"Did you get a physical exam?" Do you have a lung nodule on your medical report? ”
This is the most mentioned problem in the hospital recently, many colleagues come to the lung nodule clinic with the physical examination report, "Why didn't there be a lung nodule last year, and this year there is?" "What is the nature of my lung nodule?" "Does my nodule need surgery?" ", and today, we talk about a special kind of lung nodule, this kind of solid nodule is not uncommon in physical examination, in the past for a long time was considered to be very likely to be a malignant nodule, but in the latest study found: most of this type of nodule is benign, in clinical work must avoid excessive intervention.
What is a non-calcific nodule attached to the ribs pleural membrane
Through repeated popularization of science, we are not unfamiliar with lung nodules, when we are born, our lungs are clean, and with the acquired inflammation, trauma, tuberculosis, tumors and other factors, nodules appear on the lungs. It is worth noting that most nodules are benign, especially nodules below 5 mm are basically benign.
There are two features of non-calcified nodules attached to the rib pleura, the first of which is located on the rib pleura, which can be seen more obviously from chest CT. The second point is generally a solid nodule, but this solid nodule generally does not include a nodule with a cord extending to the rib pleura.
The rib pleura is attached to a non-calcified nodule
How to determine the benign and malignant nature of non-calcified nodules attached to the rib pleura?
In a recently published screening test involving 4425 lung nodules, people deliberately studied the benign and malignant aspects of non-calcific nodules attached to the ribs pleura, and the focus of the study was mainly on the most common discussion points in CT images, such as the size of the nodules, whether the edges were regular, whether there was emphysema or fibrosis around the nodules, and when various confounding factors that may affect the outcome were removed, the final conclusion was as follows:
●The smaller the diameter of the nodule, the greater the likelihood of benignity
In the populations included in the study, the smaller the noncalcified nodule attached to the ribs pleural membrane, the greater the likelihood of benignness. Among them, the median diameter of benign and malignant nodules is 4.2mm and 11mm, which is also in line with our long-standing judgment that nodules below 5mm are basically benign.
●The smoother the edge of the nodule, the greater the likelihood of benignness
In the populations included in the study, the smoother the edge of the non-calcified nodule attached to the ribs, the more likely it is to be benign. Among them, the proportion of smoother margins in benign and malignant nodules was 67% and 14%, respectively, which was statistically significant.
●The less emphysema in 1 cm around the nodule, the greater the likelihood of benignity
In the populations included in the study, the less 1 cm emphysema of the rib pleura attached to the non-calcific nodule, the greater the likelihood of benignness. Among them, the proportion of emphysema in the 1CM range of benign and malignant nodules was 38% and 81%, respectively, which was statistically significant.
●The less fibrosis occurs around 1 cm of nodule, the greater the likelihood of benignness
In the populations included in the study, the less 1 cm emphysema of the rib pleura attached to the non-calcific nodule, the greater the likelihood of benignness. Among them, the proportion of pulmonary fibrosis in the 1CM range of benign and malignant nodules was 3.6% and 19%, respectively, which was statistically significant.
Principles of non-calcific nodule treatment of ribbed pleural attachment
Because the solid rib pleura adheres to the non-calcific nodules mostly benign, we must be cautious and cautious when facing such nodules, especially those nodules that are flat, oval or semi-circular (LOS) or triangular, with smooth edges, emphysema around the nodules and less pulmonary fibrosis, can be followed up regularly. The current consensus is that such nodules are mostly recommended for annual screening rather than further treatment, avoiding over-intervention.