Why is the intraoperative frozen pathology different from the postoperative gross pathology?
Answer: The composition of nodules is not homogeneous, there are both atypical hyperplasia and cancerous cells. 30 minutes of intraoperative frozen section is like drawing one out of ten peasants to be a soldier, commonly known as pulling a strong man, which is not guaranteed to be diagnosed as atypical hyperplasia or carcinoma in situ.
Why can’t puncture biopsy guarantee accurate pathological results?
Answer: If you are lucky, the puncture needle will find a cluster of tumor cells and it will be lung cancer, but if you are unlucky, it will find a pile of necrotic tissue and the pathologist will not be able to tell the difference.
When should I use a locator needle to mark a nodule?
A: A marksman can point to any nodule. 5-6mm diameter micro-nodules are not easy to be found by surgeons, so it is not a good idea for doctors to point to any nodule, and it is indescribable that the surgeon in charge is in a hurry. In fact, the preoperative CT-guided placement of a hook to mark the nodule, surgery can be wedge-shaped cut out the lesion area, less invasive, short, intraoperative pathology results quickly, most of the surgeons who have done this needle surgical marker will be addicted, commonly known as “hook doctor”.
Does the size of the nodule help in the diagnosis?
A: In fact, there are no two nodules in the world exactly the same, each nodule is a test of ice and fire for doctors, patients say they have trouble sleeping and eating, doctors are not in deep water, the more expensive doctors are prone to heart attack, the real ones must have a way to solve their own psychological problems, but for some patients who are torn, we are still willing to give professional statistical probability answer, the diameter of lung cancer less than 5 mm The probability of lung cancer is 0.6%; 5-10 mm lung cancer is 0.9%~5.8%; ≥10 mm lung cancer is 11.1%~26.2%.
Is there age and gender discrimination in lung cancer?
A: Men and women are equal, in China, sensible women aged 30-50 years old are affected by early stage lung cancer, and CT examination plays a key role in helping sisters to get rid of the pain, most patients can be completely cured, and 70% of patients do not need chemotherapy; correspondingly, men aged 60-80 years old who smoke are affected by advanced squamous lung cancer, the results are not optimistic, and the average life expectancy of 3 years makes both doctors and patients unhappy, The symbolic meaning of chemotherapy, radiotherapy and surgery is more than the actual value.
Are nodules below 5mm lung cancer?
A: Difficult brother or sister, affected by ground glass nodules, many substantial nodules are also found in healthy people during physical examination, usually located within 2cm below the pleura, triangular, rectangular, polygonal, irregular, like a kite, and often trailing a thin thread-like tail, all this does not matter because they are benign.
Does CT kill blood cells?
A: Flawed, there are individual patients whose body is sensitive to the rays, there will be a decrease in red blood cells or white blood cells after CT, usually two weeks recheck will return some, and after a year should be fully recovered.
Why is the expert opinion inconsistent?
The key is that it is not very good to distinguish these two diseases that can only be diagnosed under the microscope on CT. One of the criteria is whether the density is uniform, and the second is whether there are tumor vessels, and these two points are generally recognized at a higher level in radiology than in thoracic surgery. Therefore, the ordinary thickness CT images are like chicken ribs to the experts, and the fundamental reason is that they are not clearly seen, just like myopia without glasses to watch TV subtitles, thin layer CT is equivalent to the role of glasses, three-dimensional imaging is three-dimensional glasses, so the best experts to see thin layer, three-dimensional images to ensure the closest to the truth.
Is PET-CT useful to confirm the diagnosis of ground glass?
A: It is not useless. For substantial nodules larger than 7mm, the benignity and malignancy can be deduced by measuring the SUV value. The results of one study showed that the SUV of lung cancer tissue was 5.63±2.38 and the SUV of benign lung lesions was 0.56±0.27, with a significant difference between the two (P<0.001< font="">), but there are also a small number of benign lesions (such as active tuberculosis, the Acute inflammation, etc.) showed high uptake of 18F-FDG and radioconcentration shadowing; it is not significant for pure or mixed density ground glass, but it is good for preoperative understanding of the presence of lymph node metastases, brain metastases, and bone metastases.
