The so-called pulmonary nodules refer to focal, round, increased-density solid or subsolid pulmonary shadows with a diameter less than or equal to 30 mm on imaging, without pulmonary Atelectasis, hilar lymphadenopathy, or pleural effusion.

A lung shadow larger than 3 cm is called a lung mass, and the probability of malignancy is 50%. For a mass larger than 3 cm, it is easier for us to characterize it, generally through the following methods:

1. If the mass is close to the bronchus, you can use bronchoscopy for biopsy or tracheal brushing for brushing. The accuracy of the examination is still very high. Once the pathology is confirmed as a tumor, there is no doubt; but for undiagnosed cases, It is necessary to consider whether there are false negatives caused by insufficient specimens or insufficient depth of the site. If these conditions are excluded and it is considered benign, diagnostic treatment or direct surgical resection can be given based on the results.

2. If the mass is close to the chest wall, we can use CT or ultrasound-guided puncture biopsy. The pathological specimens obtained can confirm the diagnosis and can also be sent for genetic testing to guide whether it is suitable for targeted therapy.

3. If the mass is located in the middle of the lung, and neither bronchoscopy nor puncture can obtain pathology, and if the mediastinal lymph nodes are swollen, we can perform puncture biopsy under the guidance of ultrasound bronchoscopy, and the biopsy can obtain The tissue is sent for pathological examination.

If there is no lymph node enlargement and the imaging results support the diagnosis of tumor, surgical resection can be used directly to achieve both the purpose of diagnosis and treatment.

As for pulmonary nodules, for larger nodules, if the diagnosis can be obtained through the above methods, treatment will be carried out according to the pathological results.

For smaller nodules, if pathological diagnosis cannot be obtained by the above methods, we can adopt the following methods for diagnosis and treatment:

1. Tiny nodules 5 mm; malignancy rate 1; of which Nodules smaller than 4mm are less likely to become malignant. A high-resolution CT examination is performed once a year to dynamically observe the changes in the nodule. If the nodule is significantly enlarged, a short-term review can be performed, and surgical resection can be selected based on the results. If there is no obvious change in a short period of time, you can continue to observe it. It has been reported that inert nodules can remain unchanged for more than 20 years and are eventually surgically removed. The pathology is bronchioloalveolar carcinoma. There is almost no effect on the therapeutic effect.

2. Small nodules 5-10 mm; malignancy rate 6 out of 28; among them, short-term dynamic observation is recommended for nodules 5-8 mm. If there are obvious changes in the nodules, surgical resection can be considered. If not, surgical resection can be considered. If there are obvious changes, the review time can be gradually extended. For 8-10mm nodules, if there are signs of malignancy, it is recommended to adopt more aggressive surgical treatment. If there are no signs of malignancy, it is recommended to continue observation. If it gradually decreases and dissipates, just perform a normal physical examination in the future.

3. Pulmonary nodules are 10-30 mm in diameter; the probability of lung cancer is about 10-20% if the diameter is 10-20 mm; the malignant rate is 30-40% if the diameter is 20 mm; in this case, if it can be done through bronchoscopy, CT or If a pathological diagnosis is obtained through ultrasonic puncture biopsy or ultrasonic bronchoscopy biopsy, treatment can be taken according to the diagnosis results. If a clear diagnosis cannot be obtained, the characteristics of the nodule can be examined based on imaging. If it can be basically concluded that it is benign, diagnostic treatment can be given first. If the possibility of malignancy is high, active surgical treatment is recommended.

For patients with masses accompanied by pleural effusion, if pathological diagnosis cannot be obtained, the pleural effusion can be extracted and exfoliated cells examined. However, the positive rate of this examination is low, about 20, and it is recommended to perform multiple examinations. Send for testing to increase the positivity rate.

Can PET-CT be used to diagnose lung cancer?

Here we tell you that the principle of PET-CT diagnosis of tumors is based on the ability of tumor cells to absorb a specific substance (2-fluoro-2-deoxy-D-glucose, usually referred to as 18F-FDG or FDG). But in fact, positive cases may also occur in tuberculosis and inflammation. Therefore, PET-CT can only determine the possibility that the mass is a tumor, but cannot accurately diagnose the nature of the mass.

Moreover, the guidelines for the diagnosis and treatment of pulmonary nodules also recommend that PET-CT has no obvious advantage for pure ground-glass nodules or mixed ground-glass nodules with solid components less than 8 mm; for solid components larger than 8 mm, PET-CT has no obvious advantage. It can be considered when benign and malignant nodules cannot be determined.

In conclusion, when discovering pulmonary nodules, you must pay more attention. Everyone is not alone. As long as you trust us, there will be a team to protect your lungs. Our Pulmonary Nodule Multidisciplinary Team (MDT) is here to help.

#生call令superpowergroup## The truth is coming## Is pulmonary nodule lung cancer#@ The fat man who wants to be a good doctor @神外医 Zhang Wei @ The Gazer among the Colorful Clouds