In the last month, five cases of small pulmonary nodules with a longest history of 1 year and 6 months and the shortest of only 5 days were operated on consecutively, and all of them were found during physical examination. With the popularization of chest CT examinations and the people’s awareness of their own health, more and more patients are found to have small lung nodules, a significant proportion of which are ground glass nodules. In the process of communication with these patients and their families, we found that many patients basically have a common mentality after finding small lung nodules: they are both worried and afraid, and they are holding on to the hope that the doctor can tell them the exact diagnosis. They are worried that if they have surgery, the nodule will be benign and they will suffer a knife in vain, but they are also afraid that if they do not have surgery, the nodule will be malignant and the treatment will be delayed. Some patients who are more open-minded may not care about this, but some patients are a bit overwhelmed or carry a heavy psychological burden, and even affect normal life and work; some patients with CT follow-up 1 to 2 years nodules and no significant changes, it is considered benign nodules, so let down your guard and delay the disease. Wang Wei, Department of Thoracic Surgery, Shandong Qianfo Mountain Hospital So how should we treat these small lung nodules? To be honest, even a thoracic surgeon sometimes has difficulty in making accurate judgments in dealing with small pulmonary nodules. There are reports of small solitary nodules in the lungs larger than 1cm in diameter, malignant ones can account for more than half of them, while tiny nodules smaller than 5mm are more than 90% benign if there is no history of tumor. In general, nodules larger than 2 cm are relatively accurate to determine benign and malignant by CT imaging, while nodules smaller than 1 cm are more difficult to determine by CT imaging, and the most difficult for clinicians is the nodules between 0.8 and 1.5 cm, which have a variety of shapes and natures. Therefore, it is very important to determine the nature of the nodules or how to manage these small nodules. Therefore, based on my clinical experience, I would like to make some suggestions for these patients in order to help them: 1. After the discovery of pulmonary nodules, it is important to maintain a correct state of mind, not to be overly nervous, nor to be paralyzed. Do not be overly nervous, nor paralyzed, knowing that most small nodules are curable. Benign nodules need not be mentioned, if it is a malignant nodule, in most cases belong to the early stage, early surgery to remove the cure rate is quite high. The first thing you need to do is to go to a regular hospital as soon as possible, preferably a hospital with an independent thoracic surgery program. Professional thoracic surgeons not only read a large number of chest CT images in their daily work, accumulating a wealth of knowledge of CT images of the lungs, but also often in the process of surgery to explore the small nodules in the lungs, after surgery can get the exact pathological diagnosis, so that the pathology and CT images can corroborate each other, to improve the accuracy of the diagnosis. Therefore, compared to other specialties, thoracic surgeons may have a more comprehensive understanding of small nodules and may give you more reasonable advice.3. Some patients or family members like to go online to find relevant information, and there are indeed some articles on the Internet about small pulmonary nodules, such as what to do if a 4mm nodule is found, what to do if a 6mm nodule is found, etc. However, for pulmonary nodules, even if the nodule is found to be a small nodule, it may not be a nodule. However, even medical professionals who are not specialized in chest tumor know little about pulmonary nodules, and for patients who lack medical knowledge, simply relying on the knowledge on the internet will not help much. Therefore, if you want to seek help online, the best way is not to look for related knowledge but to find a hospital and a senior thoracic surgeon you think is better for consultation or treatment. 4. Therefore, many people do not take the discovery of lung nodules seriously, and some do not even go for regular CT examinations, which often leads to delayed treatment of some malignant nodules. Therefore, patients must be vigilant if they have the following conditions: (1) a long history of smoking and are over 40 years old; (2) a family history of malignant tumors (especially if one of their parents or siblings has a malignant tumor); (3) a nodule size of 1 cm or more; (4) a nodule size or density that has changed significantly within a short period of time (e.g., within a few months).5. Once a lung nodule is found to fit the above four conditions, it should be actively Consider surgical resection. Sometimes I often say to subordinate physicians that it is better to kill a thousand wrongly than to spare one. Perhaps this statement is too extreme, but the incidence of lung cancer is indeed terribly high at present, and before there is a definite diagnosis method to clarify the benignity and malignancy of small lung nodules, early resection is the root of cure. Once a nodule is found to have significant changes, the lesion may have already started to progress, which means it may not be early, and its cure rate is greatly reduced or even the chance of cure is lost. Therefore, once a small lung nodule is found, do not delay and seek medical help as soon as possible. Sometimes, a positive attitude of the patient himself towards treatment may be twice as effective. 6. If the nodule is ground glass-like, the possibility of malignancy will be greatly increased. It has been reported that the chance of malignancy in ground glass nodules may exceed 70%; in addition, some ground glass nodules may remain unchanged for a long time, and the absence of change does not mean that the nodules are benign. At present, it is believed that the doubling time (doubling in volume) of some of these nodules (carcinoma in situ) can exceed 800 days, that is, more than two years, and once the change occurs, the nodule often evolves from carcinoma in situ to invasive carcinoma, and the chance of metastasis increases greatly, and the chance of cure decreases accordingly. Therefore, the treatment of ground glass nodules should be more aggressive, that is, surgery should be chosen more actively.7. Finally, surgery itself is not a very scary thing. Although surgery has certain risks, the current surgical techniques, surgical equipment, anesthesia techniques and drugs have reached a very high level (of course, I am referring to large hospitals that have the conditions), especially now the widespread use of minimally invasive television thoracoscopy, making lung surgery trauma and surgical risks greatly reduced, the safety factor of surgery greatly improved, so patients should have a correct understanding of the surgery itself. After all these words, the central point is: in case a small nodule is found in the lung and the nature of the nodule cannot be determined, surgery should be considered first. If the nodule is adenomatous hyperplasia (formerly called precancerous lesion), cutting it out means killing the cancer in the cradle; if the nodule is carcinoma in situ (just formed cancer foci, no possibility of metastasis), cutting it out means cure; if it is early invasive carcinoma, cutting it out can achieve a cure rate of more than 80 to 90 percent. Therefore, prolonged indecision and prolonged delay may deprive some patients with early-stage cancer of the chance to be cured, thus causing irreparable losses to individuals and families. These are some of my experiences in my work, and I write them in the hope that they can help some patients with small pulmonary nodules. If there are patients who need to communicate with me more, you can visit the website of Shandong Qianfo Mountain Hospital and look for the Department of Thoracic Surgery to get my personal and departmental information, and of course, I hope that experts or readers who access this article will criticize this article.