After discovering pulmonary nodules, how to determine whether it is lung cancer, the surgeon will give you a clear explanation.
Lung shadows larger than 3 cm are called lung masses, and the malignant probability is 50%. For masses larger than 3 cm, we can easily identify them by the following methods:
1. If the tumor is close to the bronchus, bronchoscopy biopsy or tracheal brush can be used. The accuracy of the exam is still very high. Once the tumor is diagnosed by pathology, there is no doubt; But for the undiagnosed, it is necessary to consider whether the specimens obtained are not enough or the parts are not deep enough. If these conditions are excluded and considered benign, diagnostic treatment can be given according to the results, or direct surgical resection can be performed.
2. If the mass is close to the chest wall, CT or ultrasound-guided puncture biopsy can be used, and the obtained pathological samples can be diagnosed clearly, and enough genetic testing can be sent to guide whether it is suitable for targeted therapy.
3. If the mass is located in the middle of the lung, neither bronchoscopy nor puncture can obtain pathology. If the mediastinal lymph nodes are enlarged, we can perform puncture biopsy under the guidance of ultrasonic bronchoscope, and the tissues obtained from the biopsy will be sent for pathological examination.
If there is no lymphadenopathy, the imaging results support the diagnosis of the tumor, and surgical resection can be directly used, which can achieve the purpose of diagnosis and treatment.
For lung nodules, for larger nodules, if the diagnosis can be obtained through the above ways, treatment should be based on the pathological results.
For smaller nodules, if the pathological diagnosis cannot be obtained by the above methods, we can adopt the following methods for diagnosis and treatment:
1, tiny nodule 5 mm; The malignant rate was 65438 0%; Nodules smaller than 4 mm have little tendency to malignant transformation. High-resolution CT examination was performed once a year to dynamically observe the changes of nodules. If the nodule is obviously enlarged, you can review it in a short time and choose whether to perform surgical resection according to the results. If there is no obvious change in a short time, you can continue to observe. It is reported that the inert nodule can remain unchanged for more than 20 years, and finally it is removed by surgery. Pathology is bronchioloalveolar carcinoma. It has little effect on the therapeutic effect.
2. Small tubercle 5-10 mm; The malignant rate is 6% 28%; Among them, 5-8mm nodules are suggested to be dynamically observed in a short time. If the nodule has obvious changes, surgical resection can be considered. If there is no obvious change, the review time can be gradually extended. For 8- 10mm nodules, if there are malignant signs, it is recommended to take more active surgical treatment. If there are no malignant signs, it is recommended to continue observation. If the dissipation is gradually reduced, only a normal physical examination is needed in the future.
3, lung nodules10-30 mm; The probability of lung cancer with a diameter of 10-20mm is about10%-20%; The malignant rate of 20 mm in diameter is 30%-40%; In this case, if the pathological diagnosis can be obtained by bronchoscopy, CT or ultrasound puncture biopsy, or ultrasound bronchoscopy biopsy, then treatment measures can be taken according to the diagnosis results. If a definite diagnosis cannot be made, the characteristics of nodules can be examined according to imaging, and if they can be basically judged as benign, diagnostic treatment can be given first. If the possibility of malignancy is high, it is recommended to give active surgical treatment.
For patients with pleural effusion, if pathological diagnosis cannot be obtained, pleural effusion can be taken for exfoliated cell examination, but the positive rate of this examination is low, about 20%. It is suggested to send it for inspection many times to improve the positive rate.
Can PET-CT be used to diagnose lung cancer?
I'm here to tell you that the principle of PET-CT in diagnosing tumors is that tumor cells can absorb a specific substance (2- fluoro -2- deoxy -D- glucose, usually abbreviated as 18F-FDG or FDG). But tuberculosis and inflammation can also be positive. Therefore, PET-CT can only judge the possibility that the mass is a tumor, but cannot accurately diagnose the nature of the mass.
Moreover, it is also pointed out in the Guide to Diagnosis and Treatment of Pulmonary Nodules that PET-CT has no obvious advantage for pure ground glass nodules or mixed ground glass nodules with solid content less than 8 mm; For solid nodules larger than 8 mm, it can be considered when it is uncertain whether they are benign or malignant.
To sum up, we must pay more attention to the discovery of pulmonary nodules. Everyone is not alone. As long as you believe in us, there will be a team to escort your lungs. Our multidisciplinary diagnosis and treatment team (MDT) is ready to solve your worries.
# Life calls for superior ordering # # The truth is coming # # It's pulmonary nodule and lung cancer # @ Fat man who wants to be a good doctor @ Dr. Zhang Wei @ bystander between colorful clouds.