How to prevent getting the disease again after surgery?
A: Balanced internal and external, find a Chinese medicine doctor to adjust the body, the disease must be related to their own internal environment and the external environment, the external environment can not change the Hu case, appropriate to establish healthy habits and life rules, enhance their own immunity is very important. In addition, the possibility of getting sick again is very small, clinically not seen after surgery to add new glass grinding.
Why do doctors want thin layer CT?
A: Thousands of different, gold standard is CD-ROM (U disk, mailbox) burned into DICOM lossless format, this can be MPR two-dimensional, three-dimensional reconstruction, the good doctor will come with a film viewing software, the Internet can also download a free software (EASYDICOM software, RadiAnt DICOM Viewer software); silver standard is engraved into JPG picture format, can only enlarge, the Can not be processed; copper standard is the film with lesions on the magnified image, reconstruction of the image; iron standard is the lesions condensed to the postage stamp size film, the doctor is equipped with a magnifying glass; paper standard is not printed on the film lesions, grinding glass exists in the hospital computer system, for example, shot a 1mm thin layer of flat CT, the print out is 1cm layer thickness, no doubt this kind of film can not see anything at all, even if there is a display nodules, but also Even if the nodules are shown, there is no way to see their shape.
How do I burn the disk or get the film?
A: You should try your best to take photos with your cell phone against the doctor’s computer screen; ask for help from a small doctor; consult with the director; communicate with the medical office; call the mayor’s hotline; you should never give up on a matter of life and death.
Does a woman’s period affect the surgery?
A: Poor planning, individual patients had to stay for a week in vain when unexpected old friends came during hospitalization, especially patients who refused to use hormones to change their periodical cycle had to wait dry.
Is CT positioning anesthesia?
A: Fixed-point removal, CT positioning is like doing a normal CT, completely in the awake state, but first numbing the back of the shoulder, keeping a certain posture still, and the doctor sticks a very long needle into the skin, no pain. It is only after positioning that you are asked to hold this position and be pushed to the operating room, sometimes the journey in between is a bit long.
Are all inpatient packages mandatory?
A: Be careful, it is customary to undergo a long list of tests after admission, including re-take of lung CT, head enhancement MRI, ECT whole body bone scan, bronchoscopy, blood sampling and laboratory tests, etc. Although the vast majority of patients have negative test results, it is still advisable to check in case any of the indicators suggest metastasis, the surgery will not be necessary.
How soon can I return to normal life after surgery?
A: as fast as a lightning, the day of discharge from the drainage tube can take a plane, the current record is 3 hours sailing without problems, however, the airport staff need the hospital to issue a certificate of safe travel, the official will not issue this document, you can let the doctor SMS or telephone proof; a week after discharge can go to work, engaged in light physical activity, there will be chest tightness, cough, shortness of breath; a month, you can play badminton, but for safety reasons, it is recommended that the amount of exercise is discounted.
Is the surgical treatment for small lung nodules the same?
A: A hundred and one. First, without specific localization, there are 5 lobes including the upper, middle and lower lobes of the right lung and the upper and lower lobes of the left lung in regular people, and 1/5 is removed when the whole lobe is removed, i.e. 80% is retained; second, segmental resection, the 5 lobes in regular people can be further subdivided into 18 lung segments; third, subsegmental or wedge resection, where a small part of lung tissue centered on the lesion is removed under the guidance of a localization needle.
Can a blood test diagnose lung cancer?
Answer:Not very reliable, there are no directly relevant specific markers for lung cancer, such as carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cancer antigens (CA50, CA125, CA153, CA199, CA211, CA749), squamous epithelial cell carcinoma-associated antigen (SCC), TPA (tissue peptide antigen), gastrin-releasing peptide precursor (ProGRP), and serum iron. ProGRP), serum ferritin (SF), lung cancer-associated antigen (LTA), etc. are not specific. If the physical examination reveals a slight increase in the above indexes, it is recommended to retest them in a different hospital after a month, and an increase of more than 10 times has a reference value.
