Professor Zhong Hua’s team summarized the clinical experience in diagnosis and treatment of multiple nodules in the lungs, forming the "Review on Diagnosis and Treatment of Multiple Nodules in the Pulmonary".
text | Zhou Jie
"I have cut off 5 nodules , and the doctor said that 1 more has grown now. Do you want to cut off all the lungs? What should I do..." Ms. Xu, who was in her early 40s, asked in despair in despair by the doctor of the "Miscellaneous Nodules in the Lungs" team of Shanghai Chest Hospital .
Ms. Xu discovered multiple nodules in both lungs in 2018. At that time, 5 nodules in the upper and lower lobes of the left lung were surgically removed. I thought I could feel at ease now, but I didn’t expect that during the follow-up visit last year, the doctor said that another nodule had grown in her right lung. Could it be that all the remaining lungs were removed? At the time of desperate situation, Ms. Xu found the "MDT" team of the Chest Hospital for Multiple Nodules in Pulmonary Nodules.
was led by Professor Zhong Hua, director of the Department of Respiratory Medicine, led by the "Multiple Nodules in Pulmonary Nodules" diagnosis and treatment team brought together elite backbones such as respiratory medicine, thoracic surgery, radiotherapy, and radiology. After reading Ms. Xu's reports, experts believe that the newly-occurred nodules are high-risk lesions and require intervention and treatment. However, considering that the patient had already undergone an operation, the lesion was deep this time, and the trauma was very serious when the surgery was performed. After a comprehensive judgment, the respiratory medicine team finally performed lung nodule ablation treatment on Ms. Xu. The lesions of the right lung were accurately eliminated with the minimum trauma and also eliminated Ms. Xu's "knots".
Internationally, lung cancer is the second most common cancer for both men and women, second only to prostate cancer and breast cancer , respectively. With the development and popularization of CT screening technology, more and more patients with multiple nodules in the lungs are clinically present. Against this background, people are inevitably afraid of talking about "pulmonary nodules".
multiple nodules in the lungs, which refers to the presence of two or more lesions in the lungs with diameters less than or equal to 3 cm. imaging often manifests as several nodules containing ground glass shadows. According to the latest statistics from Shanghai Chest Hospital , patients with multiple nodules on both lungs account for 18% of the total number of patients with pulmonary nodules.
Source: Oriental ic
For multiple nodules in the lungs, many patients are full of confusion: Which department should I go to see? Do you want surgery to remove it? Do you need to remove one if you find it?
For this type of patients, thoracic hospitals have formed multiple multidisciplinary joint models (MDTs) throughout the clinical-research-clinical system, and "multiple nodules in the lungs" is one of the most distinctive ones. Since its establishment, the "MDT for multiple lung nodules" diagnosis and treatment team has treated more than 200 patients with multiple lung nodules in difficult lungs. Each patient's plan is "privately customized", and one-stop diagnosis and treatment services allow patients to go from "at a loss" to "relax and rest assured".
"Whether multiple nodules should be intervened, whether they are worth surgical intervention, the dangers of each nodule need to be identified one by one. Some are benign or in the 'breeding' state, and only regular follow-up and observation are required. However, those who have grown up and become bad need to be dealt with immediately. For different situations of the lesions, further treatment will be carried out through surgical treatment, local ablation treatment, chemoradiation and chemotherapy, targeted treatment and other methods." Professor Zhong Hua introduced. Yao Feng, deputy director of the Department of Thoracic Surgery at
, is also a core member of the MDT team. As a surgeon, he often advises patients to "don't rush to surgery."
"The increase in the detection rate of nodules makes many patients feel anxious and think that they have a tumor. In fact, there are very few people with problems. Many patients with ground glass nodules do not need surgery, so they can be followed up and observed." Yao Feng told reporters that sometimes patients have greater psychological anxiety than the tumor itself, and MDT diagnosis and treatment allows surgeons and internal medicine doctors to join forces to give patients a more scientific and rigorous treatment plan. "On the one hand, doctors from multiple disciplines avoid patients going to multiple departments and solving problems in one-stop; on the other hand, the results of multidisciplinary consultations are often more authoritative, and the patients' treatment options are more abundant."
Through consultation and treatment of more than 200 patients, the team also reached some consensus rules: First of all, the focus of treatment should be high-risk nodules. Surgical treatment is recommended for nodules with high risk. If other nodules can be taken into account, we will strive to solve them in one operation; if the patient has had previous surgery, or has poor cardiopulmonary function and has concerns about the surgery, then treatment can be carried out through ablation, radiotherapy and other treatment methods.
The team encountered a patient with multiple nodules. After evaluation, a nodule needs to be removed. The pathological result is a malignant tumor. The gene detection found that there is a gene mutation, so the remaining lesions were treated with targeted drugs, which also achieved good results. The clinical diagnosis and treatment of multiple nodules in the lungs is difficult, and there is still a lack of unified diagnosis and treatment standards. In this regard, Professor Zhong Hua's team summarized the clinical accumulated experience in diagnosis and treatment of multiple nodules in the lungs to form the "Lungs' Multiple Nodules in the Lungs Review of Diagnosis and Treatment, and published in the Chinese Journal of Oncology, in order to share and discuss with colleagues in the field of multiple lung nodules in the country.
In addition, Professor Zhong Hua also pointed out that MDT solved some problems, but among more than 200 patients, there were also problems that the team could not solve, which was the "soil problem". "Medology has always been a discipline that is moving forward in exploration. We launched a 'PD-1/CTLA-4 dual anti-AK104 treatment for premature treatment The clinical study on the efficacy and safety of ground-glass nodules lesions in patients with multiple primary lung cancer stages, hoping to improve the soil problems of multiple primary nodules patients through immune drugs, and hope to open up new treatment methods for multiple primary early lung cancer”.
It is understood that this study has been listed as the second round of "Three-Year Action Plan for Promoting Clinical Skills and Clinical Innovation in Municipal Hospitals (2022-2024)" Special Project on Transformation of Integration and Innovation Achievements of Medical Enterprises.
