Is the discovery of a nodule on the lungs a sign of cancer? How far is a ground-glass nodule from lung cancer? How to correctly recognize a lung nodule and coexist peacefully with it?
In this issue, Cao Hanbo, deputy chief physician of the Department of Radiology of Zhejiang Provincial People's Hospital, is invited to explain pulmonary nodules in detail for you, and there is no need to talk about "grinding" discoloration.
01
How to tell
Benign and malignant pulmonary nodules
Clinically, most of the solid nodules in the lungs are benign, and the malignant nodules in the lungs are generally accompanied by some physical signs of malignancy.
For ground-glass nodules, Director Cao believes that there is no need to talk about "grinding" discoloration, and ground-glass nodules can be pathologically divided into four stages.
The first stage is dysplastic nodules, the second stage is adenocarcinoma in situ, the third stage is microinvasive adenocarcinoma, and the fourth stage is invasive adenocarcinoma.
Dysplastic nodules and adenocarcinoma in situ are prodromal lesions of the glands, and microinvasive adenocarcinoma is often referred to as "early-stage lung cancer" and invasive adenocarcinoma is referred to as "early-stage lung cancer".
Among them, more than 95% of dysplastic nodules and adenocarcinoma in situ will not progress within 5 to 10 years, and if surgery is intervened too early, it may cause overtreatment harm to patients.
Director Cao emphasized that carcinoma in situ is not equal to cancer, and malignant lung nodules generally refer to microinvasive adenocarcinoma and invasive adenocarcinoma.
02
Pulmonary nodules
Follow-up is key
Director Cao said that he has encountered some young patients who underwent lung nodule surgery prematurely, such as an 11-year-old patient with pulmonary nodules found to have bronchial adenoma after surgery, and another 10-year-old patient with lung nodules found to have carcinoma in situ after surgery.
These two types of lung nodules do not progress for 5 to 10 years, but early surgery may cause some adverse effects on their bodies.
Director Cao believes that it is very important to do a good job of follow-up for pulmonary nodules of different natures, and the following two principles should be followed:
1. Ensure the safety of patients
Ensuring the safety of patients is the premise and important criterion for the follow-up of patients with pulmonary nodules.
2. Minimize the number of re-examinations for patients
When pulmonary nodules are detected, they should be retested after 3 to 6 months, depending on the size of the pulmonary nodules, with a focus on excluding inflammatory nodules.
Follow-up after 3 to 6 months shows no significant change in the lung nodule and there is no significant risk of deterioration, and the annual review can be repeated every other year if there is no change.
The Fleischner guidelines in the United States mention that the longest re-examination interval for patients with pulmonary nodules can reach 2 to 4 years, and the domestic 2021 pulmonary nodule follow-up guidelines recommend that the re-examination interval for patients with pulmonary nodules should not exceed 2 years.
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