Why do I need to do CT for postoperative follow-up?
A: Self-indulgence, 1 month postoperative follow-up is because the doctor wants to know whether there are any postoperative complications, such as pneumothorax, missed lesions, etc.; 3 months follow-up is to observe whether the suture healing in the surgical area is intact, such as recording the size of inflammatory granuloma around the suture, to prove for future follow-up to exclude metastases; 6 months follow-up is to show off the surgical technique, to demonstrate the fast recovery and the beautiful opening of this incision; 9-12 months Follow-up at 9-12 months can help rule out metastases or recurrence, as PET-CT often mistakes granulomas in the surgical area for metastases, and it is not good to be rich.
Is there a big difference between multiple nodules and isolated nodules?
A: Individually and collectively, the evolution pattern of each node in multiple nodules is the same, and there is no difference with isolated nodules; multiple nodules are not associated with each other and do not interact with each other; multiple metastases basically show substantial nodal density, and multiple ground glass nodules are basically primary foci in the lung; physicians need to analyze each node independently based on the characteristics of the nodes, determine the nature one by one, and consider malignancy as the first choice Minimally invasive surgery, digging out each of the 7 nodules one by one is a routine procedure in specialty hospitals, even if the nodules grow in the left and right lungs respectively.
What is the most prudent step to take before surgery for a ground glass nodule?
A: Heteropathy with the same shadow, anti-inflammatory treatment for 1-2 weeks, rest for 2 weeks, and review a thin CT after a cumulative interval of one month, because a few inflammation looks similar to ground glass, the only distinguishing feature is the morphology, the edge is blurred is more chance of inflammation, need to distinguish carefully, if it can be reduced, it is recommended to review the CT again after 2 months of herbal anti-inflammation.
Are families with bad genetics prone to develop the disease?
A: Dragon gives birth to dragon, phoenix gives birth to phoenix, regardless of the maternal and paternal families have several cancer, it has nothing to do with lung glass grinding and lung cancer; it has to do with environment and gene mutation.
How old is grinding glass?
A: No one knows how long it takes from seeding to maturity. Doctors only see a little bit of growth every year, even if it is 1mm/year, it takes 8 years for doctors to find 8mm nodules, during which they live in peace and coexist peacefully. The cancers that are hotly debated to grow twice as big in half a year are not ground glass nodules.
What is 3D reconstruction?
A: Jigsaw puzzle – building blocks – Transformers. The image obtained from conventional CT scan is a jigsaw puzzle composed of countless tiny cubic pixels; MPR two-dimensional multi-planar reconstruction is based on the above basic pixels, re-piecing out the coronal, sagittal and arbitrary oblique building blocks, which is the main basis of radiology diagnosis; three-dimensional reconstruction is equal to three-dimensional spheroid, equivalent to Transformers, which is to keep the surface pixels of ground glass nodules It is suitable for explaining to clinicians and patients’ families.
What if surgeons are unwilling to do small nodules?
A: Willing to gamble, one is too small to be easily found, once the surgeon enters the chest cavity through thoracoscope, the lung deflates like a balloon leaking, the naked eye can’t distinguish where the ground glass is, especially for nodes less than 8mm; two, if it can’t be found how to deal with it later, it is troublesome, the surgeon can only follow the feeling and remove the whole segment along the anatomical structure to make sure it won’t be missed. So there must be a gentleman’s agreement in advance, 30 minutes intraoperative frozen section for diagnosis of atypical hyperplasia local cut, diagnosis of carcinoma in situ segment cut, diagnosis of adenocarcinoma lobe cut; in order to prevent not finding it, preoperative CT pilot localization; if unfortunately not found, deal with it according to AAH atypical hyperplasia, review CT before discharge to see if the ground glass is still there, and if it is still there after surgery, directly open a second lobe cut.
Why are nodes easy for middle-aged women?
