Good doctor | Removing 5 lung nodules and growing another? How to deal with multiple pulmonary nodules

Professor Zhong Hua’s team summarized the clinical experience in the diagnosis and treatment of multiple pulmonary nodules, and formed the “Review of the Diagnosis and Treatment of Multiple Pulmonary Nodules”.

Text | Zhou Jie

“I have already cut off 5 nodules, and the doctor said that now I have 1 more nodules. Should I cut off all my lungs? What should I do…” Xu, in his early 40s The lady desperately asked the doctors of the “Multiple Lung Nodules MDT” team in Shanghai Chest Hospital.

Ms. Xu discovered multiple nodules in both lungs in 2018. At that time, 5 nodules in the upper and lower lobes of the left lung were surgically removed. I thought I could be relieved now, but I didn’t expect that during the follow-up visit last year, the doctor said that another nodule had grown in her right lung. Should I cut off all the remaining lungs? When she was desperate, Ms. Xu found the “MDT” team of the Chest Hospital “Multiple Lung Nodules”.

The “MDT with Multiple Lung Nodules” diagnosis and treatment team led by Professor Zhong Hua, Director of the Department of Respiratory Medicine, brought together elite backbones from the Department of Respiratory Medicine, Thoracic Surgery, Radiotherapy, and Radiology. After various reports, experts believe that the new nodules are high-risk lesions and require intervention. However, considering that the patient had already undergone an operation, this time the location of the lesion was deep, and the trauma of the operation was very large. After a comprehensive judgment, the respiratory medicine team finally performed ablation of the pulmonary nodule for Ms. Xu, with minimal trauma. , accurately eliminated the right lung lesion, and also eliminated Ms. Xu’s “heart knot”.

Internationally, lung cancer is the second most common cancer in both men and women, after prostate cancer and breast cancer, respectively. With the development and popularization of CT screening technology, the number of patients with multiple pulmonary nodules is increasing. In this context, it is inevitable to talk about the discoloration of “pulmonary nodules”.

Multiple nodules in the lungs refer to the presence of two or more lesions in the lungs with a diameter of less than or equal to 3cm, which often appear as several nodules with ground-glass opacities on imaging. According to the latest statistics from the Shanghai Chest Hospital, patients with multiple nodules in both lungs account for 18% of the total number of patients with pulmonary nodules.

Source: Oriental ic

For multiple pulmonary nodules, many patients are full of confusion: which department should they see? Should it be surgically removed? Do you have to cut one off when you find one?

For these patients, the Chest Hospital has formed a number of clinical-research-clinical multidisciplinary models (MDTs), of which “multiple nodules in the lungs” are one of the most distinctive features. item. Since its establishment, the “MDT with Multiple Lung Nodules” diagnosis and treatment team has treated more than 200 patients with difficult multiple pulmonary nodules. Each patient’s plan is “privately customized”, and the one-stop diagnosis and treatment service allows patients to go from “bewildered” to “safe and secure”.

“Whether multiple nodules should be intervened, whether it is worthwhile to do surgical intervention, the risk of each nodule needs to be identified one by one, some are benign or in the ‘budding’ state, only Regular follow-up and observation is required. However, those that have grown and deteriorated need immediate treatment. According to the different conditions of the lesions, further treatment is carried out through various methods such as surgery, local ablation, radiotherapy and chemotherapy, and targeted therapy.” Zhong Professor Hua introduced.

Yao Feng, deputy director of thoracic surgery, is also a core member of the MDT team. As a surgeon, he often advises patients to “don’t rush surgery.”

“The increased detection rate of nodules makes many patients feel anxious and think that they have tumors. In fact, there are very few patients with problems. Many patients with ground glass nodules do not need surgery. Follow-up observation is enough.” Yao Feng told reporters that sometimes the psychological anxiety of patients has a greater impact than the tumor itself, and MDT diagnosis and treatment allows surgeons and physicians to join forces to give patients a more scientific and rigorous treatment plan. “On the one hand, doctors from multiple disciplines avoid the need for patients to travel to multiple departments and solve problems in one stop; on the other hand, the results of multidisciplinary consultations are often authoritative, and patients have more options for treatment.”

Through the consultation and treatment of more than 200 patients, the team also reached some consensus rules: First, the focus of treatment should be on high-risk nodules, and surgical treatment is recommended for high-risk nodules , if other nodules can be taken into account, try to solve it with one operation; if the patient has had previous operations, or has poor heart and lung function, and has concerns about surgery, then ablation, radiotherapy and other treatment methods can be used for treatment.

The team encountered a patient with multiple nodules. After evaluation, there was a nodule that needed to be removed. The pathological result was a malignant tumor. Targeted drugs have been used to treat them, and good results have also been achieved.

The clinical diagnosis and treatment of multiple pulmonary nodules is difficult, and there is still a lack of unified diagnosis and treatment standards. In this regard, Professor Zhong Hua’s team summed up the clinical experience in the diagnosis and treatment of multiple pulmonary nodules, and formed the “Review on the Diagnosis and Treatment of Multiple Pulmonary Nodules”, which was published in the “Chinese Journal of Oncology”, in order to share with the national pulmonary nodules. Colleagues in the field of multiple nodules shared discussions.

In addition, Professor Zhong Hua also pointed out that MDT has solved some of the problems, but among the more than 200 patients, there are also problems that the team cannot solve, which is the “soil problem”. “Medicine has always been a subject that is advancing in exploration. A clinical study on ‘the efficacy and safety of PD-1/CTLA-4 dual anti-AK104 in the treatment of ground-glass nodules in patients with early-stage multiple primary lung cancer’. Multiple primary early-stage lung cancer opens up new treatment avenues”.

It is understood that this research has been listed as the second round of the “Three-Year Action Plan for Promoting Clinical Skills and Clinical Innovation in Municipal Hospitals (2022-2024)” by the Shanghai Shenkang Hospital Development Center. Special project for the transformation of enterprise integration innovation achievements.