In recent years, due to the wide application of multi-row CT, some small lung lesions that could not be detected by previous plain chest X-ray (chest X-ray for short) have been discovered, and these small lesions are often in the shape of nodules, which are clinically used to be called lung nodules. Since some of the lung nodules are malignant and most of them are lung cancer, coupled with the irregular treatment of lung nodules by a few doctors and inaccurate interpretation and propaganda, some people mistakenly think that lung nodules are lung cancer, which has caused people’s panic to a certain extent, and some people are even more afraid of talking about nodules. Classification of pulmonary nodules The imaging manifestation of pulmonary nodules, mainly refers to the manifestation on CT images, is divided into three categories: the first category is solid nodules, i.e. soft tissue nodules; the second category is non-solid nodules, i.e. ground glass nodules, and ground glass nodules are divided into two types, one is pure ground glass nodules, i.e. all of the lesions are ground glass-like density, and the other is mixed ground glass nodules, i.e. part of the lesions are soft tissue density and the other part is ground glass-like density. soft tissue density and the other part is ground glass-like density. The above three types of nodules can be both benign and malignant. According to the literature and personal experience, the majority of mixed ground glass nodules are malignant, the vast majority of which are lung cancer, but a few are benign; pure ground glass nodules account for a relatively large proportion of benign, a relatively small proportion of malignant, and a relatively high proportion of soft tissue nodules are benign. What is said here is the probability, which is relative, and for each specific patient, it must be accurately distinguished whether it is benign or malignant, but this is by quite difficult. The diagnosis and management of pulmonary nodules are not very standardized and even somewhat chaotic at present. Many hospital radiology departments often do not make a clear and definite diagnosis of pulmonary nodules, and patients often get ambiguous results, such as “upper left pulmonary nodule, nature to be determined”, “upper right pulmonary nodule, malignancy not excluded”, “lower right Pulmonary nodule, benign possibility”, “left lung occupying lesion, further examination recommended”, etc. When patients get such reports, they are often confused, and the whole family is frightened and continues to seek medical advice everywhere. When they get to the surgeon, most surgeons advocate surgery because the radiologist cannot exclude malignancy. Some surgeons also advocate that nodules larger than 0.6 cm should be surgically removed, quite a bit of “I would rather kill a thousand by mistake than let one go” flavor. Once the nodule is benign, the surgeon will not be ashamed of the mistake, but will tell the patient “you can rest assured” in a dignified manner. In the hands of the internist, the radiologist did not rule out malignancy on the one hand, and it is not easy to get histological evidence of this small nodule on the other. Some primary care hospitals give chemotherapy and radiotherapy to patients without histological evidence, and only after several courses of treatment with no effect do they realize that the diagnosis is wrong, but the patient has been severely damaged physically and mentally. Some doctors, including radiologists, believe in the management guidelines of foreigners and follow up almost all lung nodules and wait for them to grow before making a diagnosis. Some of them metastasized while waiting and lost the opportunity for early treatment. Why do radiologists not make a positive diagnosis? The reasons are complex. One is because there are many kinds of pulmonary nodules and their manifestations are very different, so it is very difficult to make an accurate diagnosis; the second is the policy-oriented problem, at present, the promotion of doctors mainly depends on scientific research and papers, especially SCI papers, rather than mainly on the diagnosis and treatment level, and fewer and fewer doctors mainly focus on clinical care; the third is that the interests and safety of doctors are not guaranteed, because even a more experienced doctor cannot always Good (the total rate of misdiagnosis abroad more than 30%), but Chinese doctors can not be wrong, once the wrong, not only to bear the responsibility of financial compensation, some patients even to fist and foot. Forced to do nothing, it is better not even sure, both to save time and safety. Therefore, to really improve the level of diagnosis, and thus the overall quality of care, both require doctors to improve technical skills, but also need the corresponding policy support. There are many means to confirm the diagnosis of pulmonary nodules How should pulmonary nodules found incidentally in the clinic or on CT or PET-CT physical examination be handled? One should not be opposed to either open surgery or follow-up. However, there is a principle, not an arbitrary one, as to what needs to be opened and what needs to be followed up. This principle is that the diagnosis must be clarified first, and any treatment measures must be taken after, not