Most patients are found to have a lung nodule during a physical examination, or during a chest examination for other diseases. Once a nodule is found, there is no need to be overly nervous. The doctor will make a judgment based on the patient’s specific situation by looking at the CT film or doing some other tests, and at the same time give more adequate and appropriate advice to help you solve the problem; or give two choices and let you make up your mind to choose one. That’s why pulmonary nodules are a problem that patients and doctors have to face together. Of course, sometimes you will be more torn, especially when doctors in different hospitals give different advice.
So how do doctors determine whether a lung nodule is good or bad, good or bad. Just like criminals always leave some traces and evidence when they commit a crime, there are some characteristic signs of lung nodules that will help doctors make a judgment. Malignant nodules have signs specific to malignant nodules, while benign nodules also have their own characteristics, which can be used to determine the appropriate conclusion.
Analysis from nodule characteristics.
1. Location: Most lung cancer is found in the anterior segment of the upper lobes of both lungs. The posterior segment of the upper lobe tip and the dorsal segment of the lower lobe are mostly benign lesions, especially tuberculosis foci.
2. Size of lung nodules: the larger the lung nodule, the higher the possibility of malignancy. Nodules less than 5.0mm have a high possibility of benignity; nodules of 5.0mm-10.0mm should be followed up closely; malignant tumors in nodules of 10.0mm-30.0mm account for more than 50-80%. The larger the nodule is, the higher the possibility of lung cancer and the need for surgical treatment.
3. Morphology: those with shallow lobulation, short and thin burrs and pleural depression sign suggest lung cancer; those with smooth edges and coarse, long and sparse burrs suggest benign. But sometimes it is difficult to distinguish.
4.Density: Nodules with uneven density, small vesicles and tubules inside the nodules, or small nodules accumulation, and eccentric small cavities are mostly malignant; those with uniform density are mostly benign.
5, surrounding: surrounding lung tissues showing inflammation, emphysema, dysplasia, infiltration and thickening of bronchial and vascular bundles are mostly malignant nodules; while those with satellite foci, “halo”, etc. are mostly suggestive of benign nodules.
6.Enhancement: Enhanced CT shows uneven enhancement or moderate enhancement is mostly malignant; non-enhancement or high enhancement is mostly seen in benign nodules.
7, whether there is calcification: calcification may be benign.
Types of diseases that need to be distinguished in pulmonary nodules.
1, tuberculoma: uneven density, may have calcification and cavity, no enhancement.
2. Inflammatory pseudotumor: history of infection or inflammatory sequelae, uniform density.
3, sclerosing hemangioma: spherical or round-like mass with smooth edges, can be significantly enhanced when doing enhanced CT, or connected with intrapulmonary vascular shadow
4.Malignant hemangioma: mostly below 50px, with smooth edges and may be lobulated, and can be diagnosed when fatty density or “popcorn”-like changes are detected in it.
5. Arteriovenous fistula: When enhanced CT is done, the lesion is enhanced with the large vessels and is equally enhanced.
6.Adenoma: low grade malignant tumor, round or round-like, mostly located in the periphery of the lung or in the trachea or bronchus, with smooth margins, uniform density, no calcified satellite foci, moderate enhancement, uniform enhancement, requiring surgery.
7, metastases: single or multiple, varying in size, clear or blurred margins, uniform density, relatively common in the lung field zone or subpleural.
If none of the above is true, we should consider whether it is lung cancer.
Many nodules do not have obvious features, so it is very difficult to determine, or surgery or continued observation is the choice. It is important to trust the doctor and make a reasonable decision based on the doctor’s advice at this time.