This multiple ground glass nodules, follow-up or surgery?

​【Internet consultation case】

First consultation on February 6, 2022:

■ Disease description: The patient, female, 69 years old, has underlying diseases such as hypertension, coronary heart disease, sinus bradycardia,

The contents of the CT report are as follows: Ground-glass density nodules were seen in the upper lobe of the right lung, with clear borders and a maximum diameter of about 2.

Impression: ground glass density nodules in the upper lobe of the right lung, ground glass density nodules in the lower lobe of the right lung with small vacuoles, the nature of which is to be determined.

■ Picture display: During the first consultation, I was unable to provide the electronic version of the image data because of the repeated communication between my friend and the inspection hospital.

Figure 1 The lesion in the right upper lobe, with a clear outline and a ground-glass opacity

Figure 2 Left upper lobe lesion, a well-defined ground-glass nodule with no solid component

Figure 3 Ground-glass nodules in the right lower lobe with small vacuoles in the middle

Figure 4 Patchy shadow on the lower right leaf with clear outline

■ Director Ye suggested: Your nodules initially look like tumor nodules, those circled in big red may be invasive adenocarcinomas, mainly adherent; those circled in orange are likely to be atypical hyperplasia; Carcinoma in situ may be more likely to be circled in purple

Second consultation March 16, 2022:

■ Disease description: The new CT source file and report on March 14: 2022-03-14: The comparison between this examination and 2022-01-22 chest CT showed: ground-glass density nodules in the upper lobe of the right lung and The density is less than the previous one, and the maximum diameter is about 2.

■ Video display:

Figure 5.

Figure 6 Lesion 2 in the upper left lobe: tiny ground-glass nodules with high density and clear outline, which are considered to be tumor in nature, but once it is really in the category of tumors, the density is likely to be carcinoma in situ, or even invasive adenocarcinoma glands The vesicular, atypical hyperplasia is less dense

Fig.

Figure 8 Lesion 5 in the upper left: high-density solid nodules, like benign, more likely to be fibrous hyperplasia

Fig.

Figure 10 Lesion 7 in the lower right: ground-glass nodule with vacuolar sign, with uneven wall thickness and clear outline, it is more likely to consider invasive adenocarcinoma lepidic

Figure 11 Lower right focus 8: The one shown in pink is more likely to be considered as carcinoma in situ, and it may also be atypical hyperplasia, but the outline is so clear that the tumor should be considered in the tumor category

Fig.

■ My opinion: There are multiple nodules in both lungs, mostly in the tumor category.

1.

A: Generally it should be possible
.
It also depends on the endurance of daily activities.
If you can walk up to the 3rd floor in one breath, most of them have little to do
.

2.
Q: My mother also has high blood pressure and coronary heart disease
.

.

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You can see that her lung function is normal
.
The local cancer hospital in Tianjin suggested going to a general hospital with a cardiology department for treatment.
Are you afraid of this situation
?

A: It depends on the overall situation of the person.
If there is an opportunity, try to strive for it
.
The one on the left is still very small, and there is no risk in the near future
.

3.
Q: Hello, I will communicate with the doctor of the hospital here today
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His opinion is that both the upper and lower parts of the right lung are wedge-shaped, and the right lower lung is preserved as much as possible
.
Given that my mother's lung function is average, and she has coronary heart disease and hypertension, his opinion is that follow-up is okay
.
I would like to ask you, if the follow-up is how often to check CT? Will it deteriorate rapidly? If there is surgical intervention, will the mother's right lung function also be basically lost, and will it be worse than it is now? If surgery, are there high risks during surgery?

Answer: For this type of invasive adenocarcinoma, which is basically invasive, the follow-up will either worsen or progress slowly, and it is impossible to improve
.
Now the health is not good.
When you are older, the overall condition of the body will be worse than it is now.
When the disease progresses, if you still seek surgical intervention, the surgery will be even more difficult than it is now
.

So if you want to fight for surgery, you have to go as soon as possible
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On the premise that the overall situation can tolerate, right lower lobectomy plus lobe wedge resection, and lymph node sampling or dissection is a relatively thorough surgical plan, because the lesions on the left side are small and light, and they are unlikely to be dangerous in recent years.
, can be followed up, if it really progresses, other local treatment measures such as ablation can be considered
.

Of course, another more conservative method is to only perform wedge resection of the right upper lobe with colored lymph nodes, and the cystic lesions of the lower lobe can be treated with ablation or stereotactic radiation therapy (SBRT), so that the most risky nodules are relieved and the largest Extent control eliminates secondary nodules, and secondary lesions are followed up for later consideration
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This requires you to weigh the pros and cons by yourself, and also to evaluate the patient's physical condition.
After all, it is difficult to understand the full picture of the physical condition through online consultation
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The above is for reference!