Lung cancer is one of the most harmful malignant tumors to human health. Although with the clinical application of targeted therapy and immunotherapy, the survival period of advanced lung cancer has been significantly extended, the overall five-year survival rate is still not high. Optimistically, the most effective method for lung cancer is early detection, early diagnosis and early treatment. Therefore, early lung CT screening is an effective method to prevent and treat lung cancer. However, with the popularization of CT, more and more pulmonary nodules are discovered as a "side effect". According to statistics, 1 in 500 people who undergo chest physical examination are found to have pulmonary nodules, and more than 90% of them have no symptoms. The diagnosis of pulmonary nodules on the CT report has brought panic to many people and seriously affected the quality of life. Our correct attitude towards pulmonary nodules should be to treat them scientifically and seek medical treatment in a timely manner.
What are pulmonary nodules?
Pulmonary nodules refer to nodular shadows within the lung parenchyma that are not part of normal lung tissue, with a diameter of less than 3 cm. Those with a diameter of less than 1 cm are called small nodules, and those with a diameter of less than 3 mm are called small nodules. are called micronodules, and those larger than 3 cm are called masses. A pulmonary nodule can appear as a single one or as multiple pulmonary nodules. More than 80%-90% of pulmonary nodules are benign, such as benign lung tumors, pneumonia, tuberculosis, pulmonary arteriovenous malformations, old lesions, etc. Of course, some nodules are malignant, and a small number of benign pulmonary nodules Nodules may undergo malignant transformation during follow-up.
What is ground glass nodule?
Ground-glass nodules are also called ground-glass opacities, ground-glass nodules, etc., and are abbreviated as GGO or GGN in English. They appear as cloud-like thin shadows or nodules with slightly increased density. They appear similar to ground-glass opacities on CT. Named for the same reason. Depending on whether the nodules contain solid components, they can be divided into mixed ground-glass nodules with solid components and pure ground-glass nodules. According to the pathological properties, ground glass nodules can be benign lesions such as focal fibrosis, inflammation or hemorrhage, or precancerous diseases such as atypical adenoma, adenocarcinoma in situ, or malignant tumors such as minimally invasive adenocarcinoma, Metastatic cancer, etc.
What are high-risk lung cancer nodules?
High-risk lung cancer nodules are pulmonary nodules that may be lung cancer or may have a higher risk of transforming into lung cancer. If there are multiple risk factors such as long-term smoking history, family history of lung cancer, and clear malignant tumors in other organs of the body, the tumor diameter is ≥1.5 cm or the diameter is between 0.8-1.5 cm but shows lobulation, burrs, and pleural traction. Nodules with malignant CT signs such as air-containing bronchioles and vacuoles, eccentric thick-walled cavities, and partially solid nodules with a diameter greater than 0.8 cm are considered high-risk nodules. High-risk nodules require comprehensive judgment by experienced radiologists, pulmonologists, or thoracic surgeons.
The more nodules, the higher the possibility of lung cancer?
The answer is no. There is no correlation between the number of pulmonary nodules and the possibility of lung cancer. On the contrary, multiple tiny nodules in the lungs indicate a higher possibility of chronic inflammation, but if there are multiple ground glass nodules Nodules should be taken seriously.
What should I do if I find pulmonary nodules?
First of all, it should be clear that pulmonary nodules do not mean lung cancer or early lung cancer. There is no need to be overly anxious. Excessive panic is not advisable, but it is not advisable to ignore it. Excessive panic will affect physiological and immune functions and induce disease; ignoring it will delay the condition and lose the best opportunity for treatment. If you find pulmonary nodules, you should bring detailed imaging data and medical history to the hospital. You can do some further examinations, such as a detailed physical examination, tumor markers in the blood, finding tumor cells in the sputum, etc. For example, patients with good financial conditions can PET/CT examination can also be performed. For high-risk patients, lung biopsy tissue can be guided by fiberoptic bronchoscopy and CT to confirm the diagnosis. Another powerful tool for the diagnosis and treatment of small pulmonary nodules is electromagnetic navigation bronchoscopy. Its principle is similar to the navigation system we use when driving. It can accurately find small nodules distributed in every corner in the complex bronchial network of the lungs. In addition to diagnosis, it also It can be used for precise positioning before surgery to reduce the scope of surgical resection. What is even more gratifying is that it can also directly perform ablation treatment on high-risk nodules based on precise navigation, saving many patients from the pain of surgery.
After detailed examination, patients generally have four options:
1. Short-term review after oral antibiotics
Pneumonia or atypical pneumonia manifests as pulmonary nodules In many patients, the pulmonary nodules disappear or become significantly smaller after short-term oral antibiotic treatment. Especially when ground glass nodules are discovered for the first time, antibiotic treatment is particularly important.
2. Close follow-up
Close follow-up is like the police watching a suspect. It must be determined through long-term observation. The CT examination is the policeman, and the pulmonary nodule is the policeman. suspect. The way to judge is to do another CT examination (preferably thin-section CT) within a period of time, and compare it with the previous CT to determine whether there are changes in size, density, location, etc. Benign nodules generally will not be detected during long-term follow-up. Changes occur, and malignant nodules can grow significantly in a short period of time. The specific follow-up interval should be comprehensively judged by the treating doctor based on medical history and examination results. The follow-up time should be shortened for high-risk lung cancer nodules. If most nodules do not grow within two years, they should be considered benign or low-grade malignant. However, for some nodules, such as ground-glass nodules, the follow-up period should be increased.
