Understanding Common Nodules: Unraveling Health Concerns

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Regular physical examinations are important. What should you do with the report after each examination? What are some common abnormalities reported in physical examination reports, such as abnormal blood lipids, overweight, fatty liver, and thyroid nodules? How can you deal with and improve these conditions? Starting today, this section will launch a series of reports titled "Understanding Your Physical Examination Report" to help you understand the intricacies of your physical examination report.

The word "nodule" on a medical examination report has caused many people sleepless nights. What is a nodule? How far is a nodule from cancer?

"Nodules are far from cancer because over 90% are benign. Only a small fraction of nodules require attention, usually less than 5%. We shouldn't worry too much about nodules, nor should we ignore them. Relax, face nodules squarely, and strive for a healthy life," explained Xu Aimin, deputy director of the Health Checkup Center at Chaoyang Hospital. Nodules are new growths with a density different from surrounding tissues, discovered during imaging examinations. Pathologically, they can be classified as benign or malignant.

According to Xu Aimin, with advancements in imaging techniques and examination methods, nodules are becoming increasingly easier to detect. Currently, lung nodules, breast nodules, and thyroid nodules are common nodules with high detection rates during physical examinations.

pulmonary nodules

Beware of mixed density nodules

Besides nucleic acid testing, another important screening method for COVID-19 is lung CT scans. Thanks to this preventative examination, many asymptomatic lung nodules have been discovered, bringing the term "lung nodules" into the public eye.

“Lung lesions smaller than 3 cm in diameter on chest X-rays or CT scans are called nodules, while nodules larger than 3 cm in diameter are called masses,” Xu Aimin explained. In imaging examinations such as CT scans, lung nodules appear as shadows with increased density. “They look like mass shadows with a density different from normal lung tissue; they can be round or irregular, single or multiple, with clear or unclear borders.”

Experts explain that lesions smaller than 1 cm are difficult to detect on chest X-rays, but small lung nodules smaller than 3 mm can be detected on low-dose CT scans. With the increasing prevalence of physical examinations, the detection rate of lung nodules is rising. While this high detection rate helps improve the early detection rate of lung cancer, it may also place a certain psychological burden on the public.

For some, lung nodules seem to always carry the risk of developing lung cancer, which is frightening. Xu Aimin explains that while research on the incidence of lung nodules is currently lacking, data from lung cancer screening studies show an overall detection rate of approximately 20%-30%. "This is a high percentage, but over 95% of lung nodules are caused by benign lesions, so there's no need to worry too much," Xu Aimin points out. Benign lesions that lead to lung nodules include: bacterial infections, such as Staphylococcus aureus; benign tumors, such as fibromas and hemangiomas; vascular diseases, such as arteriovenous malformations and varicose veins; and inflammatory diseases, such as granulomatous vasculitis.

What should you do if you discover a lung nodule? "The larger the nodule, the more likely it is to become a malignant tumor. You need to consult a doctor and have regular follow-ups," Xu Aimin explained. Generally speaking, for lung nodules smaller than 6mm, it is recommended to have a chest CT scan every year; for lung nodules of 6mm or larger, the doctor will determine the interval between follow-up examinations based on the nodule's location, size, shape, density, spiculation, lobulation, pleural traction, etc., so close follow-up should be carried out under the guidance of a doctor.

If the lung nodules do not show significant progression or abnormal enlargement during the follow-up period, they are generally considered to be benign lesions or low-risk nodules, and can be observed regularly as advised by the doctor. If an increasing trend of lung nodules is observed during the follow-up process, it should be taken very seriously, and standardized diagnosis and treatment should be initiated as soon as possible.

What kinds of lung nodules should you pay attention to?

"Based on their density, lung nodules can generally be classified into solid nodules, ground-glass nodules, and mixed-density nodules," said Xu Aimin. Nodules with higher density are usually called solid nodules; nodules with a density lower than solid nodules but higher than normal lung tissue appear as ground-glass opacities on imaging and are called ground-glass nodules; however, mixed-density nodules exhibit the characteristics of ground-glass nodules and are accompanied by solid components. Among these three types of nodules, the risk level is relatively high and requires attention.

Breast nodules

Develop the habit of breast self-examination

Many people believe that breast diseases are closely related to negative emotions. Some jokingly say, "Endure a little, and you'll get breast hyperplasia; take a step back, and you'll get breast nodules." But how much are breast nodules related to negative emotions?

