Don’t be afraid of grinding! Ground glass nodules are actually inert.
Pulmonary nodule has become a high-frequency word on the physical examination list. People pay attention to pulmonary nodules, even to the point of panic, all because part of the nodules is early lung cancer. Especially when the word "ground glass" appears in the inspection report, the patient is more anxious and thinks that the difference is cancer.
Chen Liang, director of the Department of Thoracic Surgery of jiangsu province hospital (the First Affiliated Hospital of Nanjing Medical University), told the reporter that with the increase of cases, the medical consensus on pulmonary nodules is constantly being updated. Now the ground-glass nodules have been classified into the "relative safety zone". As long as the word "ground glass" appears, the nodules are inert, so patients need not be afraid, just follow up regularly. In this big coffee health class, let’s learn more about pulmonary nodules!
With the word "ground glass", nodules are inert.
"Many lung cancers are developed from ground glass nodules!" "Be careful when there are solid components in ground glass nodules, and the malignant probability of semi-ground and semi-solid nodules is the highest!" — — This is the main point that will be mentioned in many popular science of pulmonary nodules before. If there is a "ground glass nodule" on the physical examination list, the fear of patients with pulmonary nodules will escalate. Director Chen Liang told Yangzi Evening News/Zi Niu News reporter that this concept needs to be updated. There are ground glass nodules, but it is relatively safe.
Director Chen Liang explained that infectious diseases such as tuberculosis and fungal infection and chronic inflammation may produce nodules on the lungs. Ground-glass nodules are flaky blurred shadows that we can see on chest CT, just like ground glass. Ground glass nodules are divided into "pure grinding" and "mixed grinding". The diameter of pure ground glass nodules within two centimeters in the international guidelines can be followed up; There are ground glass components and some solid components in the "mixed grinding". The guidelines for this kind of nodules also stipulate that: if the diameter is less than 6 mm, there is no need for follow-up or annual follow-up; 6-8 mm, it is recommended to follow up once every 6-12 months; Those larger than 8 mm are followed up every 3-6 months.
The observation and summary of pulmonary nodules in medicine are also updated. The consensus now is that even if it is already an invasive adenocarcinoma, as long as there is ground glass, it is a low-grade malignant and inert tumor, and the surgical prognosis is excellent.
Don’t intervene too early, even minimally invasive surgery is invasive.
Director Chen Liang said that such patients are often encountered in outpatient clinics. This hospital found nodules by filming and quickly went to a large hospital for enhanced CT or even PET-CT；. Some patients will give an example, "Some people around me have nodules smaller than me, and they are all malignant", so they strongly demand surgery. There will also be patients with three or four millimeters of nodule reports coming from other places to "seek an answer".
Patients often want big experts to determine whether their nodules are cancer. "But the eyes of experts are not microscopes, and sometimes they can’t completely determine whether they are benign or malignant." Director Chen Liang said, is it possible that two or three millimeters of nodules are malignant or have malignant "potential"? It’s a small chance, but it’s possible, but is it wrong for the doctor not to operate? Not really. When a doctor watches a film, what he really needs to grasp is the opportunity of intervention, so as to make the patient benefit the most.
Small nodules of 3-4 mm, some hospitals and doctors may also advise patients to operate, which is actually overtreatment. Minimally invasive surgery is also invasive, and there will be injuries. It is definitely not the optimal solution to let patients who could have been "calm" for several years, more than ten years, or even without intervention for life, bear surgical injuries and various risks prematurely.
Director Chen Liang, for example, said that the patients with pulmonary nodules who were followed up in his hand were suspected to be carcinoma in situ. After 12 years of observation, it was confirmed that they were still carcinoma in situ after surgery. "Atypical hyperplasia, cancer in situ, now think they are precancerous lesions, not cancer. From carcinoma in situ to minimally invasive carcinoma, it seems to be ‘ Advanced ’ In fact, they are only 1-2 mm apart, and the progress is very slow. Many patients are followed up for 5-10 years, and grasping the indications and timely surgery will not affect their health. " Director Chen Liang said that they spend the most time in outpatient clinics, but instead advise patients not to worry, and they can afford to wait.
