Studies have found that after surgical resection of early-stage (stage Ia) lung cancer, the 5-year survival rate can reach more than 80%!
In contrast, the five-year survival rate after surgery for moderately advanced (stage IIIa-IV) lung cancer is only about 36%[1].
The comparison of these two sets of data is enough to illustrate the importance of early diagnosis and treatment.
Pulmonary nodules are one of the most important manifestations of early lung cancer. If malignant pulmonary nodules can be detected early and intervened, the prognosis of lung cancer patients can be greatly improved.
So, what methods can we use to initially determine whether pulmonary nodules are malignant?
"Nine Looks" to identify malignant pulmonary nodules
1Look at the age[1][2]
Normally, there is a positive correlation between the patient's age and the malignant probability of pulmonary nodules. In patients over 40 years old, the probability of malignant pulmonary nodules increases with age.
2Look at the smoking history [1]
Some studies have found that the probability of malignant pulmonary nodules is higher in smoking patients.
3Look at the history of cancer [1]
Patients with a past history of cancer have a higher probability of malignant pulmonary nodules. In addition, patients with a family history of lung cancer are at greater risk of developing malignant pulmonary nodules.
4Look at the size[1][3]
The diameter of pulmonary nodules is significantly related to the probability of malignancy of the nodules. The larger the diameter, the greater the possibility of malignancy.
Source: Vision China
The malignant probability of micronodules <5mm> nodules >10mm is 33% -60%.
5Look at the density[1]
The malignant probability of pulmonary nodules is related to its density, among which some solid nodules have the highest probability of malignancy. The solid part of the nodule is invasive, and the increase in the solid component often represents the infiltrative progression of the lesion.
6Look at the appearance[1][4]
Malignant nodules are mostly lobulated, with mostly clear edges but not smooth. If the spicule sign (or spinous protrusion), pleural indentation sign, and vascular bundle sign appear, it often indicates that the nodule is likely to be malignant.
7Look at the internal structure [1]
Calcification in pulmonary nodules can appear as central, diffuse, lamellar, punctate, eccentric and popcorn-like.
Among them, when the lesions are punctate and eccentrically calcified, the nodules are more likely to be malignant.
8Look at the doubling time [5][6]
The doubling time of pulmonary nodules refers to the time it takes for the tumor volume or cell number to double (calculated in months or days).
The doubling time of pulmonary nodules is an important observation indicator during follow-up.
Generally speaking, when the doubling time of a pulmonary nodule is between 25 and 400 days, it is likely to be a malignant pulmonary nodule.
Source: Visual China
It should be noted that the doubling time of different pathological types of lung cancer is different. For example, small cell lung cancer and squamous cell carcinoma progress faster and have a shorter doubling time than adenocarcinoma .
In addition, smoking, lung disease , etc. may also affect the growth rate of lung cancer.
9Look at the location [2]
Pulmonary nodules located in the upper lobes of the lungs are mostly malignant nodules, while pulmonary nodules located in the middle and lower lobes of the lungs are mostly benign nodules.In addition, the nodules located on the periphery of the lung and under the pleura are also mostly benign.
Finally, it needs to be emphasized that for the qualitative diagnosis of pulmonary nodules, relying only on a certain examination method or a certain indicator has certain limitations.
Therefore, the first priority after detecting pulmonary nodules is to consult a doctor for comprehensive analysis. This will not only reduce over-treatment as much as possible, but also avoid delayed treatment, achieve early diagnosis and treatment, and prolong survival.
Finally, this article can be read in conjunction with this article~
END
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References:
[1] Wu Bin, Ma Jun, Shi Hongcan. Research progress in early diagnosis of benign and malignant pulmonary nodules [J]. International Journal of Surgery, 2020, 47(7): 484-488. DOI: 10.3760/cma.j.cn115396-20200310-00056.
[2] Liu Shiqian, Wu Haixin. Identification and clinical follow-up of benign and malignant solitary pulmonary nodules[ J]. Journal of Aerospace Medicine, 2019, 30(5):588-592. DOI:10.3969/j.issn.2095-1434.2019.05.039.
[3] Liu Jingwei, Zhang Xining. Latest progress in diagnostic methods of pulmonary nodules [J]. Chinese Journal of Surgery, 2022, 60(5):500-505. DOI:10.3760/cma.j.cn112139-20211123-00551.
[4] Lung Cancer Group of the Respiratory Disease Branch of the Chinese Medical Association, Chinese Lung Cancer Expert Group of Prevention and Treatment Alliance. Chinese expert consensus on the diagnosis and treatment of pulmonary nodules (2018 edition) [J]. Chinese Journal of Tuberculosis and Respiratory Medicine, 2018, 41(10): 763-771. DOI: 10.3760/cma.j.issn.1001-0939.2018 .10.004.
[5] Chen Yanan, Chen Wufei, Hua Yanqing. Progress in CT research on pulmonary nodule doubling time [J]. Chinese Journal of Anatomy and Clinic, 2017, 22(6): 522-527. DOI: 10.3760/cma .j.issn.2095-7041.2017.06.016.
[6] Zhang Rui, Chen Bojiang, Ren Jing, et al. Application of volume doubling time in the diagnosis of lung cancer[J]. International Respiratory Journal, 2018, 38(12):941 -944. DOI:10.3760/cma.j.issn.1673-436X.2018.12.012.