A: Women entangled into knots, women enter middle age, busy, strenuous work, and do not see the sun (few outdoor activities), lack of exercise (including not getting out of the kitchen), sleep late, under the influence of estrogen in the body, breast, uterus, thyroid, lung nodules at the same time, of which, the vast majority are atypical hyperplastic nodules. Slowing down the pace and increasing outdoor activities, especially under the sun, is not only good for the lungs, but also for the prevention and control of breast diseases (sisters, this is important).
Where does carcinoma in situ evolve from?
A: There is no love or hate in the world for no reason. Atypical adenomatous hyperplasia → atypical adenomatous hyperplasia with some cells proliferating too fast or heterogeneous (localized carcinoma) → carcinoma in situ.
Three in situ carcinomas are not necessarily?
A: Atypical adenomatous hyperplasia does not necessarily evolve into carcinoma in situ; atypical adenomatous hyperplasia does not necessarily evolve into carcinoma in situ when; atypical adenomatous hyperplasia does not necessarily evolve into carcinoma in situ for any reason.
Does the surgery hurt?
A: There are no nerves in the lung tissue, and the minimally invasive incision is only the size of a coin plus a 2-3 cm linear incision, so the pain is not strong. It is actively encouraged to breathe as deeply as possible in the first few hours after surgery, as well as coughing brought out from the abdomen, this can help open the lung lobes (those hours have the effect of anesthesia, and people are very sleepy to overcome).
What is the ratio between inflammation, precancerous lesions, and early lung cancer in ground glass nodules?
A: In my personal outpatient experience, it is usually 5%:80%:15%.
What is the patient’s decision to operate based on?
A: The patient’s goal is to decide whether or not to operate based on the risk level of the lesion presentation. What are the future trends?
What should I supplement after lung cancer surgery?
A: If the appetite is poor and protein intake is too low after surgery, the synthesis of cells will be affected, including the reduction of immune function. (1) Each 100 grams of soybean contains 36.3 grams of protein, 18.4 grams of fat, 25.3 grams of sugar, 412 kcal, 197 mg of calcium, 571 mg of phosphorus, 11 mg of iron, 0.4 mg of carotene, 0.79 mg of vitamin B1, 0.25 mg of vitamin B2, and 2.1 mg of nicotinic acid, which is one times more protein, 33 times more calcium, and 26 times more iron than the equivalent amount of pork. 26 times more protein, 33 times more calcium and 26 times more iron than the same amount of pork. Soybean protein contains various amino acids needed by human body, especially lysine, leucine, threonine and other essential helium base acids, but only methionine is less. You can choose from soy milk, tofu skin, tofu, bean curd, dried beans, pepitas, bean sprouts, etc. (2) Cordyceps sinensis, contains 8.50% fat, 25.3% crude protein, 18.55% crude fiber and 28.90% carbohydrates. The fat contains 13.00% saturated fatty acids and 82.2% unsaturated fatty acids. In addition, it also contains cordycepic acid about 7%. It also contains cordycepin, a light yellow crystalline powder, which can inhibit the growth of germs in the test tube. (3) Sea cucumber contains 50.2g of protein, 262cal of energy, 4.8g of fat, 39mg of vitamin A, B10.04mg of vitamin B, B20.13mg of vitamin B, 1.3mg of niacin, 4967.8mg of sodium, 10mg of calcium, 9mg of iron, 62mg of cholesterol, and 80mg of sea cucumber mucopolysaccharide per 100g.(4) Maple dock, also known as Dendrobium ferrugineum. It contains 22% polysaccharide substances, 17 kinds of amino acids and 7 kinds of inorganic elements. Dendrobium ironbark polysaccharide can significantly raise the peripheral blood leukocyte count and improve the immune function of the body after chemotherapy.
The question arises, can you take the medicine as a meal? The protein of one pound of tofu is equal to half a pound of sea cucumber, if you are a human being, you can’t eat this way, for the same reason, Dendrobium and Cordyceps are special in nutrition, but they can’t be eaten as a meal, it’s not bad to nourish them, a shallow taste is the rule of consumption of these miracle drugs.
