Will a "lung nodule" found during a physical examination turn into cancer? This type is mostly benign
2024-08-15
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In recent years,Pulmonary nodules"Suddenly appeared in many people's medical examination reports.Nodules, solid nodules, ground glass nodules... These words inevitably make people worry: Will it get worse? Do they need to be removed immediately?Some netizens on social media platforms have also discussed why so many people are diagnosed with lung nodules now, and whether it is related to the new coronavirus.InfectDoes it matter?Zhi Xiuyi, chief expert of thoracic surgery at Beijing Tsinghua Chang Gung Hospital and chairman of the Chinese Thoracic Surgery Lung Cancer AllianceZuo Jianxin, Director of Thoracic Surgery at the Air Force General HospitalThe Third Xiangya Hospital of Central South UniversityZhou Yan, deputy chief physician of respiratory departmentWhy are more and more people being diagnosed with lung nodules?
Compared with the past, the frequency of "pulmonary nodules" in physical examination reports has increased in recent years, which is mainly caused by the following factors:
Domestic and foreign data show that the first chestCT scanMore than 95% of the small lung nodules screened out are benign, but many are removed surgically. Currently, there is a phenomenon of over-diagnosis and treatment of small lung nodules in hospitals across the country.People with a smoking index of more than 400 (the calculation method of the smoking index is: the number of cigarettes smoked per day multiplied by the number of years of smoking), heavy smokers over 55 years old, and people with chronic lung diseases and long-term environmental and occupational exposure are included.Lung cancerHigh-risk groups need to undergo low-dose spiral therapy once a yearCTScreening: During the COVID-19 epidemic prevention and control, hospitalized patients and their accompanying family members need to undergo chest CT scans to screen for COVID-19.pneumoniaMany infected people are still worried about the impact on their lungs after they recover, so they go for check-ups, which greatly increases the amount of screening.In addition, AI-assisted detection has high sensitivity.Many county hospitals have been equipped with relevant software, and even small nodules smaller than 5 mm can be found.。After lung nodules are detected, many people think that "it is better to remove them than not to remove them". Some people do not understand small lung nodules and suspect that they are a precursor to lung cancer. Some patients are too worried and have follow-up examinations much more frequently than recommended by doctors.In 2021, the "Chinese Journal of Radiology" published an article stating that a chest CT scan once a year is sufficient. Frequent examinations may increase the risk of cancer and may also cause anxiety and other emotions to patients.First visit doctor experience
For thoracic surgeons, especially some primary care physicians or young general practitioners, they lack experience in diagnosis and treatment, or some hospitals fail to implement standardized management of the diagnosis and treatment of lung nodules, or increase performance evaluation indicators such as the number of related surgeries and outpatient visits. In addition, people with lung nodules are eager to undergo surgery to solve the problem. The combination of various factors has led to clinical overtreatment.Excessive surgical intervention for small pulmonary nodules has certain risks. On the one hand, surgery may be accompanied by local infection, postoperative pain, etc.complicationOn the other hand, some ground-glass nodules in the lungs are prone to occur in both lungs. If surgical intervention is performed too early without standardized review and observation, other problems may also arise.In addition, COVID-19 infection may induce infectious lung nodules. Some critically ill patients after COVID-19 infection, combined with mixed infections such as bacteria and fungi, may also induce small lung nodules.
Many lung nodules are "inflammatory"
InfectPathogensAfterwards, the bodyInflammatory responseIt can stimulate local tissues to produce nodular hyperplasia, such as granulomas, also known as "inflammatory nodules."Imaging reports often show "patch-like changes", "ground-glass density shadows" or "more regular shapes, smoother edges, and clearer boundaries", which can appear in the thyroid, pleura, lungs, lymph nodes, renal arteries and other parts.How are inflammatory nodules formed?
