A month ago, I received a patient in the outpatient clinic, this lung cancer patient has been operating for a year and a half, because of a little cough, worried about whether there is a recurrence, so come to the outpatient clinic for a review. From the perspective of the entire medical history, it is not complicated, this patient is the unit routine physical examination when the CT found out a solid lung nodule, there are 8mm, after the chest hospital and pulmonary hospital multiple experts read the film, all think that malignant tumors are likely, recommended timely surgery. Later, surgery was performed in the thoracic surgery department of our hospital, and lymph node dissection was routinely performed during the operation. The pathological results surprised both family members and doctors, invasive adenocarcinoma, 3 of the 10 lymph nodes have metastasized. There is lymph node metastases, which means that the staging is late in the middle stage. The patient underwent chemotherapy after surgery, but the genetic test did not have sensitive genetic mutations and could not be used for adjuvant targeted therapy.
Nodules that are only 8 mm, there has been lymph node metastasis, why is it so serious?
Many people see ground glass nodules will be worried, think that it will not be lung cancer, indeed, a certain proportion of ground glass nodules will be early cancer, but in fact, the growth of ground glass nodules within 1cm is very inert, "lazy to grow, lazy to metastasis", even if it is early cancer, there is no need to worry about metastasis in the short term.
However, solid nodules are different, if the solid nodules are malignant, the degree of malignancy will be relatively high, the growth rate is relatively fast, and lymph node metastasis may occur within one year, and even distant organ metastases. Many people think that 8mm nodules appear lymph node metastasis, must be small cell lung cancer, this is not necessarily, the pathological type of solid nodules is also likely to be squamous cell carcinoma, adenocarcinoma and small cell lung cancer must be several. If the solid nodule is adenocarcinoma, it is generally more common in older men who smoke and relatively rare in young people.
In terms of probability, the probability of malignancy of a solid nodule within 1 cm is lower than that of a ground glass nodule. Therefore, if the physical examination encounters a solid nodule, it is recommended to follow up in the following ways:
1. For solid micronoids with a ≤5 mm, the probability of malignancy is extremely low, and it is recommended to conduct low-dose CT follow-up once a year until the screening object is no longer a potential lung cancer patient.
2. For solid nodules of 6 to 7 mm, CT follow-up is recommended at an interval of 6 months.
3. For solid nodules of 8-14 mm, it is recommended to perform routine dose high-resolution CT examination at intervals of 3 months, PET-CT can be done, for patients with high suspicion of malignancy, consider lung puncture biopsy or direct surgical resection, and patients who are temporarily difficult to judge benign and malignant can be followed up by CT at intervals of 3 months.
4. For solid nodules with a > of 15 mm, it is recommended to perform routine dose CT examination, PET-CT examination is possible, and patients with high suspicion of malignancy are considered for biopsy or surgical resection, and patients with low malignancy possibility can be followed up with low-dose CT at intervals of 3 months.
5. For solid nodules in the bronchi cavity, it is recommended to review the CT within 1 month, and if there is no change, bronchoscopy is recommended.
Lung cancer manifested by solid nodules has similarities with inflammatory pseudomas, tuberculosis, lung aspergilloma, etc. in imaging, and sometimes it is difficult to judge, and there are indeed very few patients whose surgical pathological results are not lung cancer, but several conditions. When it is difficult to fully determine the nature of the nodule, short-term follow-up review is the best approach. Overly aggressive immediate surgery, or ignoring it altogether, is not the right thing to do.