The old general Lian Po sea, a meal, three omissions, is the middle of the meal he went to the toilet three times, spleen qi deficiency, absorption function is particularly poor, even if you eat a lot of nutritious things, you can not absorb, so you need to avoid spicy, spleen qi, such as three yellow (yellow beef stew with astragalus with millet rice), party ginseng, honey, sorghum syrup, licorice, ready-made drugs including tonic zhong yi qi pill, yu ping feng san, etc.. The most simple and effective nutritious food for soybean products, such as soy milk, tofu, soybean flowers, northeastern people grow taller and larger with the perennial consumption of soybean products have a direct relationship, and now the popular high nutrition protein powder is also derived from soybean extract.
Where did the surgical signer go?
A: Given that nine out of ten grinding glass nodules are female onset, the decision whether to operate is generally based on the patient’s own wishes, this time the doctors appreciate the female man, they can decide for themselves when to operate, who is in charge, the female man in the case has decided to have an additional opportunity to test love, that is, when they are anesthetized by the doctor, the operation does not go well, there is an accident situation, let who signed responsible for their own For the signer, in the face of the doctor’s printout now a horrible to the extreme complications, disability, death and other words that have not heard, panic to see and hear the doctor’s patient explanation, only left with silly questions: where to sign?
As part of the medical file, the signature will be sealed forever in the hospital’s database. Those who can be trusted by women and are responsible for the signature should be glad that they have given their lives to you, which is an immense trust in you. Unless it’s a woman who doesn’t want her lover to know, generally speaking, there’s only one answer: her lover.
Which is the best open technique?
A: In view of the grinding glass nodules is really too professional, not only patients confused, I’m afraid that doctor friends are also very difficult to come up with ideas, online information is mixed, do not exclude the medical trust, water army and other false information, our advice is to look for tertiary general hospital thoracic surgery, look for tertiary specialist hospital thoracic surgery, North, Shanghai, Guangzhou as the leading medical city, a variety of advanced surgical techniques, equipment, drugs can be found. You can consult the thoracic surgery department of the best local hospital, understand which doctors of the big hospitals can go to the local surgery, ask the local doctors to match, in this way, the surgeon is the best, family care is the most convenient, medical insurance can be reimbursed, because this kind of surgery generally need about 40,000, out-of-pocket surgical materials need about 20,000, of course, you can also choose to come to the big cities to register and queue up, the online two weeks in advance can be registered to the Shanghai big hospitals. If you know your peers, ask them to ask who the doctors in the hospital are looking for to operate on, this person will not be wrong, if you do not know anyone, the first choice is Executive director, deputy director of the number, of course, open surgery also to fate, you can look at several experts at the same time, listen to who is more reliable some, using women’s intuition to feel who cares more about you: faster, more economical, safer surgery.
”Minimally invasive thoracic surgery with CT guidance for dehiscence”
A: For lesions that are relatively shallow and close to the lung surface, in the CT room, the patient lies on the examination bed with the diseased side of the body upward, and the location of the lesion is determined by the first CT scan, and the surgeon inserts a positioning system sleeve needle to the vicinity of the nodule via skin, subcutaneous muscle, intercostal space, pleura, and normal lung puncture under local anesthesia, followed immediately by placing a hooked wire and retrieving the sleeve needle to obtain a second CT image. Since the needle is very thin, no pneumothorax occurs; since the needle is not inserted into the nodes, no metastasis occurs. The patient with the needle, lying on a trolley, is taken to the operating room, where the surgeon follows the vine, wedges a small piece of lung, carries this small piece of tissue with a hook and sends it to the pathology department, where the lesion is sure to be found; the entire operation takes an average of 20 minutes, the operation is clean, and the patient does not need a blood transfusion.
Post-surgery depression phenomenon
A: Women’s body estrogen is always in a state of fluctuation, in the encounter of large trauma such as childbirth, surgery and other emergency situations, the fluctuations in the body hormone levels intensify, a little sad to cry, family members will find these women after surgery for a while a little made, very easy to drop tears, these are unconscious changes, in the company of family members slowly will pass, adjust the mood is very important, nothing can go to work as early as possible, so that You can go to work as early as possible to divert your attention.
