September 30, 2022

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What should you do if the lungs are screened to find small nodules?

What should you do if the lungs are screened to find small nodules?


What should you do if the lungs are screened to find small nodules?  




The therapeutic effect of lung cancer is closely related to the discovery of the disease. The 5-year survival rate of carcinoma in situ and early lung cancer is close to 100%, while the 5-year survival rate of advanced lung cancer is less than 20%. It can be seen that if lung cancer can be detected early and received standardized treatment , Then the ending may be quite different. Therefore, early detection and early treatment of lung cancer are essential!



One. How to screen for early lung cancer?

With so many inspection methods, how to make a choice? Choose chest X-ray, low-dose spiral CT, ordinary CT, or PET/CT?

First of all, let’s talk about the issue that everyone will consider before doing the inspection, that is, the radiation dose. It’s very simple. The average natural radiation dose per person per year is 2.4mSv. Based on the calculation of 365 days a year, the natural radiation dose received by living on the earth for 3 days is about 0.02mSv. As a reference, it is exactly equal to 1 chest radiograph. Radiation dose. Although the chest X-ray radiation is small and the operation is simple, it is difficult to find tiny tumors below 5mm, and it is not sensitive to small non-calcified nodules. There are also dead spots in the detection of tumors in certain locations of the lungs, etc. It is easy to miss the diagnosis, so it is not suitable for the screening of early lung cancer.

PET/CT is very expensive, thousands or even tens of thousands, and it is prone to false positives, and the price/performance ratio is too low! Of course, it is a good choice for baseline or staging examinations of advanced cancer. In addition, the average amount of radiation for a PET/CT is 25mSv, which is equivalent to 7-10 years of sun exposure.

At present, low-dose spiral CT screening for lung cancer is being carried out all over the world. Studies have shown that it has reduced the mortality rate of lung cancer by 20% by screening for lung cancer in high-risk groups of lung cancer! The low-dose CT scan radiation dose is calculated according to 1mSv, which is about the radiation dose of a person living on the earth for 150 days. Its radiation dose is about 1/5 of that of ordinary CT! Of course, the sharpness of the image will decrease when the dose is reduced, so it may be insufficient. Sometimes some lesions are difficult to distinguish, and high-resolution CT or even enhanced CT is needed to confirm! This explains that some people have done low-dose CT, and they will require other types of CT examinations if they find problems, because there are many types of CT examinations, and different examinations can complement each other. In general, low-dose CT is suitable for health checkups and lung cancer screening, etc. It is also suitable for patients who have multiple re-examinations in a short period of time and who require follow-up observation throughout the year. It is a scientific and economical examination method.

So, does everyone need to be screened? Does a young person who has no addiction to tobacco or alcohol and has no family history also need to be screened? Of course not! This brings up the issue of high-risk groups.



Two. Who are the “high-risk groups” of lung cancer?

1. Long-term active or passive smoking;

2. Occupational exposed persons, long-term exposure to industrial pollution of uranium, radium, asbestos, radon and some other carcinogens (such as diesel exhaust) and other substances;

3. Patients who have suffered from head and neck tumors or smoking-related cancers in the past;

4. People whose first-degree relatives (parents, siblings) have had lung cancer;

5. Patients suffering from chronic lung diseases such as tuberculosis/ COPD;

6. People who have been active in air-polluted areas for a long time, especially in confined polluted spaces (including kitchens). (I have a relative who is a chef. I call every year to suggest that he do a low-dose chest CT!)



Three. What about high-risk groups?

If you encounter high-risk groups, it is recommended to screen low-dose CT once a year. Of course, it is also necessary to actively treat the primary lung disease, quit smoking, maintain mental health, proper exercise and good eating habits.



Fouth. What should you do if a lung nodule is found?

What should you do if the pulmonary nodules are screened out? According to the risk prediction models of lung nodules in multiple centers in Europe and the United States, the following steps are summarized

Nodule classification:

pulmonary nodules are divided into calcified and non-calcified pulmonary nodules. Non-calcified nodules include solid nodules and subsolid nodules, and the latter includes non-solid nodules (ground glass nodules) And some solid nodules. Compared with solid nodules, non-solid nodules are more malignant and are obviously related to the incidence of lung cancer.

Nodule size measurement:

Accurate measurement of nodule size is the core of lung nodule management. The measurement of volume is better than the measurement of diameter; volume measurement can calculate the volume doubling time (VDT), which is a reflection of the growth rate.

Nodules risk stratification:

Through the diameter, volume, and volume doubling time of the nodules, lung nodules found in lung cancer screening can be classified into low-risk or intermediate-risk nodules, and the most appropriate follow-up can be calculated according to the situation Time, regular (1 year) or short-term (3 months). If the re-examination finds that the nodules become larger, denser, and more solid components, then the possibility of carcinoma in situ or micro-invasive adenocarcinoma is high, and timely surgical treatment should be considered.



(source:internet, reference only)

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