Pulmonary nodules are focal, round-like, hyperdense solid or subsolid lung shadows with a diameter of less than or equal to 3 cm on lung imaging. In clinical practice, it is necessary to integrate various factors to determine whether pulmonary nodules need surgical resection.
First of all, in terms of the size of lung nodules, in general, lung nodules larger than 8 mm in diameter need to be more closely observed or considered for surgery. This is because larger nodules are more likely to become malignant. Especially when the diameter of the nodule exceeds 15 mm, the risk of malignancy increases significantly. However, size is not the only determinant, and smaller nodules may require surgery if they have certain high-risk features.
Secondly, from the analysis of the morphological characteristics of nodules, if the edges of solid nodules are irregular, lobulated, spiculated, or pulled with pleura, then a high degree of vigilance is needed. Lobulation means that the growth rate of nodules is uneven, which may be caused by the growth difference of tumor cells in different directions. The spiculation sign suggests that the nodule grows infiltratively into the surrounding tissues, which may invade the surrounding blood vessels, lymphatic vessels or bronchi. Pleural traction indicates abnormal adhesion between the nodule and the pleura, which is common in malignant tumors. For subsolid nodules, especially ground-glass nodules, if there are solid components inside, that is, mixed ground-glass nodules, the possibility of malignant transformation will also increase. Pure ground-glass nodules also require attention if they persist and exceed a certain range in diameter.
Moreover, from the point of view of the growth rate of nodules, if the pulmonary nodules grow rapidly during the follow-up process, such as a significant increase in volume or density in a short period of time (within a few months), it often indicates that the nodules have a high malignant tendency. Surgical removal may be a better option for nodules that grow faster to prevent further deterioration and metastasis.
In addition, from the perspective of patients’high risk factors, if patients have a long-term history of heavy smoking, occupational exposure (such as asbestos, radon, etc.), family history of lung cancer, then the treatment of lung nodules should be more active. For example, a patient who has smoked more than 20 cigarettes a day for 30 years and has a 6-mm nodule in the lung has a higher risk of malignant transformation than a non-smoker, so closer observation may be needed and even surgery may be considered if there are suspicious features. At the same time, the age of patients is also a factor, the possibility of malignant transformation of pulmonary nodules in elderly patients is relatively higher, especially with other underlying disease, physical condition allows surgery, the treatment of suspicious nodules may be inclined to surgical resection.
In addition, surgical resection is a necessary treatment when various examination methods, such as PET-CT, show increased metabolism of pulmonary nodules, or pathological results obtained by bronchoscopy and percutaneous lung biopsy suggest malignancy or highly suspected malignancy. These examinations can help doctors to judge the nature of nodules more accurately and provide a basis for surgical decision-making.
In a word, whether pulmonary nodules need surgical resection can not be judged only by one factor, but by a multidisciplinary team of thoracic surgeons and radiologists, which should consider the size, shape, growth rate of nodules, the high risk factors of patients and the results of relevant examinations, so as to formulate the most reasonable treatment plan for patients.
