In what circumstances should pulmonary nodules be considered for surgery during follow-up? Others are secondary, the most important thing is to see changes

Pulmonary nodules are the heart disease of many people, because in most people’s cognition, seeing lung nodules is associated with lung cancer, and even think that even if it is not cancer now, will it develop in the future? for lung cancer. This is the source of everyone’s worry and anxiety. In fact, 95% of all lung nodules screened by chest CT are benign. Fewer than 5% of pulmonary nodules actually require surgery.

When a pulmonary nodule is first discovered, we usually recommend follow-up for the patient, and the duration of follow-up varies according to the risk of the nodule. The following conditions during follow-up suggest that the patient may consider surgery.

1. Enlarged nodules

Size is an important factor in evaluating benign and malignant nodules. Nodules within 5mm are called micronodules. If it is a solid micronodule, it is basically considered benign, especially Multiple solid micronodules. The probability of malignancy of a single microsolid nodule is extremely low, but attention should be paid if this single nodule gradually enlarges and exceeds 8 mm during the follow-up process.

Compared with solid nodules, the probability of malignancy of ground glass nodules is higher, but some of them are caused by inflammation, so those who find it for the first time can be reviewed for a period of time with anti-inflammatory treatment. Even if the ground glass nodules are malignant, the growth is extremely slow. This inert growth characteristic makes some of them remain unchanged in size for several years, but if the persistent ground glass nodules start to grow after a few years, it is necessary to Attention, more than 8mm, short-term follow-up or surgery can be considered.

2. The solid component of ground glass nodules increases

In addition to size, the density of ground-glass nodules is also an important factor in judging benign and malignant nodules. The above is a pure ground-glass nodule. At this time, the risk is relatively small, and follow-up can be continued. It may be adenomatous hyperplasia or carcinoma in situ stage.

When the intermediate density of the ground glass nodule increases, there is a real component, and during the follow-up process, the range of the solid component increases, at least it is a micro-invasive cancer, and surgery can be considered.

3. Thickening of blood vessels in the nodule

The thickened and stiff blood vessels directly extend into the pulmonary nodule, which is the basis for diagnosing the pulmonary nodule as a malignant tumor. “Ground glass plus abnormal blood vessel passage” can almost directly diagnose lung cancer. Not only that, if during follow-up, the thickening of blood vessels means that the tumor has infiltrated and needs to be surgically removed, so do not follow-up at this time.

4. Morphological changes of nodules

Generally speaking, benign nodules are round in shape with smooth borders. If the shape of a pulmonary nodule changes gradually during follow-up, be vigilant. For example, if a lobulation sign appears, it may be malignant. , at this time due to the uneven growth of tumor cells, resulting in the formation of lobulated signs. If the nodule is associated with malignant signs such as spicule sign, vascular cluster sign, vacuolar sign, and air bronchus sign, it is highly likely to be malignant and belongs to a high-risk nodule. Short-term follow-up or direct surgery may then be considered.