Ground glass density nodules

Some people will find some small nodules when doing lung imaging, and the density is uneven, which is called ground-density nodules. If the diameter of the nodule is not large and the density is low, most of them are benign symptoms, but the patient also needs to be checked every three months or so to avoid lesions. Nodules are very common, and some people are careless, leading to adverse consequences, so no matter where the nodules occur, they should be taken seriously.

1. Isolated pure GGO with a diameter less than 5 mm does not require follow-up. Especially in the elderly, because its pathology represents AAH, and a few are adenocarcinoma in situ. The scanning slice thickness must be 1 mm to determine whether it is a true GGO.

2. For isolated pure GGO with a diameter greater than 5 mm, reexamination should be performed after 3 months to observe whether the lesion disappears. If the condition persists, review it every year for at least 3 years. Pathologically, they were AAH, adenocarcinoma in situ and a small number of microinvasive adenocarcinomas. Antibiotics are not recommended. PET scans are of little value. CT-guided puncture is not recommended because the positive rate is low. If the lesion increases in size or density, surgical treatment can be adopted. The recommended surgical procedures are thoracoscopic wedge surgery, segmental or subsegmental resection.

3. For isolated partial solid density GGO, especially those with solid components larger than 5 mm, if the lesion is found to have increased or remained unchanged after a follow-up examination 3 months later, the possibility of malignancy should be considered. A set of data showed that the possibility of malignancy for partial solid density nodules is 63%, while that for pure GGO is 18%. Large pure GGOs are mostly invasive lesions. Inflammation is common in women and young patients. CT-guided puncture is not recommended. The recommended surgical procedure is thoracoscopic wedge surgery or segmental resection, but lobectomy is not recommended.

4. For multiple GGOs with clear margins less than 5 mm, a more conservative approach should be adopted, and follow-up after 2 and 4 years is recommended.

5. For multiple pure GGOs, at least one lesion is larger than 5 mm, but there are no particularly prominent lesions. It is recommended to re-examine after 3 months and follow up for a long time, at least 3 years.

6. Multiple GGOs with prominent lesions, the main lesions need further treatment. If the lesions persist during the first follow-up examination 3 months later, more aggressive treatment is recommended for larger lesions, especially those with solid components larger than 5 mm. The recommended surgical procedure is thoracoscopic wedge surgery or lung segment resection. Patients were followed up annually after surgery for at least 3 years. For ground-glass nodules in the lungs, the most important and urgent issue to be addressed is the possibility of overtreatment.