A false alarm of "lung cancer", why does CT examination suggest malignant lesions? After biopsy, it is benign.

Xifeng is 50 years old. Recently, she has frequent cough and general weakness. She hurried to the hospital to take a chest CT. The results showed that there were multiple masses and bilateral pleural effusion, and the serum tumor markers were abnormally increased. PET-CT examination also suggests malignant lesions. All the evidence seems to be consistent with the characteristics of malignant tumor. It was like a bolt from the blue for Xifeng. Is it really advanced lung cancer?

However, in the eyes of respiratory doctors, there is still a saying that it is best to check everything, which means that pathological biopsy is the gold standard for diagnosing lung masses, so the doctor arranged for her to make further examination and finally make a definite diagnosis. She doesn't have lung cancer, but sarcoidosis, a benign granuloma disease. What is sarcoidosis? Why is it so similar to lung cancer in imaging? Let's take a look at it next.

Sarcoidosis is a multi-system positive granulomatous disease with unknown causes, which mainly invades the lung and lymph node system, followed by the eye and skin system. About 50% patients can have no symptoms, just take X-rays or chest CT during physical examination and then be found. The typical imaging manifestations are bilateral hilar symmetric lymphadenopathy, while patients with severe sarcoidosis may show symptoms such as cough, hemoptysis, chest pain, dyspnea, erythema nodosum, ocular nodules, anemia and neuritis.

The diagnosis of sarcoidosis should meet three conditions:

First of all, the imaging findings are consistent with the characteristics of sarcoidosis, such as mass, bilateral hilar symmetric lymphadenopathy and mediastinal lymphadenopathy.

2. Pathological biopsy was consistent with non-caseous granulomatous lesions.

Third, rule out tuberculosis and tumors.

Asymptomatic sarcoidosis does not require special treatment for the time being. If symptoms appear, prednisone is often used in the treatment, and the course of treatment is long, often taking 6 months to 24 months. If the patient is intolerant to glucocorticoid, other immunosuppressants, such as methotrexate, azathioprine or infliximab, can be considered. Because the recurrence rate of sarcoidosis is very high, cured patients usually need to be followed up for 3 to 6 months until their condition is stable.

As mentioned above, after giving Feng Jie prednisone orally for one month, CT scan showed that her bilateral pleural effusion and lung mass had completely disappeared. After that, she checked every three months and followed up for two years. During this period, her condition was stable and the lesion did not recur.

The incidence of lung cancer is getting higher and higher, and it has become the largest malignant tumor in the world. CT screening of high-risk patients can find diseases as early as possible and treat them in time, but can CT examination be the only criterion for diagnosing lung cancer? Through Feng Jie's case, we found that there are still many misunderstandings in the screening and treatment of lung cancer.

First of all, imaging examination, such as CT or PET-CT, may have some errors, some benign lesions, and there may be reports of suspected malignant tumors. Many outpatients give up further examination and treatment immediately after getting the examination results. This is not right. Once they find any problems with their lungs, they should go to the clinic to seek the diagnosis of professional doctors.

Secondly, in recent years, the role of tumor serum markers has been exaggerated, especially in many physical examination items, which claim to be able to screen tumors. In fact, high serum tumor markers are not necessarily tumors. Many patients are particularly nervous when the serum tumor markers are high. They feel that they have a tumor and feel restless all night, making it difficult to sleep. If the serum tumor markers are high, we must judge the condition of the whole patient and don't be blindly nervous.

Finally, even if the lung mass and pleural effusion are not necessarily malignant, when we find a lung mass, we can further make a comprehensive judgment through other examination methods to avoid blindly judging ourselves or searching online, causing unnecessary tension.

Collaborator of this medical content: Gu Xing, chief physician of Department of Respiratory and Critical Care Medicine, Xi Chest Hospital.