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Lung Nodule

Respiratory MedicineCardio Thoracic Surgery

A lung nodule is a visible spot on the lungs seen in chest X-rays or CT scans. It is usually discovered incidentally during these imaging tests and typically does not cause any symptoms. Pulmonary nodules can be caused by non-cancerous conditions such as inflammation or benign growths, or they can be cancerous.

Symptoms

Lung nodules refer to localized shadows or masses in the lungs with a diameter of less than 3 cm. They are often asymptomatic and are usually discovered incidentally during health check-ups or imaging studies. However, in some instances, patients may experience the following symptoms:

Cough: Persistent dry cough or cough with a small amount of sputum.
Chest Pain: Localized discomfort or dull pain.
Hemoptysis (Coughing up Blood): Some malignant nodules can cause blood in the sputum.
Shortness of Breath: Occurs when the nodule is large or compresses the bronchi.

Classification

Based on the nature and imaging characteristics, lung nodules can be classified as follows:

（1）Classification by Nature

Benign Nodules: Commonly caused by inflammation, infection, tuberculosis, or benign tumours (e.g., hamartoma).
Malignant Nodules: May indicate lung cancer or other malignant lesions.

（2）Classification by Imaging Characteristics

Solid Nodules: Nodules with uniform internal density and clear or slightly blurred boundaries.
Part-Solid Nodules: Nodules containing both solid components and ground-glass opacity, which are highly suspicious for malignancy.
Pure Ground-Glass Nodules (GGN): Nodules that appear hazy and translucent. Early-stage lung cancer often exhibits this characteristic.

（3）Classification by Size

Micronodules: Diameter less than 1 cm.
Small Nodules: Diameter between 1 and 3 cm.

Diagnosis

Imaging Examinations	Chest X-ray: A preliminary screening tool, but less sensitive for small nodules. Low-Dose Chest CT (Low-Dose CT): The standard tool for detecting nodules; it displays the location, size, density, and boundary characteristics of the nodule. Positron Emission Tomography (PET-CT): Used to evaluate the nodule's metabolic activity, helping distinguish between benign and malignant lesions.
Pathological Examinations	Bronchoscopy: Suitable for nodules close to the bronchi, allowing tissue sampling for biopsy. Percutaneous Needle Biopsy: Performed under CT guidance, using a fine needle to extract tissue samples. Surgical Biopsy: Used in cases where diagnosis is uncertain; samples are obtained through minimally invasive surgery.
Follow-Up Monitoring	Regular imaging follow-up is usually recommended for nodules smaller than 1 cm and considered low-risk (e.g., every 6-12 months) to observe any changes over time.

Treatments

The treatment plan depends on the size, nature, and pathological results of the nodule:

Benign Nodules

Most benign nodules do not require treatment and only need regular follow-ups.

Suspected Malignant or Malignant Nodules

Surgical Resection:
- Minimally Invasive Video-Assisted Thoracoscopic Surgery (VATS): Suitable for isolated nodules suspected to be early-stage lung cancer.
- Lobectomy: Performed for nodules confirmed to be malignant tumours.
Radiation Therapy: Recommended for high-risk patients or those unfit for surgery.
Chemotherapy: Applied in cases of malignant tumours with metastasis or late-stage patients.
Targeted Therapy or Immunotherapy: Suitable for lung cancer patients with specific gene mutations (e.g., EGFR, ALK).