：
The aim of this review is to evaluate the current evidence regarding the best management in terms of active surveillance of angiomyolipoma (AML) cases less than 4 cm, particularly the optimal timing of active surveillance. In addition, we aimed to describe their initial size, clinical presentation, and growth rates. The present systematic review included prospective and retrospective studies that evaluated and followed up patients with AML through active surveillance. Studies were retrieved through an online bibliographic search of the Medline database via PubMed, SCOPUS, Web of Science, and Cochrane Library from their inception to January 2022. Seven studies were included in the present systematic review. Concerning the active surveillance protocol, only four studies describe the frequency of active surveillance and the utilized imaging modality. Some studies followed up lesions by ultrasound annually for two to five years, while other studies followed-up patients twice for the first year, then annually for a median follow-up period of 49 (9-89) months. The used modalities were ultrasound, CT, and magnetic resonance imaging (MRI). Notably, the incidence of spontaneous bleeding was consistent across the included studies (ranging from 2.3 - 3.1%), except for one study which showed an incidence rate of 15.3%. In terms of the need for active treatment, the rate of active treatment was slightly higher in some studies than the others. However, this variation could not be considered clinically relevant to favor one surveillance strategy over the other. We concluded that active surveillance is the first line of management in all small asymptomatic ALMs. ALMs less than 2 cm do not require active surveillance. The current published literature suggested that active surveillance for two years may provide the same benefits as a five-year surveillance strategy, with fewer radiation hazards and less socioeconomic burden.
摘要：
这篇综述的目的是评估目前关于对小于4厘米的血管平滑肌脂肪瘤（AML）病例进行积极监测的最佳管理的证据。特别是主动监测的最佳时机。此外,我们的目的是描述它们的初始大小，临床表现,和增长率。本系统综述包括前瞻性和回顾性研究，通过主动监测评估和随访AML患者。研究是通过PubMed通过Medline数据库的在线书目搜索检索的，Scopus,WebofScience,和Cochrane图书馆从成立到2022年1月。本系统综述包括7项研究。关于主动监测协议，只有4项研究描述了主动监测的频率和所使用的成像模式.一些研究每年通过超声跟踪病变两到五年，而其他研究第一年对患者进行了两次随访，然后每年一次，中位随访时间为49(9-89)个月。使用的模式是超声，CT,磁共振成像（MRI）。值得注意的是,纳入研究中自发性出血的发生率是一致的(范围为2.3-3.1%),除了一项研究显示发病率为15.3%。在需要积极治疗方面，在一些研究中,积极治疗的比率略高于其他研究.然而,这种差异不能被认为是临床相关的支持一种监测策略。我们得出的结论是，主动监测是所有小型无症状ALM的第一线管理。小于2厘米的ALM不需要主动监测。目前发表的文献表明，两年的主动监测可能提供与五年监测策略相同的益处。辐射危害更少，社会经济负担更少。
