How to properly treat lung nodules

  In recent years, the incidence rate and mortality rate of lung cancer have both leaped to the top of malignant tumors. Although the treatment means, such as surgical resection, chemotherapy, radiotherapy and biological therapy have made great progress, the ultimate 5-year survival rate of lung cancer patients is still only 10%-20%. After in-depth analysis, we found that the 5-year survival rate of early-stage lung cancer patients can reach 70%-90%, while the 5-year survival rate of late-stage patients is difficult. Therefore, the key to improve the treatment effect and prognosis of lung cancer still lies in the “three early stages”, i.e. early detection, early diagnosis and early treatment.  In our clinical work, we often encounter a scene where a patient apprehensively holds up an imaging film and asks the doctor: My chest X-ray or CT scan reveals an isolated nodule in the lung, what can it be? Is it a benign or malignant lesion? It is really difficult to answer these questions at once.  Generally speaking, one of the manifestations of peripheral lung cancer is an isolated spherical lesion in the lung, but not all isolated spherical lesions in the lung are malignant. Isolated intrapulmonary nodular shadow alone has many possible lesions, such as early stage lung cancer/tuberculosis spheroid/inflammatory pseudotumor/mismatous tumor/sclerosing hemangioma/mesothelioma/pulmonary cyst/pulmonary varicocele/pulmonary arteriovenous fistula, and metastatic carcinoma metastasized to the lung from malignant tumors elsewhere. Therefore, it is difficult to diagnose exactly whether a small intrapulmonary nodule is a lung cancer, or a tuberculosis ball, or a misshapen tumor, or an inflammatory pseudotumor, or other lesions purely from imaging or clinical manifestations; doctors consider more the nature of small intrapulmonary nodules, benign or malignant lesions, the significance of which is that benign lesions can continue to be observed, while malignant lesions need to be dealt with immediately so as not to delay diagnosis and treatment and bring patients unnecessary The significance of this is that benign lesions can continue to be observed, while malignant lesions need to be treated immediately to avoid delaying diagnosis and treatment and causing unnecessary harm and injury to patients.  As the understanding of small pulmonary nodules continues to improve, that is, more than 60% of small pulmonary nodules are benign lesions, and malignancy only accounts for about 30%. However, the 1997 WebbWR report pointed out that 50% of pulmonary nodules are benign lesions, 40% are lung cancer, and 10% are metastatic cancer, which means that the proportion of benign lesions in isolated pulmonary nodules is reduced to 50%. In other words, the proportion of benign lesions in isolated pulmonary nodules has decreased to 50%. In recent years, clinical statistics in China have also shown that the proportion of malignant lesions has increased.  Among isolated pulmonary nodules, there is a glassy lesion that is more likely to be an early adenocarcinoma of the lung, or a bronchoalveolar carcinoma, or an atypical adenomatous hyperplasia that is a precursor to lung cancer – which should be of greater concern. If these cases can be detected in the early stages of lung cancer, it will greatly improve the outcome of lung cancer treatment.  Therefore, it is very important to use the available clinical and imaging means to conduct relevant examinations, synthesize and summarize, analyze comprehensively, and identify early stage lung cancer from the many manifestations of ground glass-like lesions, and then adopt effective treatment strategies. In recent years, with the development and clinical application of low-dose spiral CT examination, the number of patients with early lung cancer exhibiting ground glass-like lesions has been improved; and minimally invasive thoracoscopic or adjuvant small incision surgical interventions have also helped to increase the detection rate of early lung cancer and improve the prognosis of lung cancer.