Pure ground glass nodules cut or not cut?

*Only for medical professionals to read for reference.
Regarding lung nodule management, "international authority" and "Chinese characteristics", which one do you pick? In recent years, the application of lung CT testing in physical examinations has become more and more common.
More and more people undergoing physical examinations have found nodules in the lungs in their CT reports.
This not only makes patients highly stressed, but also clinicians are also prepared.
Troubled
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From October 8th to October 10th, 2021, the 7th Zhongshan Lung Cancer Forum was successfully held in Shanghai.
During this period, the "Medical Oncology Channel" set up a special site for famous doctors Kung Fu tea, and the guest of the conference-the King of Thoracic Surgery, Zhongshan Hospital Affiliated to Fudan University Professor Qun discussed and shared the issues related to the follow-up strategy of lung nodules
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Figure 1: Professor Wang Qun at the Zhongshan Lung Cancer Forum famous doctor Kung Fu Tea site.
The domestic diagnosis and treatment of pure ground glass nodules has "Chinese characteristics".
According to the number of lesions, lung nodules can be divided into isolated (single lesion) and multiple (2 or more) Lesions), according to the size of the lesions can be divided into small nodules (long diameter ≤ 5 mm), small nodules (long diameter 5-10 mm) and nodules (long diameter 10-30 mm), and according to the density of the lesion Pulmonary nodules can be divided into solid pulmonary nodules and subsolid pulmonary nodules, the latter includes pure ground glass nodules and some solid nodules (also called mixed nodules)
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When a patient finds a nodule in the lung, how to deal with it is a problem that every cancer clinician has to face
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Professor Wang Qun said in the interview: “At present, there are many guidelines for the diagnosis and treatment of small lung nodules, especially pure ground glass nodules.
The most classic one is the small lung nodules guidelines issued by the Fleischner Society
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National Comprehensive United States The Cancer Network (NCCN) clinical practice guidelines and the American Association of Chest Physicians (ACCP) guidelines are all citing the essence of the "2017 Fleischner Guidelines for Pulmonary Nodules" to provide clinical guidance
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"Take the NCCN guidelines that are most well-known to domestic oncology clinicians as an example.
The current "NCCN Lung Cancer Screening Clinical Practice Guidelines"[1] and the "NCCN Lung Cancer Screening Patient Guidelines"[2] are for both high-risk groups after screening.
It is found that the treatment recommendations for pure ground glass nodules accidentally discovered by non-high-risk groups are more inclined to follow-up rather than further surgical intervention
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Table 1: The 2020 NCCN Lung Cancer Screening Guidelines recommends the follow-up strategy for ground glass nodules according to World Health According to the “WHO (2021) Histological Classification of Lung Tumors” published by the World Health Organization (WHO), the in situ adenocarcinoma corresponding to the pure ground glass nodules has been excluded from the category of malignant tumors and classified into the category of glandular precursor lesions.
It is the lesion before gland damage [3]
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This also confirms that the pure ground glass nodule is indeed a benign lesion, and there is no need to rush for surgical intervention
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For some solid nodules, the NCCN guidelines have always followed the past guidelines.
Surgical intervention is recommended when the solid component of nodules ≥ 6 mm [1]
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Table 2: The 2020 NCCN Lung Cancer Screening Guidelines recommends follow-up strategies for some solid nodules.
However, the spectrum of lung cancer diseases in China is quite different from that in the United States.
Many domestic medical centers propose or perform surgical interventions for patients with persistent pure ground glass nodules greater than 8 mm, and also advocate early intervention for some solid nodules, which is different from the guidelines of the NCCN guidelines
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Professor Wang Qun Emphasizes: "The CSCO Guidelines for the Diagnosis and Treatment of Non-Small Cell Lung Cancer [4] The clinical guidance for stage I-IV non-small cell lung cancer is highly consistent with the NCCN guidelines, but its treatment strategy for lung nodules does not clearly stipulate , And the consensus documents published in some domestic journals are inconsistent with the provisions of the international mainstream guidelines, which has formed this kind of "Chinese characteristics"
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"Many questions about lung nodules still lack data to support Professor Wang Qun," said: "The current domestic guidelines and consensus on the diagnosis and treatment of pure ground glass nodules are relatively'advanced'.
Most lung nodules over 6 mm in the periphery of the lung are advanced Intervene
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For this kind of clinical practice strategy that is inconsistent with the recommended content of the international mainstream guidelines, relevant research needs to be carried out to provide evidence support for it
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"With regard to the domestic controversy over the diagnosis and treatment strategy of lung nodules, Professor Wang Qun said: "After the follow-up of patients under the age of 80 who found ground glass nodules with a diameter of less than 20 mm, it was found that less than 1% of the cases per year The patient's lesion will progress or change, indicating that the pure ground glass nodule is a very stable lesion
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Compared with pure ground glass nodules, the proportion of patients with some solid nodules has changed slightly, but the probability of changes is also very low
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Therefore, this somewhat "radical" diagnosis and treatment strategy in China is still controversial
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"Picture 2: Professor Wang Qun at the Zhongshan Lung Cancer Forum famous doctor Kung Fu tea site.
