With the popularity of CT tests, more and more people are found to have lung nodules during physical examinations, which also brings more and more confusion and anxiety, how to face lung nodules?
Zhejiang University Second Hospital Radiology Expert Outpatient Clinic patients are mainly lung nodules, the editor invited the deputy director of the Department of Radiology of the Second Hospital of Zhejiang University, Wang Lihua, deputy chief physician to chat with you about the common sense of lung nodules, from the perspective of radiologists and everyone to talk about those things about lung nodules.
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How do you know if you have a lung nodule
Need to do chest CT examination, it is recommended that people over 45 years old do low-dose high-resolution CT examination, Zhejiang Province is conventionally high-resolution CT, physical examination will use low radiation dose CT scan, close to one-third of the conventional dose, low-dose CT can meet the screening needs, do not worry about image quality.
The physical examination report will be sent to the mobile phone, convenient for everyone to inquire, what needs everyone to pay attention to is that no matter in which hospital to do the examination, it is best to keep their own digital images, the paper report sheet will have a two-dimensional code attached, WeChat scan can see their own images, do not need to bring film to the doctor.
How to interpret the report
See the report mentions pulmonary nodules, first do not panic, look at the size and density of the nodules:
Those under 3 cm are nodules, those under 1 cm are called small nodules, and those under 5 mm are called micronods.
A lump over 3 cm is called a lump, so pay more attention to it. According to the density, it is divided into pure ground glass nodules, partial solid nodules and solid nodules.
After seeing the nodule, it is not recommended to search on the Internet, everyone's situation is different, and what may be found is a very worrying result, which only increases anxiety. Sometimes the ground glass nodules mentioned in the report are fake, such as the image solid nodules with a thick layer of 5mm showing the density of ground glass, and some are screened by artificial intelligence software, which may be bronchial or vascular bifurcation or artifacts, and the results of different doctors interpreting the nodules are also biased. Therefore, it is necessary to find a professional doctor to evaluate the nature of the lung nodules.
How lung nodules are produced
Benign nodules
Why do I have lung nodules? Most benign nodules are due to trauma, inhalation of dust, foreign bodies, previous infections or scarring from tuberculosis.
Malignant nodules
Malignant nodules have some high-risk factors, such as family history of lung cancer or other malignant tumors, environmental factors, atmospheric pollution, long-term smoking and second-hand smoke exposure, long-term exposure to oil smoke, occupational exposure such as asbestos, radon, radioactive elements, etc. There are underlying lesions in the lungs such as emphysema, diffuse pulmonary fibrosis, tuberculosis, and pneumoconiosis.
Clinically, to exclude the factors of infection, such as the appearance of some symptoms of infection and abnormal laboratory indicators suggesting the possibility of infection, the relationship between the size density and morphology and the blood vessels and the surrounding manifestations solved from the image can help the doctor judge the possible nature of the nodule, of course, the final determination of the nature of the nodule depends on surgical pathology.
Which departments do you want to visit for your lung nodules?
Clinical departments related to pulmonary nodules include respiratory and critical care medicine, thoracic surgery, and radiology clinics, which have only been slowly recognized in the past decade, because there is a more professional interpretation and experience accumulation of imaging signs, and from the perspective of diagnosis, the opinions of radiologists are particularly important.
You don't need to bring film when you go to the clinic, and you can see it on the computer when you do the examination in our hospital, and you can even see the image of ten years ago.
If you do not do the examination in our own hospital, the doctor can query through the mutual recognition system, if the mutual recognition system does not have an image, you need to scan the two-dimensional code on the patient's report sheet to see the image, it is recommended to bring your own tablet or laptop, the image is opened to show the doctor.
Recently, due to the impact of the new crown epidemic, if patients cannot come to the hospital for face-to-face treatment, they can consult on the Zhejiang Second Internet Hospital of our hospital and upload their own report form QR code online.
How often the lung nodules are rechecked
After the outpatient visit, the doctor will tell you how long it takes to do another CT every other day, which is called follow-up. The spacing of follow-up depends on the nature of the nodule. Intensive short-term follow-up is not recommended, given the dose of CT radiation. Generally 3 months, 6 months, 12 months follow-up. CT examination is contraindicated during the 3 months of pregnancy.
The growth rate of the nodule determines the interval between follow-up visits, and the growth rate of the lung nodule is often used to evaluate the good and malignant of the lung nodules by volume doubling time (VDT), and the follow-up time is determined according to the volume multiplication time of the nodules:
Lesions enlarge rapidly within 30 days and should be considered for infection, inflammation, or lymphoma and some metastases.
More than 400 days suggests a possible benign tumor or inflammatory granulomatous after lung infection.
A 2-year absence of changes in solid lung nodules suggests benign.
