I remember a female patient a year ago. I can’t remember the specific age. I was about 60 years old. When I came to the clinic, I complained that there was a nodule on my lung. When I first found it, it was 1.5cm in size, but I didn’t review it for two years. Recently, I had some symptoms. There was a small amount of blood in the sputum. I wanted to reexamine a CT. I hastened to open it to her. As a result, the nodule turned into a 4cm mass, which had been transferred If you take targeted drugs now, you can live a good life, but you can’t cure it.
in fact, the above patient is a special case. Generally, patients will follow the doctor’s advice and regularly review the chest CT to observe the changes of nodules. However, many netizens have a question in mind: do you need to review all the time if you find a few millimeters of small pulmonary nodules in physical examination? When can the follow-up be stopped?
when a nodule is found for the first time, doctors will make a comprehensive judgment according to the size, shape, density and relationship with surrounding tissues. For highly suspected malignant nodules, such nodules are generally larger than 1 cm. Direct surgical treatment or puncture biopsy are usually recommended. If the nodules meet the surgical indications, they should be removed directly. Follow up is not required for the nodules. However, patients need to conduct regular reexamination according to the postoperative requirements of lung cancer.
the vast majority of pulmonary nodules are benign, but the initial examination can not reach a definite conclusion, which requires follow-up review to observe the changes of nodules. For the continuous observation time of pulmonary nodules, it is recommended in many guidelines that continuous observation should be carried out for 2 years, and in recent years, it has also been suggested to observe for 3 years. Due to the slow growth and inertia of ground glass nodules, some people found that the nodules increased after 4-5 years of follow-up and turned into malignant transformation. Therefore, we usually recommend that the patients be followed up for 5 years, and then, according to the frequency of routine physical examination, CT lung cancer screening should be conducted once a year.
the problem of follow-up interval time is relatively complex and needs hierarchical analysis. The possibility of malignant lesions was predicted according to whether the patients were at high risk of lung cancer. The follow-up frequency of solid and semi solid nodules was different.
when the small nodule is less than or equal to 4 mm, it is not necessary to reexamine and keep the rhythm of routine physical examination for 1-2 years. CT scan was performed 12 months later. When the small nodule is 4-6 mm, we should pay attention to it slightly. The low-risk patients should reexamine CT after 12 months, and the patients with medium and high-risk should recheck CT after 6-12 months and 18-24 months to observe the change of size or density. If there is no obvious change in the small nodule during the reexamination, it can still return to the original physical examination frequency. If the small nodule is 6-8 mm, the low-risk patients can set the review period as 6 months. If there is no change after the review, the review period can be extended to 12-18 months, while the high-risk patients can be reexamined in 3, 6 and 12 months. Small nodules larger than 8 mm in diameter can be reexamined every 3-6 months. If it is a mixed ground glass nodule, it needs to be reexamined every 3 months, and antibacterial treatment should be considered. When the solid component increases, it can also go to the thoracic surgery department and consider direct surgical resection or puncture biopsy.
the above review intervals need to be carried out in combination with the doctor’s advice. We can’t review according to the above rhythm to avoid delaying the diagnosis and treatment of nodules under special circumstances. Most of them can have a radical cure even if they are malignant tumors. Most people can review according to the doctor’s advice, but some people are worried all day and go to see a doctor in two or three days. It takes one or two months Seek reexamination, this is not advisable, after all, CT is radiation, there is harm to the body and unnecessary. As for the follow-up methods, chest CT scan is enough, generally do not need to do enhanced CT, PET-CT will not be used as a follow-up review. Review of the hospital and doctors had better be fixed, so as to understand the overall situation, but also easy to compare before and after.
in a word, small inflammatory nodules can disappear by themselves, and the follow-up can be stopped after such nodules disappear; for solid small pulmonary nodules, if the size does not change in 2 years, the follow-up can be stopped, but it is recommended to take chest CT every year; for ground glass nodules, the follow-up time should be extended to 3-5 years. If there is no obvious change, it is recommended to take chest CT every year. At present, physical examination is becoming more and more popular in China. Even if the nodules are not followed up, it is necessary to do chest CT every 1-2 years. Focus