Is low-dose CT suitable for glass grinding?
A: Low-dose CT is equivalent to a machine gun, one shot a large area, the advantage is safe, radiation is lower than the general CT, the disadvantage is poor density resolution, so it is only suitable for extensive screening of healthy people. Once an abnormal lesion is found, including patchy shadow, grinding glass nodule shadow, etc., the need for conventional dose + thin layer + high resolution local magnification image, equivalent to a precision sniper gun installed with a scope, a shot, because, grinding glass nodules benign and malignant diagnosis of the most most critical indicator, is the use of the naked eye to distinguish the subtle density differences within the lesion, which is precisely what low-dose CT can not do.
Is it okay for a surgeon to look at the film?
A: There is a difference between where to point and where to hit. Specifically, the imaging doctor is responsible for indicating the lobe (localization) and clarifying the benignity and malignancy (characterization, accurately speaking, according to the level of risk of lesion performance to decide whether to operate), so that the surgeon will not be entangled before operating; if the surgeon does not study the location and nature of the lesion before surgery, and directly open the knife to explore, the result is either not found, or benign nodules The results are either not found or benign nodules. A well-known hospital chief of surgery summed up quite classic: “surgery to find me, the other useless”. However, the surgeon is supposed to manage the knife, the index of their examination is only the clean cut, but it is true that now some surgeons may also improve the diagnosis of attainment.
What are the preoperative tests?
A: Head enhancement MRI is to find out whether there are brain metastases; chest enhancement CT is to check whether there are metastases in the mediastinum, lymph nodes in the lung and adrenal glands; bone imaging is to find out whether there are bone metastases throughout the body; tracheoscopy is to find out whether there are airway metastases; ultrasonography is to find out whether there are abdominal (liver, gallbladder and spleen) metastases. Therefore, based on the principle that it is better to kill a thousand by mistake than to spare one, most hospitals believe that these tests are necessary for patients with preoperative suspicion of lung cancer. Although in 99% of cases, the results of the above tests are negative for patients with ground glass nodules, there are only 0% or 100% possibilities for individuals, and chemotherapy is needed once metastasis occurs. School of thought.
What are the schools and styles of grinding glass diagnosis?
A: (1) peak school: Shanghai Chest Hospital, through computer software to count the number and peak of high-density components in one-dimensional cross-sectional images of ground glass lesions, drawing as a sandbox of density distribution and peak model map; (2) proportional school: the Japanese statistical one-dimensional cross-sectional images of mixed density ground glass nodules in the proportion of high density to project the analysis of the degree of malignancy, the pulmonary hospital has also published a similar study; (3) measurement school: Renji Hospital to measure the proportion of high-density grinding glass nodules to analyze the degree of malignancy; (3) (3) measurement school: Renji Hospital measured CT values of ground glass lesions on one-dimensional cross-sectional images to estimate the weight of substantial components within the nodule; (4) two-dimensional reconstruction school: Shanghai Pulmonary Hospital showed sagittal, coronal and oblique images by MPR multiplanar reconstruction to look for evidence of inhomogeneous density; (5) three-dimensional imaging school: Changzheng Hospital considered that reconstruction with round or round-like shape was bad; (6) enhanced vascular school: East China Hospital looked for microvessels representing malignant components by enhanced post-CT.
To sum up: 3-D faction is skin, 2-D faction is flesh, 1-D faction is bone, and enhancement faction is blood, each with its own characteristics.
Put differently: 3D faction is the face, 2D faction is the lining, 1D faction is the bone, and enhancement faction is the old man.
It can also be: hot and lively is the mistress, seven colorful metropolis to please people; plump and charming is the concubine, the master like maid love; a righteousness is the first room, not meticulous smile near the Buddha Hall; blood is the male master, easy not to appear, on the horse that is far away.
By the way, the pulmonary hospital most like patients to bring thin DICOM format CT discs to the scene two-dimensional reconstruction, direct diagnostic conclusions.