With the popularity of CT and the application of high-resolution CT for physical examination, the detection rate of lung nodules has increased year by year, especially in the middle-aged and young groups around the age of 35 to 45. Usually, CT reports will show tiny nodules, multiple nodules, and even mention some tumor lesions that are not excluded, which will bring greater distress and even panic to the general public.
Multiple lung nodules, as the name suggests, are multiple nodules in the lungs. Some people see multiple nodules, very nervous, think it will not be more serious, because in everyone's inherent thinking mode, "multiple" definitely means worse. In fact, in terms of probability, the probability of malignancy of multiple nodules is very low compared to that of single nodules, especially the small solid nodules within 5 mm, the probability of malignancy is lower, and the vast majority are some benign chronic inflammatory proliferative foci.
For multiple pure ground glass nodules
Multiple pure ground glass nodules may be benign diseases such as nonspecific infectious diseases, respiratory bronchiolitis, and subacute allergic pneumonia, and such patients may have symptoms such as cough, sputum production, or asthma, and are more likely to appear as patchy ground glass shadows than regular nodules.
There is also a rare benign disease called lung Langerhans cell hyperplasia, which can be presented on CT as tiny ground glass nodules and nodules, nodules with hollows, cyst changes, and mesh shadows. Identification by imaging physician and clinician is required.
When the CT shows malignant nodules such as bronchial signs, obvious lobeing, vacuole signs, pleural depression signs, or solid components in the nodules, considering the possibility of early cancer, it is necessary to decide whether to continue follow-up or surgery according to the size, density, location and patient's wishes.
For multiple mixed glass nodules, multiple primary lung cancer, infectious inflammation, non-infectious inflammation, etc. should be considered. For such multiple nodules found for the first time, anti-inflammatory treatment can be started, if the lesion is not significantly reduced, faded or absorbed after the first 3 months of follow-up CT, the possibility of multiple primary lung cancer should be considered. Due to the low metabolic rate of ground glass nodules, PET-CT has limitations in judging multiple mixed ground glass pulmonary nodules.
Multiple pulmonary nodules generally require an individual evaluation of each nodule and screening for high-risk nodules (high-risk nodules are the most suspicious, but not necessarily the largest). In principle, the treatment of multiple lung nodules should adopt corresponding clinical strategies according to the situation of dominant nodules, whether to "grasp the big and let go of the small" or "exhaust the net", it is best to organize multidisciplinary discussions in imaging, thoracic surgery and interventional medicine.
Strictly speaking, even if it may be multiple carcinoma in situ, the operation should be considered as carefully as possible, after all, the lung tissue is not renewable, and repeated lung cutting will inevitably affect postoperative lung function. Those who are reluctant to operate can take a second place and choose radiofrequency ablation to solve multiple high-risk nodules.
In people with a history of malignancy, the possibility of lung metastases should be considered if multiple solid lung nodules are present. PET-CT is useful for judging metastatic nodules and their primary lesions and is of some value for the diagnosis and treatment of multiple lung nodules; in most cases, the increase of metastases can be significantly observed within 3 months.