"So far, there is no definitive answer in medicine," said Xu Aimin. "Clinically, breast nodules are suspected to be related to infection, injury, lifestyle habits, environment, genes, hormones, and endocrine disorders. However, a bad mood can indeed affect physical and mental health. I suggest you pay attention to regulating your emotions and try to avoid getting angry."

What are breast nodules? "Breast nodules are changes in breast shape that are detected during imaging examinations," said Xu Aimin. Most breast nodules are benign; benign lesions such as breast hyperplasia, breast cysts, breast fibroadenomas, and mastitis can all manifest as breast nodules.

How are breast nodules detected? "Patients can use examinations such as breast ultrasound and mammography to initially differentiate between benign and malignant breast lumps. Breast nodules with a diameter of less than 1 cm can generally be checked regularly," Xu Aimin explained. Currently, the BI-RADS classification is the most commonly used method in breast ultrasound reports to evaluate the benignity or malignancy of breast nodules.

Breast nodules assessed as grade 2 or lower by BI-RADS are generally benign and can be checked annually. Grade 3 nodules should be checked every 3-6 months to monitor changes. If a nodule significantly enlarges or its grade improves rapidly, it warrants attention. If a nodule is grade 4 or higher, further investigation is needed, and a biopsy may be necessary to determine its nature. Some high-risk benign tumors, such as intraductal papilloma and phyllodes tumors, may become malignant and surgical treatment is recommended.

What should you pay attention to on a medical examination report if a breast nodule is discovered? Experts explain that phrases such as "irregular shape, unclear or blurred boundaries with surrounding tissues, enlarged axillary lymph nodes, clustered microcalcifications, and posterior attenuation" are common. When these terms appear, review them promptly to determine the cause and avoid delaying treatment.

"We recommend that women develop the habit of self-examining their breasts," Xu Aimin pointed out. Compared with an annual physical examination, self-examination can detect changes in the body more promptly. "While showering, you can observe and touch your breasts for any abnormal changes. Use your fingertips to touch your breasts from bottom to top to look for any abnormal lumps. If you find any abnormal lumps or pain, you should seek medical attention promptly."

thyroid nodules

Don't worry too much about cancer.

"The thyroid gland is located at the front of the human neck, covering the front and outer sides of the trachea like a butterfly," explains Xu Aimin. Thyroid nodules are abnormally proliferating clusters of cells within the thyroid gland. Thyroid nodules can occur in proliferative diseases, neoplastic diseases, autoimmune diseases, and inflammatory diseases. "Thyroid nodules are very common. Reports show that 20% of people undergoing physical examinations discover thyroid nodules, with women being more frequently affected than men, possibly related to the levels of estrogen and progesterone in women's bodies."

Do thyroid nodules require surgery? "The most important thing about thyroid nodules is determining whether they are benign or malignant," explains Xu Aimin. Over 95% of thyroid nodules are benign, not affecting thyroid function or impacting daily life and work. Benign thyroid nodules, unless excessively large and potentially causing discomfort such as difficulty swallowing or breathing, generally do not require special treatment; regular follow-up is sufficient. If the nodule is malignant, surgical removal is the preferred treatment.

Some people worry that their thyroid nodules, currently benign, might become malignant later. Xu Aimin explains that research has found that thyroid cancer and benign thyroid nodules have their own independent "growth trees." Thyroid cancer develops directly from a normal thyroid gland and has no direct relationship with benign thyroid nodules. In other words, there's no need to worry about a thyroid nodule diagnosed as benign developing into cancer. However, current testing methods have the potential for false negatives, meaning thyroid cancer might be misdiagnosed as benign. Therefore, for thyroid nodules with suspicious signs, even if diagnosed as benign, further examination is still necessary.

How to distinguish between benign and malignant nodules? According to experts, ultrasound is currently the preferred method for screening and differentiating the nature of thyroid nodules. Ultrasound can not only identify the presence of nodules but also determine their size, number, and shape. "If the ultrasound examination shows that the nodule's length-to-width ratio is greater than 1, its shape is irregular, its borders are unclear, it is hypoechoic or very hypoechoic, and there is strong punctate calcification, this nodule should be taken very seriously. Further diagnosis is recommended, and once diagnosed, the best treatment plan should be implemented promptly," Xu Aimin pointed out. Compared with other cancers, the treatment effect of thyroid cancer is relatively ideal, so there is no need to worry too much.