Absorption becomes smaller during follow-up, it is basically determined that it is inflammation, and if it is stable and unchanged during follow-up, it can be followed up, and slowly enlarged nodules, accompanied by signs of malignancy, are recommended for surgical treatment.
Special emphasis is placed on follow-up visits, preferably for CT in the same hospital and on the same machine, and the image quality can be compared. Therefore, do not panic when you find a nodule, first determine the direction, and then follow up for observation.
Do you need an enhancement test?
Do pet-CT tests need to be done?
About Enhanced Checks
Ground glass nodules and solid nodule enhancement scans smaller than 8 mm are not visible in mediastinal windows, so an augmentation scan is not required unless an assessment of mediastinal lymphadenopathy is required.
About PET-CT examination
Positron emission computed tomography (PET-CT) is useful for determining metastatic nodules and their primary lesions, which in most cases increase within 3 months.
PET-CT has limitations in the judgment of multiple subnatural lung nodules. PET-CT is not recommended for ground glass nodules, and PET-CT examination is recommended for solid nodules greater than or equal to 8 mm and enlarged within 3 months.
≤ 1 cm of lung nodules to be treated
In the outpatient clinic, nodules with ≤ 1cm are the most common consultations for patients. Most are ground glass nodules, with a small percentage of solid and partial solid nodules, and often visited by respiratory and critical care or thoracic surgery clinics.
Pure ground glass nodules
Common single or multiple 6-8 mm pure ground glass nodules are not absorbed at the first 3 months of follow-up, and it is necessary to continue follow-up observation, such nodules grow slowly, often need to follow up for several years to grow, the average doubling time is about 3-4 years.
Even after diagnosis, the 5-year survival rate of stage IA1 lung cancer is 92%, and the 5-year survival rate of carcinoma in situ and micro-invasive carcinoma (stage 0 and IA1) can even reach 100%. Subsnerenza lung nodules include pure ground glass nodules, mixed ground glass nodules, mixed ground glass nodules: 40% to 50% are lung cancer, and the solid component often contains invasive adenocarcinoma. The likelihood of lung cancer increases as the diameter increases.
Solid nodules
The malignant proportion of solid nodules under 1 cm is about 2.2%, some nodules are judged according to their position, often belong to the lymph nodes in the lungs, and some of the multi-solid nodules are inflammatory, tuberculosis, and there is also the possibility of metastases, and malignant signs such as lobe burrs will appear in large malignant nodules.
It should be emphasized that some solid nodules, because different scanning models, different image quality sometimes have misjudgments, and it is necessary to make a comprehensive judgment based on whether there are vascular, pleural and adjacent structural changes and the evolution of signs in previous images.
Subjunctive nodules
Some subauricular nodules or false shrinkage may be due to partial volumetric effects, respiratory artifacts and other misjudgments, or need to continue follow-up without stopping observation.
The narrowing of the ground glass part of the nodule and the increase in the solid part are manifestations of progression and should be treated surgically as soon as possible. Biopsy is not recommended for ground glass nodules, and there is a risk of needle transfer if puncture is difficult.
What to do with multiple nodules
Regardless of density, it is recommended to assess the size density and signs of each nodule, select the dominant nodule or protruding lesion, the most risky and most likely cancerous nodule (not necessarily the largest nodule), and determine a follow-up or management strategy later in life.
Multiple solid nodules can be lung metastases, infectious granulomas (such as tuberculosis, fungi), non-infectious granulomas, etc., and multiple sub-solid nodules can be multiple primary lung cancer, infectious inflammation, non-infectious inflammation, etc. If the lesion does not significantly smaller, lighten, or absorb after the first 3-month follow-up, the possibility of multiple primary lung cancers should be considered.
The nature was determined, and what the long-term prognosis was
If surgery has identified lung cancer and removed the nodule, the prognosis for early lung cancer is good.
According to a 2021 study published in the Journal of Thoracic Oncology, long-term survival outcomes for adenocarcinoma in situ and microinvasive adenocarcinoma were evaluated: none of the patients had a recurrence during a follow-up period of up to 10 years. Some solid nodules have a better prognosis than a solid nodule, and the more ground glass components, the better the prognosis.
How to prevent lung nodules
Avoid smoking
First of all, avoid smoking, long-term smoking of second-hand smoke is one of the high risk factors, away from the smoking crowd, urge people around to quit smoking.
Occupational exposure
Second, get out of high-risk work environments and occupational exposures.
Habits of life
Maintain a good mood, actively exercise, regular work and rest, and eat a healthy diet.
Regular medical check-ups
It should be emphasized that regular physical examinations are carried out every year to prevent problems before they occur.
Multidisciplinary joint outpatient clinic for pulmonary nodules
Popular science expert
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Text | Department of Radiology Wang Lihua
Figure | Partly from the network
Audit | Chen Guozhong Wang Lihua
Editor-in-charge | Zhu Junjun