The most common inflammatory lung nodules are caused by acute and chronic minor lung infections caused by pathogens such as bacteria, viruses, fungi, mycoplasma, such as tuberculosis infection, new coronavirus infection, and allergic pneumonia.When immunity is low, upper respiratory tract pathogens can descend to the lungs and trigger an inflammatory response; acute and chronic pharyngitis, tonsillitis, rhinitis, sinusitis and other inflammations can also involve the lungs and cause lung nodules.Most of these nodules are benign and are less than 3 cm in diameter.Why do inflammatory nodules become smaller?
If it is an inflammatory nodule in the acute phase of infection, the nodule will shrink significantly or even disappear completely as the inflammatory response subsides, but larger nodules may remain for a long time.Therefore, if lung shadows or nodules are found after recovery from an infectious disease, they may be new inflammatory shadows. Observe them first and then decide on the next step of treatment.How to determine whether it is an inflammatory nodule?
Generally speaking, it is impossible to determine whether a lung nodule is inflammatory based solely on imaging findings. Clinically, anti-infection treatment is usually performed first. If the lesions or density decreases, it means that the anti-inflammatory treatment is effective and malignant lesions can almost be ruled out.Usually, after using antibiotics for about 10 days, inflammatory nodules may show a trend of shrinking. Once the inflammation disappears, the nodules are very likely to heal on their own, while malignant lung nodules often do not show obvious changes.It should be noted that even if it is only a benign nodule, it may leave permanent marks on the lungs, which is equivalent to a scar after recovery from the disease. In principle, it will not shrink or disappear over time and may accompany you for life.In addition, if it is a non-inflammatory nodule with combined infectious factors, it can be significantly reduced in size after treatment, but it is difficult to disappear completely.Look at 5 points to determine whether the nodule needs to be removed
Zhi Xiuyi said that many 3-5 mm micronodules may not actually change for many years and do not require immediate treatment.The clinical diagnosis and treatment of pulmonary nodules usually refers to the following factors:If the patient with lung nodules is a heavy smoker, has a history of exposure to asbestos or radioactive substances, is over 40 years old, or has a family history of lung cancer, etc., high attention should be paid.If the nodule diameter exceeds 8 mm, clinical intervention should be performed as appropriate.Generally, small solid nodules have the lowest chance of malignancy, while mixed ground glass nodules have a higher malignancy rate. Solid nodules larger than 8 mm and mixed ground glass nodules larger than 6 mm are both high-risk nodules and require regular review.If follow-up reveals irregular nodule margins, lobulation, spiculation, pleural traction, air-containing bronchioles and vesicles, or eccentric thick-walled cavities, clinical intervention should be considered.If the diameter of the nodule continues to increase, for example, it doubles within 30 days, you need to be highly vigilant.For people at high risk of lung cancer, such as first-degree relatives (parents, siblings) with a history of lung cancer, patients with a history of long-term heavy smoking, and patients with long-term exposure to carcinogens such as asbestos, radon, and uranium, the follow-up interval may be shorter. Please discuss the details with your attending physician.
Several types of nodules grow more slowly and usually do not require immediate intervention:- The first is an indolent nodule, which may develop into a malignant tumor in 10 to 20 years and is relatively rare in clinical practice.
- The second is carcinoma in situ, which has the characteristics of a benign lesion, develops very slowly, does not metastasize, and does not recur after resection, and is no longer classified as adenocarcinoma;
- Third, those that grow slowly, especially solid nodules, usually will not develop in the future if they do not change during the 2-year follow-up period.
Chen Haiquan, chief physician of the Department of Thoracic Surgery at the Fudan University Cancer Hospital, said:Most of the lung nodules that occur in smokers are solid lung nodules;Most of the lung nodules that occur in non-smokers are ground glass lung nodules.Solid lung nodules, if they meet the surgical indications, need to be surgically removed as soon as possible, because such solid lung nodules grow very quickly and may quickly turn into mid- to late-stage lung cancer within a year.70% of ground glass nodules develop very slowly, so there is no need to rush for surgery. Once "ground glass nodules" appear in the physical examination report, do not rush to "cut it off". Follow-up is the best policy.▲Editor of this issue: Zhang Yu