In addition, if women of childbearing age find pure membrane glass nodules, whether it will affect their pregnancy is also a hot issue that many people pay attention to
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When young women found pure membrane glass on physical examination After a nodule, whether it needs clinical intervention or not, it will have a great impact on its psychology and physiology
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In addition, whether the internal environment changes in the body after pregnancy will accelerate the development and changes of the nodule also makes oncology clinicians doubtful.
However, there is still a lack of relevant evidence to support
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For this reason, Professor Wang Qun’s team has carried out a related study.
The study included pregnant or pregnant women who found pure ground glass nodules, and adopted measures such as lead coats and lead plates as the research subjects.
Protective CT examination, and strictly follow the follow-up time recommended by NCCN guidelines for the study.
At present, more than 70 patients have been enrolled, and nearly 20 pregnant women have successfully given birth.
It is believed that the results of this study will fill this controversial issue in the future.
Blank
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Screening can be performed once in 1-2 years without excessive intervention.
With the popularization of low-dose spiral CT (LDCT), the detection rate of lung ground glass nodules is getting higher and higher, which also brings "the general population".
Does CT test also need to be performed? "The question
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In this regard, Professor Wang Qun said: “Relevant studies in the past have shown that compared with traditional X-ray detection, CT detection can indeed reduce the mortality rate of people at high risk of lung cancer, but there is currently no evidence that the general population can also be screened from CT.
Benefits
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Regarding this issue, there are related studies or comments that indicate that CT detection for the general population may further increase the detection rate of lung nodules, but it may also cause problems such as over-diagnosis and over-medical treatment
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At present, mainstream international guidelines do not CT screening is not recommended for non-high-risk populations under the age of 40.
At the same time, pure ground glass nodules are very stable.
Excessive intervention will increase the psychological burden on young non-high-risk populations
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However, Professor Wang Qun also said that with With the continuous improvement of people’s living conditions, CT screening cannot be called a “bad thing”.
How to deal with and deal with lung nodules is the key to the problem
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According to the relevant recommendations of the NCCN guidelines, it is the first time for non-high-risk groups After the pure ground glass nodules are detected, they can be followed up regularly once a year, and there is no need to take premature clinical treatment measures for intervention
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Professor Wang Qun emphasized: “For people who are not at high risk of lung cancer, CT should be performed every 1-2 years.
Screening or re-examination is a very safe and effective detection strategy.
There is no need to rush to intervene with drugs, surgery and other therapeutic methods! "Expert profile Wang Qun Professor Wang Qun, graduated from Shanghai Medical University (now Fudan University School of Medicine) in 1987, chief physician, professor, doctoral supervisor, and leader of the Department of Thoracic Surgery, Zhongshan Hospital Affiliated to Fudan University
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Chinese Medical Association Thoracic and Cardiovascular Member of the Surgery Branch and Deputy Leader of the Thoracoscopy Group, Fellow of the Royal College of Surgeons (FRCS), Member of the Standing Committee of the Esophageal Cancer Professional Committee of the Chinese Anti-Cancer Association, Member of the Standing Committee of the Lung Cancer Professional Committee of the Chinese Anti-Cancer Association, and Thoracic Surgery Professional Committee of the Research Hospital Society Deputy Chairman, Member of the Standing Committee of the Thoracic Surgery Branch of the Endoscopy Professional Technology Evaluation Committee of the Ministry of Health, Deputy Chairman of the Thoracic Surgery Branch of the Shanghai Medical Association, and Deputy Chairman of the Thoracic Oncology Committee of the Shanghai Anti-Cancer Association
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As a major participant, he won the second prize of National Science and Technology Progress Award, the first prize of China Medical Science and Technology Award, and the first prize of China Medical Science and Technology Award
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Published nearly 100 papers, including more than 70 SCI papers
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Served as a member of the editorial board of ATS Chinese Journal, Chinese Journal of Thoracic and Cardiovascular Surgery, Chinese Journal of Gastrointestinal Surgery, Chinese Journal of Thoracic and Cardiovascular Surgery, Shanghai Medical Journal and Journal of Thoracic Disease
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One of the first thoracic surgeons to carry out endoscopic minimally invasive treatment in China, leading the development and popularization of minimally invasive sublobectomy and lobectomy
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Proficient in the diagnosis and treatment of various common diseases and rare diseases in general thoracic surgery, and has rich clinical experience in various conventional thoracic surgery and complex operations, especially for lung cancer, esophageal cancer and other diseases, and advocates lung cancer and esophageal cancer.
Standardized treatment, with special attention to the thoroughness of lymph node dissection for lung cancer and esophageal cancer surgery
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He has been committed to the standardized treatment of ground glass nodules in the lungs for a long time, and has carried out a number of prospective multi-center clinical trials on the follow-up of ground glass nodules in the lungs
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References: [1]NCCN Guidelines for Patients.
Lung Cancer Screening,2020 https:// Cancer Screening,Version 1.
2021,NCCN Clinical Practice Guidelines in Oncology https:// Classification of Tumours Editorial Board.
WHO classification of tumours.
Thoracic Tumours［M］.
5th ed.
Lyon: IARC Press, 2021.
[4] Chinese Society of Clinical Oncology Guidelines Working Committee.
Chinese Society of Clinical Oncology (CSCO) Guidelines for the Diagnosis and Treatment of Non-Small Cell Lung Cancer (2020)