“The first time I did a chest CT for a physical examination at my work unit, I discovered the first lung nodule in my life.” “It is said that the ‘three-piece set’ of nodules (pulmonary nodules, thyroid nodules, and breast nodules) is common in the workplace. Standard, nodules are very common, don’t pay too much attention to it, right?”… At the end of the year and the beginning of the year, various hospitals ushered in a period of intensive physical examinations. Many people were very anxious and nervous when they saw the word pulmonary nodules in the physical examination report; some people Thinking that pulmonary nodules are becoming more and more common, they don’t care about it.
Recently, the news that a 29-year-old woman had pulmonary nodules and was subsequently diagnosed with lung cancer has become a hot topic, which has caused many people to discuss the importance of early detection and treatment of pulmonary nodules. So, what are pulmonary nodules? What to do after pulmonary nodules are detected? Focusing on the issues that everyone is concerned about, the reporter interviewed Professor Liu Jun, Director of the Radiology Department of the Second Xiangya Hospital of Central South University, and the team of Associate Researcher Zhao Wei.
The risk of malignancy in pulmonary nodules is proportional to size
“With the continuous advancement of medical imaging technology, especially the application of high-resolution CT, doctors can observe lung tissue more precisely. In the past, small nodules of one or two millimeters were easy to hide, but now they can be seen clearly.” Zhao Wei Introduction: With the improvement of health awareness, more and more people are aware of the importance of physical examination, and physical examination usually includes imaging examination of the lungs, which gradually increases the detection rate of pulmonary nodules.
Pulmonary nodules are not only common among middle-aged and elderly people, but also among young people. According to the “2022 Annual Health Examination Big Data Blue Book”, about 54% of the population has pulmonary nodules. As age increases, the prevalence of pulmonary nodules is gradually increasing.
What exactly are pulmonary nodules? In fact, pulmonary nodules are not the name of the disease, but an imaging term. Pulmonary nodules refer to high-density lesions with a diameter of ≤3 cm found on lung images. Their shapes are approximately round, oval, or irregular, and their borders may be clear or unclear. It can be single shot or multiple shot. If the diameter is ?3 cm, it cannot be called a nodule, but a mass.
There are two main types of pulmonary nodules: benign and malignant. Authoritative research shows that 95% of pulmonary nodules are benign, especially nodules less than 10 mm in diameter. For small nodules less than 6 mm in diameter, the cancer risk is less than 1%; for solid nodules 6 to 8 mm in diameter, the cancer risk is between 0.5% and 2%; for nodules greater than 8 mm in diameter, the cancer risk is approximately is 3%.
Most lung nodules will not go away on their own
It can be found from the physical examination report that there are three places in the human body that are prone to nodules, namely the lungs, thyroid and breasts. Among them, the lungs inhale air from the outside and are in close contact with the outside world. Inflammation, tuberculosis, tumors, connective tissue diseases, and pulmonary thromboembolism caused by infectious or non-infectious factors may be the main causes of pulmonary nodules.
Some lifestyle and environmental factors may also be related to the incidence of lung diseases, thereby indirectly affecting the formation of pulmonary nodules, such as smoking, air pollution, and occupational exposure.
In the clinic, people often ask whether pulmonary nodules will disappear? Some lung nodules may disappear on their own over a period of time, especially benign nodules caused by infection or inflammation. However, this situation is relatively rare, and most pulmonary nodules are stable and will not disappear on their own. Therefore, regular follow-up is necessary after pulmonary nodules are discovered.
Zhao Wei said that if pulmonary nodules are found during examination, there is no need to panic because most pulmonary nodules are benign and there is no need to worry too much. It is recommended to consult a clinician for a comprehensive evaluation. The doctor will develop a diagnosis and treatment plan based on the size, shape, location and other characteristics of the nodule.
Be wary of such nodules in CT reports
In the CT report, which nodules require high vigilance? CT reports are mainly classified according to the nature and characteristics of pulmonary nodules, which are generally divided into ground-glass nodules (including pure ground-glass nodules and mixed ground-glass nodules) and solid nodules. Ground-glass nodules discovered by physical examination are malignant. The possibility is relatively high, so we should pay special attention to it because some of them are early-stage lung cancer.
