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If a pulmonary nodule is detected by physical examination, if it is larger than this diameter, attention should be paid to it, it may be a high-risk nodule

Time:2023-02-01 23:57:49 source:psychiatricethics.com author:Depression Read:466次
If a pulmonary nodule is detected by physical examination, if it is larger than this diameter, attention should be paid to it, it may be a high-risk nodule

As everyone pays attention to health, more and more people begin to have physical examinations every year. Although they do not usually feel any discomfort, the results of the physical examination are unexpected. Some people accidentally discover "pulmonary nodules" during the physical examination, because If you don't understand, don't know, you start to panic: what is a lung nodule? What should I do? Will it develop into lung cancer? Now Xiaohe Medical Dictionary will answer everyone's confusion.

What is a pulmonary nodule?

"Lung nodules" are focal, round or irregular shadows with increased density found in the lung tissue with a diameter of ≤3cm by X-ray or CT examination. In recent years, the detection rate of pulmonary nodules is getting higher and higher due to the more and more extensive clinical application of chest CT examination. According to the National Lung Cancer Screening Trial in the United States, the overall detection rate of pulmonary nodules in the high-risk population in the three rounds of screening is 24.2%; based on the screening of 14,506 randomised populations in Shanghai, my country, the detection rate of pulmonary nodules is 29.89%. When you see the "pulmonary nodules" on the medical report, don't panic. Most of the "pulmonary nodules" are benign. At the same time, it needs to be clear that: pulmonary nodules ≠ pulmonary sarcoidosis, and don't directly equate it. For lung cancer, pulmonary nodules are only one of the lung manifestations seen through imaging, and many lung diseases may appear as pulmonary nodules when they develop to a certain stage. Therefore, there are many possibilities for "pulmonary nodules" detected by physical examination: it may not be a tumor at all, it may be a benign tumor, and there is a certain probability that it is a malignant tumor. As for whether this pulmonary nodule is good or bad, whether it needs to be removed, and whether it will develop into lung cancer, doctors need to evaluate it based on clinical information and imaging. Relevant examinations such as surgery or surgical biopsy can be confirmed.

What do the descriptions on the medical report represent?

When we get the chest CT report, we are often at a loss because we can only understand the pulmonary nodules at the conclusion. In fact, in imaging, the characteristics of pulmonary nodules are mainly described by "location\number\size\nodule density". Quantitative description:
  • Solo pulmonary nodule: generally refers to a single pulmonary nodule;
  • Multiple pulmonary nodules: Two or more pulmonary nodules were defined as multiple pulmonary nodules.
Described by largest diameter:
  • Micro nodules: diameter <5 mm, malignant probability <1%;
  • Small nodules: 5~10 mm in diameter, with a malignant probability of 6%~28%;
  • Nodules: 10~30 mm in diameter, with a malignant probability of 6%~28%; is 33%~60%.
Described by nodule density: Pulmonary nodules are divided into solid pulmonary nodules and subsolid pulmonary nodules. Subsolid pulmonary nodules can be further divided into pure ground glass nodules and partially solid nodules.
  • Solid nodules: refers to nodules with density of all soft tissues, the density is relatively uniform, and the images of blood vessels and bronchi are covered;
  • Ground-glass nodule: refers to the indistinct nodule in the lung, the density of the nodule is slightly higher than that of the surrounding lung parenchyma, but the outlines of blood vessels and bronchi are still visible;
  • Partially solid nodules: Refers to nodules that contain both ground-glass density and solid soft tissue density, with uneven density. It has the highest probability of malignancy.
Source: TuCong Creative

What kind of lung nodules should be paid attention to?

Generally speaking, benign pulmonary nodules are more uniform in density, with smooth edges and insignificant lobulation notch, and calcification features may appear; while malignant pulmonary nodules are often inhomogeneous in density, with blurred edges, and often have burr signs, spiculations, and Malignant signs such as leaf sign, vacuole sign, vascular cluster sign and pleural depression sign. If a pulmonary nodule has the following characteristics, it is necessary to be alert to the possibility of malignancy:
  • Look at the size of the nodule
If the maximum diameter of the nodule is ≥8mm, It may be a high-risk nodule, and it should be paid attention to.
  • Look at the density of the nodule
If the density is not uniform, or it is ground-glass-like, especially the ground-glass nodule with a solid component, May be malignant.
  • Look at the edge of the nodule
The nodule is not smooth, with a crab-like "burr mark" around it, or there are many rounded borders The "lobulated sign" may be a malignant nodule.

What should I do if a lung nodule is accidentally discovered during a physical examination?

If a pulmonary nodule is found in the physical examination, do not panic or ignore it, but should go to the hospital for diagnosis by a doctor. Departments that can be selected for treatment are: respiratory medicine, thoracic surgery, oncology, etc. For pulmonary nodules accidentally discovered during the physical examination, the most important thing is to do "regular follow-up", and check regularly according to the doctor's advice.
  • If a pulmonary nodule cannot be clearly diagnosed, the changes of the nodule can be observed in about 3 months.
  • Pure ground glass nodules have a good prognosis, and regular follow-up can be maintained if there is no significant change.
  • Some mixed ground-glass nodules with no obvious changes after observation can be reviewed and followed up every year without special treatment.
  • For nodules with early malignant morphological changes such as enlargement, solidification and burr sign, it is up to the doctor to decide whether to implement surgery or other treatment .
In addition, there are errors in the measurement of nodules. Different doctors, different hospitals, and instruments with different degrees of precision may produce significantly different results. Therefore, the re-examination of pulmonary nodules is best fixed. In the same hospital, the same machine is used for examination, if the growth exceeds 2mm, it can be regarded as growth. Photo source: TuCong Creative finally reminds everyone that if lung nodules are found in the physical examination, then the following points should be paid attention to in life:
  • Be sure to quit smoking and stay away from kitchen fumes and smog and air pollution.
  • Do a good job of occupational protection and avoid industrial dust.
  • Stay happy.
  • Do moderate exercise.
In short, when you are told that you have pulmonary nodules, all you need to do is to pay attention and not be nervous, respond scientifically, and cooperate with the doctor for examination and treatment.
References: [1] Wu Bin, Ma Jun, Shi Hongcan. Research progress in the early diagnosis of benign and malignant pulmonary nodules [J] . International Journal of Surgery, 2020,47 (07): 484-488.[2] Chen Bojiang , Li Weimin, Liu Dan, et al. Establishment and thinking of the whole-process management model for pulmonary nodules in healthy people during physical examination [J]. Chinese Journal of Health Management, 2020,14 (03): 208-212.[3] Au-Yong I T H, Hamilton W, Rawlinson J, et al. Pulmonary nodules[J]. British Medical Journal Chinese Edition, 2021, 24(4): 231-237.[4] Lung Cancer Group, Chinese Society of Respiratory Medicine, China Lung Cancer Prevention and Control Alliance Expert group. Chinese expert consensus on the diagnosis and treatment of pulmonary nodules (2018 edition)[J] . Chinese Journal of Tuberculosis and Respiratory Medicine, 2018, 41 (10): 763-771. [5] The latest progress in the diagnosis of pulmonary nodules[J] . Chinese Journal of Surgery, 2022, 60(5) : 498-503.[6] MacMahon H, Naidich DP, Goo JM, et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017 [J] . Radiology. 284 (1): 228–243. Medical editor: Xue Hong Content curation: Duffy Medical review: Zhao Min

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