Source: The Second Affiliated Hospital of Xi’an Jiaotong University

What is a “pulmonary nodule”? How to find out?

Pulmonary nodules are nodular lesions on lung tissue. Clinically, lung lesions larger than 3 cm are called lung masses.

Pulmonary nodules are clinically defined as: round or irregular lesions with a diameter of less than or equal to 3 cm in lung tissue, imaging examinations (including chest fluoroscopy, chest X-ray, Chest CT, chest magnetic resonance MRI, PET-CT, etc.) manifested as shadows with increased density, surrounded by lung lesions surrounded by air-containing lung tissue, which could be single or multiple lesions with clear or unclear boundaries. There is generally no evidence of atelectasis, hilar enlargement, or pleural effusion.

Clinically, a solitary pulmonary nodule with a diameter greater than 1 cm and less than or equal to 3 cm The nodules are called typical solitary pulmonary nodules (SPNs); pulmonary nodules less than 1 cm are called small nodules, and nodules less than 5 mm are called micronodules.

Because the size of the nodule is closely related to the benign and malignant pulmonary nodule, the larger the diameter of the pulmonary nodule, the higher the malignancy rate, so the typical solitary pulmonary nodule (circle The clinical treatment of small nodules is more active, while the imaging appearance of small nodules is used to judge the benign and malignant, so as to decide the treatment strategy. For small nodules, especially pure ground glass nodules, due to the lack of specific markers for lung cancer, it is difficult to obtain clinical materials for biopsy, so regular observation of imaging changes is the main treatment strategy.

Therefore, once a pulmonary nodule is found in clinical work, it is necessary to identify the benign and malignant pulmonary nodule in order to guide further treatment. Pulmonary nodules are classified into three categories based on nodule density: solid nodules, partially solid nodules, and ground-glass nodules.

★ Ground-glass nodules are blurred nodules in the lungs. The nodule density is slightly higher than that of the surrounding lung parenchyma, but the outlines of blood vessels and bronchi are still visible.

★ A solid nodule is a nodule with soft tissue density in its entirety, and the density is relatively uniform.

★ Partially solid nodules refer to nodules that contain both ground-glass density and solid soft tissue density, and the density is uneven.

What exactly is a pulmonary nodule?

It is certain that pulmonary nodules are not normal lung tissues, but they are not necessarily lung tumors, especially small nodules. pulmonary nodules≠ lung cancer.

For example, pulmonary contusion and pulmonary inflammation caused by trauma can also manifest as ground glass nodules, and intrapulmonary lymph node hyperplasia or calcification can also manifest as solid nodules. Scarring of lung tissue after cure of pneumococcal disease, pneumonia, or tuberculosis can also appear as solid nodules, and, of course, benign lung tumors and lung cancers can also appear as pulmonary nodules.

Because pulmonary nodules mostly grow in the surrounding tissues of the lungs and are relatively small, they have no effect on lung function, and do not invade or oppress the bronchi. Patients generally do not have cough, shortness of breath, chest pain, or bloodshot sputum. Other clinical manifestations, the patient’s life is normal and not affected, so it is difficult to know whether he has pulmonary nodules.

Pulmonary nodules are mostly discovered by accident. In clinical practice, nodules in the lungs are sometimes found only by looking at other diseases or by physical examination. Therefore, physical examination is the main way to find pulmonary nodules. In recent years, due to the improvement of people’s living standards, the awareness of prevention has been popularized among the general public, and more and more people have taken active medical examinations. Since the epidemic of the new coronavirus in 2020, CT has been used as the main screening method for diagnosing the new coronavirus infection. , found a large number of pulmonary nodular lesions.

According to research, the probability of finding pulmonary nodules in routine chest fluoroscopy or chest X-ray examination is only 0.09% to 0.20%. The CT detection rate of pulmonary nodules was significantly increased, about 8% to 51%. In recent years, multi-slice spiral CT and low-dose CT scanning have been widely used in lung cancer screening. At present, artificial intelligence has also been applied to the diagnosis of pulmonary nodules, with a higher detection rate, but there are also many problems, such as false positives. Too high, further research is worth looking forward to.

Because low-dose CT is not yet popularized in clinical practice, multi-slice spiral CT is the main method to detect pulmonary nodules.

What is the significance of early detection of lung nodules?

Because pulmonary nodules are both benign and malignant, early detection of pulmonary nodules can lead to early diagnosis and early treatment of lung cancer. At present, the five-year survival rate after surgery for intermediate and advanced lung cancer is about 15%. According to research, the five-year survival rate for early-stage lung cancer is more than 60-90%, especially for small nodular lung cancer lesions found by screening. The survival rate is over 95%.

Therefore, if pulmonary nodule lesions are found, more early lung cancers can be screened, which is the “three early” of lung cancer, namely early detection, early diagnosis, early treatment, and improved treatment of lung cancer. The effect lays a solid foundation.

Review: Hu Haiyan

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