Zhao Wei introduced that ground glass nodules generally require regular follow-up to determine their nature. Although the probability of malignancy of ground-glass nodules is relatively higher than that of solid nodules, most ground-glass nodules grow inertly and may not change much during long-term follow-up. At the same time, there are also inflammatory nodules that appear as ground-glass nodules, which may disappear during short-term follow-up. Therefore, there is no need to be overly anxious when finding ground glass nodules, just consult a professional doctor for evaluation.
To determine whether a pulmonary nodule is benign or malignant, a series of examinations and evaluations are usually required, including: ① Imaging examination: CT scan is the most commonly used imaging examination, which can provide information about the size, shape, edge characteristics, and Density and other information. PET-CT scans can also provide information about nodule activity. X-rays give priority to the ability to observe details of nodules. MRI examinations have certain value in distinguishing benign and malignant nodules. ②Pathological examination: Histopathological examination after puncture biopsy or surgical resection is the gold standard for judging the nature of the nodule. ③Clinical evaluation: The doctor will consider the patient’s tumor history, smoking history, symptoms and other information to help determine the nature of the nodule.
Doctors will have different treatment plans for different types of lung nodules. Most benign nodules do not require treatment, and changes in the nodules can be monitored with regular follow-up visits. Some nodules may require surgery or other treatments, depending on the type of nodule and the patient’s medical history.
Usually, these nodules tend to be observed progressively: 1. The nodules are small, with a diameter of less than 6 mm; 2. The nodules are regular in shape and have smooth edges; 3. Low risk factors, the patient has no smoking history or a short smoking history; 4. .The nodules show typical benign features on imaging.
Treatment for malignant nodules usually includes surgical resection, ablation therapy, radiotherapy, chemotherapy, targeted therapy, etc. The specific treatment plan will be determined based on the type and stage of the cancer, the patient’s overall health status and other factors.
Why do some women get lung cancer even if they don’t smoke?
It is said that smoking can easily lead to lung cancer. Why do some people never get lung cancer after smoking all their lives, while some women get lung cancer even if they don’t smoke? In this regard, Liu Jun explained that smoking is one of the main risk factors for lung cancer. However, the incidence of lung cancer is not only caused by smoking, but also related to factors such as genetics, occupational exposure, carcinogen exposure, lifestyle, and immune system. For some non-smoking lung cancer patients, their lung cancer may be related to second-hand smoke and kitchen fume inhalation.
In addition, not all lung cancer presents as pulmonary nodules, and the manifestations of lung cancer vary depending on the type and individual differences. Some lung cancers do not necessarily manifest as pulmonary nodules, such as scar cancer, pneumonia-type lung cancer, cystic lung cancer, etc.
Who needs early screening for pulmonary nodules? Early screening is mainly targeted at people who are at risk of the disease, including: smokers or former smokers; people with family genetic history; people who have been exposed to carcinogens for a long time; patients who have suffered from lung cancer or other related cancers in the past; and older people; Individuals with chronic respiratory disease (such as chronic obstructive pulmonary disease) or immune system disease.
At the same time, by grading the risk of the target population, it is clinically recommended to conduct low-dose CT examinations for high-risk groups. The inclusion criteria for the high-risk group include people aged ≥50 years and those with a smoking history of ≥20 packs/year.
Main causes of pulmonary nodules
infection and inflammation
Can pulmonary nodules be prevented?
There is no specific way to completely prevent the development of lung nodules, but the following steps can reduce your risk
quit smoking or avoid smoking
Build a healthy lifestyle
Avoid inhalation of harmful substances
Regular physical examination
These factors may increase the risk of malignant transformation of pulmonary nodules
2. Long-term exposure to harmful substances
3. Family inheritance
4. Patients with other chronic lung diseases, such as chronic obstructive pulmonary disease and tuberculosis, may have nodules that are more susceptible to malignant transformation.