3. Surgical resection
Surgical resection is currently the best radical cure for malignant pulmonary nodules. Surgical treatment can be considered for patients who cannot be diagnosed clearly and are highly suspected of malignant lung tumors. Currently, the commonly used surgical procedure is thoracoscopic pulmonary wedge resection, which is less invasive, faster to heal, and has less impact on life. On the one hand, patients should not worry too much about surgical treatment. On the other hand, they still need to remember that most pulmonary nodules are benign, and they should not over-treat due to excessive anxiety.
4. Ablation treatment
Compared with surgical treatment, ablation treatment is more minimally invasive, and diagnosis and treatment can be completed in one operation. Ablation is only targeted at killing pulmonary nodules. It hardly affects normal lung function and can treat multiple lung nodules located in different lung lobes at one time. Ablation therapy can be completed under the guidance of electromagnetic navigation bronchoscope or CT guidance. It can also achieve the curative effect of early lung cancer. However, currently surgical resection is still the preferred treatment method for most malignant pulmonary nodules. Ablation therapy can be considered for the following patients: 1. Poor lung function and cannot tolerate surgical treatment; 2. Already had a pulmonary nodule resection, and further resection will seriously affect life; 3. Multiple pulmonary nodules, surgery cannot remove them all at one time; 4. Patients who are excessively afraid and anxious about surgery.
Illustration: Electromagnetic navigation bronchoscopy accurately locates pulmonary nodules. When the pathology at the biopsy site is confirmed to be adenocarcinoma, ablation treatment is performed to achieve a curative effect.
How to correctly view follow-up review?
As mentioned earlier, most nodules are benign, so for most friends who discover pulmonary nodules, the answer they get after seeing the hospital is follow-up. When the doctor makes the decision to follow up, it means that he is relieved about the nodule. However, in clinical practice, we found that follow-up has brought a great psychological burden to many patients. Many people are anxiously waiting for the next review. There are even some friends who are counting the days until the re-examination every day or are eager to advance the re-examination. In fact, this kind of mentality is not advisable. Patients and friends should realize that whether pulmonary nodules are ultimately proven to be benign is still a high-probability event. The follow-up time is also determined by the doctor based on the comprehensive judgment of clinical and imaging characteristics, and it is a scientific diagnosis and treatment. Part of what you need to do between follow-up visits is forget about the nodules and live a normal life. For patients who are first diagnosed with ground glass nodules, follow-up can save 40% of patients from unnecessary surgery.
Can CT be done repeatedly due to radiation?
Follow-up is currently the main means of prevention and treatment of pulmonary nodules, but patients in outpatient clinics often have concerns about CT examinations. The main reason is the radiation of CT. Both CT and X-rays contain X-ray radiation, and CT has slightly greater radiation than X-rays. Therefore, pregnant women, infants and young children should avoid CT or X-ray examinations when preparing for pregnancy. However, adults generally have no problem if they undergo several examinations a year (within 10 times). Patients and friends should adjust their mentality and cooperate with the examination
How to choose among various CT scans?
Low-dose CT:
Current evidence shows that low-dose CT is an effective method for screening lung cancer. The main advantage is that the radiation dose is small, and its radiation dose is about 1/1 of ordinary CT. Around 4.
Ordinary CT plain scan:
Ordinary CT plain scan is currently the most widely used CT examination in clinical practice. Most primary hospitals are equipped with it. The slice distance of ordinary CT plain scan is Usually 8-10mm. Both low-dose CT and ordinary CT are commonly used for physical examination and chest examination. The advantages are fast examination and low equipment requirements. The disadvantage is that the slice distance is too wide, which may cause the missed diagnosis of small nodules.
High-resolution CT:
High-resolution CT refers to CT with smaller slice distance, generally less than 5mm. Compared with conventional CT, it has higher accuracy and stronger resolution. , can clearly see the small structures in the lungs, and can be used for follow-up of small pulmonary nodules, especially ground-glass nodules.
Thin-section CT of small pulmonary nodules:
Thin-section CT of small pulmonary nodules is an examination item specially set up by the Radiology Department of Zhongshan Hospital for pulmonary nodules. The slice distance can be as low as 1mm. , has a higher resolution for small pulmonary nodules, and can also accurately measure the density of nodules. Through three-dimensional reconstruction, the volume of nodules, relationship with blood vessels, edges, etc. can be accurately measured, which is beneficial to the judgment of benign and malignant, and can be used for pulmonary Definite diagnosis and follow-up examination of small nodules. It is currently the preferred examination method for pulmonary nodules.
Enhanced CT:
Generally, small pulmonary nodules do not require enhanced CT examination, but dynamic enhanced CT, especially dynamic enhanced CT of small nodules, is useful in identifying solitary small nodules. The significance should be grasped by experienced respiratory physicians or thoracic surgeons.
PET/CT:
PET/CT can mainly be used to diagnose high-risk solid nodules or partially solid nodules in lung cancer. When there are multiple nodules, it can also be used to select which nodule. Biopsy of nodules is provided to provide reference opinions. The main principle is that tumor cells have higher glucose uptake and metabolism. The disadvantage is that it is expensive and is not recommended as a routine follow-up for small pulmonary nodules.