before, the diagnosis is clarified. It is irresponsible to decide on treatment measures without a clear diagnosis, and we now have the ability to make a clear diagnosis before treatment for the vast majority of patients. The emphasis here is on a one-time diagnosis, i.e., the patient comes to the hospital for the first time and the diagnosis is made in the shortest possible time and without interruption. Some patients can be clearly diagnosed on the same day just by films or other imaging data, and some patients may bring films that do not meet the diagnostic requirements due to irregular examination and need to redo CT examination, and the results can be obtained on the same day or the next day, which means that most patients can be clearly diagnosed in 1-2 days just by imaging examination. However, imaging is not a panacea. A few patients who cannot be diagnosed clearly by imaging may need to be diagnosed clearly by bronchoscopy, percutaneous puncture, sputum cytology, etc. These tests take about a week. It should be emphasized that those who are clearly diagnosed with malignancy by either method and have indications for surgery should be recommended for surgical treatment. This is because surgery is still the first treatment option for early or earlier stage lung cancer. For clearly benign lesions, such as small benign tumors, inactive tuberculosis or other inflammatory granulomatous lesions, no treatment and no follow-up may be recommended. Since a definitive diagnosis can be made in about a week or so for most patients with pulmonary nodules, the remaining ones that need follow-up are the minority. These patients, in turn, are different and should be treated differently. For those who cannot exclude acute or malignant acute infectious lesions, they should be reviewed within a short period of time (within one month) after appropriate treatment. The patient and family should be relieved from the panic as soon as possible. For those with a basic tendency to benign and no risk of growth and metastasis in the short term, longer intervals of follow-up can be scheduled. For those who cannot completely rule out malignancy and the patient is unwilling to deal with it in time, close follow-up at shorter intervals should be arranged. Low-dose CT is preferred for lung cancer screening Many lung nodules are benign, and even if they are malignant, as long as they are detected early and treated timely, the prognosis is very good, so lung nodules are not terrible. However, if malignant lung nodules are found late, it is also scary. Most patients with small pulmonary nodules, whether malignant or benign, have no symptoms. So how can you detect a lung nodule? Currently the only way is a health checkup. But again, the problem lies in the physical examination. There are many medical examination centers in the society, and the majority of them still use chest X-ray. However, almost all of the early lung cancer nodules that appear as ground glass-like nodules are missed on chest radiographs, and most of the soft tissue nodules are also missed due to their small size. This is the main reason why the majority of lung cancers detected in the past were in the middle and late stages. The best way to detect lung nodules, including of course early lung cancer, is CT, and in terms of detection, low-dose CT is available. In fact, there are two sides to many things in the world, and so are X-rays. Since its clinical application in 1895, X-rays have saved hundreds of millions of lives, but mankind has forgotten its good points and remembered, exaggerated and exaggerated its flaws. This in turn has harmed us ourselves. Everyone is afraid of X-rays and does not go for check-ups, and early tumors are dragged out to advanced stages, which are welcomed only by Hades. The effect of radiation on people depends mainly on the amount of it, the amount of the atomic bomb is to die. But the right amount of radiation is not only harmless to people and is necessary for the growth and development of humans and all living things. Sunlight is an important health measure. How harmful are the X-rays used for daily diagnosis to people? A study by the Academy of Military Medical Sciences showed that less than 100 mSv (mSv, millisieverts, a unit of measurement for radiation) has no effect on the human body. A course of conventional radiation therapy of at least 2,000 mSv or more is acceptable, although the patient has a reaction, and can recover by stopping the exposure. Long March Hospital study measurement results: one routine chest X-ray: 0.2-1.2mSv, one low-dose CT examination: 0.5-1.0mSv, one routine chest CT examination: 3-5mSv. Thus, it can be seen that X-rays used for diagnosis, as long as they are used correctly, do not cause damage to human health. People who eat grains and cereals are sick and may grow lung nodules, and small lung nodules may be missed on a regular chest X-ray. It is recommended that people over the age of 45, regardless of gender, have a chest CT at least once a year. If you really find out that you have a lung nodule, don’t panic and get the diagnosis right first, because there are many lung nodules that are benign, and even if they are malignant, as long as they are detected early, diagnosed accurately and treated correctly, your health still belongs to you.