Big coffee biography
Chen Liang, director of thoracic surgery department of the First Affiliated Hospital of Nanjing Medical University, chairman of the thoracic surgery branch of Jiangsu Medical Association, and president-designate of the thoracic surgeon branch of Jiangsu Medical Association. Committed to the surgical treatment of early lung cancer, he is good at the diagnosis and treatment of thoracic surgery-related diseases, especially lung segments. He has completed more than 1,500 cases of thoracoscopic anatomical pneumonectomy, including more than 500 cases of segmental pneumonectomy and subsegmental pneumonectomy. Thoracoscopic subsegmental pneumonectomy was reported for the first time in the world, which was widely recognized by people in the industry. He has performed surgical demonstrations at conferences at home and abroad for many times, and his technology has spread throughout the country and even abroad. Successfully performed the world’s first mixed reality (MR) assisted lung tumor resection; In China, the concept of "accurate pneumonectomy under the guidance of 3D-CTBA" was first put forward, and the first 3D-CTBA reconstruction system, DeepInsight, was developed in cooperation with Neusoft Company, and the software was successfully copyrighted, which has been widely used in China, including Taiwan Province. He has made many special reports and surgical demonstrations at international and domestic thoracic surgery conferences, and is committed to promoting accurate thoracoscopic pneumonectomy.
He presided over the compilation of the first Atlas of Thoracoscopic Anatomical Segmental Pulmonary Resection in China and the first Atlas of Endoscopic Anatomical Segmental Pulmonary Resection in the world.
The image is hanging in the air, and it can be seen synchronously 30 kilometers away from here.
What kind of nodule needs surgery? Director Chen Liang said that there are "standards" in domestic and foreign guidelines at present. Generally speaking, surgery will only be considered if it is greater than 8 mm. If the nodule is suspected to be carcinoma in situ, micro-invasive carcinoma, or the size, shape and density of the nodule change, follow-up or elective surgery can be selected. If the nodule is located at the periphery of the lung, it is easier to handle, and local resection can be used, with little damage to the lung; If the position is deep, the pulmonary vessels and bronchi may be damaged during the "forced" resection, resulting in postoperative hemoptysis, limited lung expansion and other complications. "At present, minimally invasive surgery has been able to achieve anatomical lung resection, that is, to dissect a lung segment from the lung lobe, while ensuring the margin and minimizing the damage." Jiangsu province hospital is one of the earliest hospitals in China to carry out pneumonectomy, and has trained many domestic thoracic surgeons. The "Anatomical pneumonectomy course" of thoracic surgery has just passed the final certification of the Royal College of Surgeons, and it is also the first training course of pneumonectomy in the world.
In 2017, jiangsu province hospital Thoracic Surgery completed the world’s first thoracoscopic segmental resection of early lung cancer assisted by mixed reality (MR) technology. In 2019, with the help of 5G technology, the first international 5G+MR remote real-time combined segmental pneumonectomy was completed. Under MR technology, after the doctor wears special glasses, the lung image data is "dragged" from the computer screen through artificial intelligence three-dimensional reconstruction, suspended in the air and shared in real time. Director Chen Liang, who is in the hospital headquarters, can mark the image remotely with voice and marker pen, and every instruction detail will appear clearly and without delay in the operating field of the surgeon in the operating room of Pukou Branch, 30 kilometers away. With the support of new technology, the treatment of pulmonary nodules can be more and more minimally invasive and accurate, and difficult remote surgery has also become possible.
See the real pulmonary nodules from the numbers.
Director Chen Liang said that jiangsu province hospital Thoracic Surgery conducted a cohort study of lung cancer in the physical examination center of the hospital. From May 2019 to 2020 (except January-March of the COVID-19 epidemic), a total of 10,225 cases were examined by CT, of which the nodule detection rate was 74.1%, and lung cancer confirmed by pathology accounted for three thousandths of the total number of people examined. It can be seen from this data that the proportion of cancer in pulmonary nodules is still not high.
At the same time, the number of pulmonary nodule operations in jiangsu province hospital was 1,836 in 2016 and 4,393 in 2020, an increase of 139% in five years. At present, the malignant rate of surgical patients is more than 90%.
The increase of pulmonary nodule cases is mainly related to the increase of incidence, the increase of detection rate after the improvement of imaging examination accuracy and the early diagnosis.