Lung cancer is the most important cause of cancer related deaths in the world, which is not only related to the high incidence rate of lung cancer, but also related to the fact that about 75% of patients are in advanced stage of lung cancer at the time of treatment, and the 5-year survival rate is less than 20%. Therefore, to improve the survival rate of patients, we must pay attention to early diagnosis and standardized treatment.

The most important part of early diagnosis is early detection of early lung cancer, while lung nodules are often the manifestation of early lung cancer. Therefore, it is particularly important to deal with the pulmonary nodules found in the examination and what countermeasures to take. Today I will talk with you about this topic.

2 out of 10 people can find small pulmonary nodules, which is particularly common. Why

In fact, the so-called pulmonary nodule, butis a standardized medical imaging term.

You can understand that this lung nodule, we can call it nodule, also can call it”summary”,”small”, even”small” and so on. But when we call it this way, we will communicate with each other, and it will be chaotic. You don’t know what I’m talking about, and I don’t know what you’re talking about? Then the imaging doctors will finally unify the standard and call the lesions with similar shape and size as”lung nodules”.

Clinically, when the lesions in our lungs are characterized by nodules or masses, our imaging doctors will call them nodules withdiameter ≤ 3cm; And those>3cm are called lumps. However, no matter whether it is a nodule or a mass,can appear alone (single) or several (multiple) at the same time.

Single occurrence is often seen in lung cancer, tuberculoma and inflammatory pseudotumor; Multiple lung metastases are most common. Of course, we have seen them in some patients with necrotizing granuloma and multiple liquid-containing lung cysts. Nodules and lumps are similar except for their different sizes.

Understand lower lung nodules and masses

As shown in the figure, both the lung window and the mediastinal window,a and b are intrapulmonary nodules, with irregular edges, short bristles, uneven density in the nodules, and the pathological result is”lung adenocarcinoma”c and d showed intra-pulmonary masses, with smooth edges, and the pathological result was”hamartoma”.

There are two main reasons why pulmonary nodules are so common:

First, the lung is the most important respiratory organ in our body, and many of its lesions can be manifested in the basic pathological form of”nodules”That is to say, under normal circumstances, there are no nodules in our lungs, which is a pathological state;

Second, the development of imaging technology is the keyYou can ask our parents or your grandparents. At that time, they didn’t have many lung nodules, and the answer must be that they didn’t hear or said very little. That’s the fact. When did pulmonary nodules begin to appear more and more? It is the appearance of our spiral CT examination that more and more small lung lesions are found.Especially the appearance of high-resolution CT and other post-processing techniques of CT and dynamic enhanced examination, more and more”lung nodules” small lesions are found.

Therefore, you can also find thatpulmonary nodule is not a disease, but an imaging manifestation. It does not represent a specific thing, but people should not have nodules under normal circumstances Therefore, the discovery of this nodule in the lung indicates that it must be pathological. Some of the same pathological nodules are benign and others are malignant, which need further examination and follow-up to distinguish. But usually, we all call pulmonary nodules in the image, which is very common.

What to do if pulmonary nodules are found in physical examination? Does it need to be removed

This score is different because the lung nodules found by each person may be different, so the degree of benign and malignant will also be different!

First of all, see whether it is the first discovery or regular follow-up

For pulmonary noduleswho are regularly followed up, it is very important for everyone to keep the results of the first imaging examination, because without comparison, it is impossible to know whether the nodules have changes, and if there are changes, they need to be treated, and the possibility of malignancy is high; If there is no change and the possibility of benign is high, continue to follow up.

If you find”nodules” in your lungs for the first time, we should first look at the size

For<1cm lung nodules, there are few special typical imaging signs, which are often very difficult to distinguish and clear.It is just like an ant is too small to catch.

If this pulmonary nodule is found to increase gradually during the follow-up, the degree of malignancy may increase; If it is stable for a long time, it is more likely to be benignOf course, this is only a change in size, but also a change in density. If there is a change, it is necessary to have surgery as soon as possible.

For lung nodules ≥ 1cm, in addition to the relatively large size of lung nodules at this time, we found that they generally have some typical imaging features, the same features have good and bad, we call the malignant characteristics of lung nodules, There are several common ones:

First, pulmonary nodules withlobulatedsuggest that malignancy is more common;

Second, the edges are relatively complete, but the presence ofburrsalso indicates malignancy;

Third, the mixed ground-glass nodules have increased solid componentsor were previously simple ground-glass nodulesturned into mixed ground-glass nodules, indicating that the possibility of malignancy is high;

Fourth, there are changes in the structure adjacent to the pulmonary nodules, such aspleural indentation sign or vascular clustering sign, which is also an important manifestation of malignancy.

For lung nodules with more malignant features, the higher the degree of malignancy, and more than four are recommended to be removed this morningBut if you have only one or two malignant features and do not want to operate, you can take puncture biopsy in time to further determine whether it is benign or malignant.

For those lung nodules that do not have any malignant characteristics, a comprehensive analysis should be made according to the size of the lung nodules, the tendency of benign and malignant, age, and whether the individual has a long-term smoking history, and whether he has a family history of lung cancer. A professional doctor should set an appropriate follow-up time for you Generally, recheck every 3 or 6 months. If the focus is small, the interval time can be appropriately extended, but if the focus is large, the interval time should be relatively shortened!

If there is no change in pulmonary nodules during the follow-up, or the change is not significant, can we immediately stop the follow-up

There is no doubt that there is no change in the observation process, which is a good thing! The most important part of the follow-up is imaging observation, because the pulmonary nodules will not have any symptoms. Generally, as long as the nodules have no imaging changes, our doctors will recommend to continue the follow-up.

As for when to stop the follow-up, there is no standard answer. Some doctors would recommend that the follow-up should be continued, but others would recommend that the follow-up should be at least 5 years, or after 5 years, the review period would be extended, for example, from one year to two or three years, However, note that not all nodules are acceptable, especially some high-risk nodules.

Moreover, if there is no change in the follow-up, it means that the patient can keep it.

Finally, for patients with pulmonary nodules who need surgical treatment, the best time for surgical treatment should be done as soon as possible when our professional doctor judges that your pulmonary nodules aremalignant; At the same time, for those individual patients who do not appear to have a malignant tendency at present, but can not work normally without cutting them off, we also suggest that they can be solved throughminimally invasive surgery.

Aboutpulmonary nodules, if you have any questions, you can leave a message below. Let’s talk together. I insist on using words that you can understand to explain and provide you with”understandable” science popularization. If you think it is helpful to you, you can forward it to the people around you and learn together!