With the development of medical technology, the diagnosis and level of lung cancer are constantly improving.
However, in practice, we still face many challenges, one of which is how to identify multi-site lung tumor-like nodules.
In order to solve this problem, in 2013, the ACCP revised the Martini-Melaed diagnostic criteria, proposing a new, more detailed differential diagnosis criteria for multisite lung tumor-like nodules.
This article will explain this new standard in detail, in order to provide a useful reference for the majority of clinicians.
1. Diagnostic criteria for simultaneous multiple primary lung cancer.
Clinically, we have found that many patients have multiple lung cancer lesions at the same time, which may come from different parts of the same lung lobe or from different lobes.
In addition, the histological types of these lesions may also be different, such as adenocarcinoma, squamous cell carcinoma, etc.
Therefore, when making a differential diagnosis, we need to pay attention to the differences between these lesions, such as histological type, site of origin, and molecular genetic characteristics.
Same histological type but different anatomical location (different lobes) and absence of N2, N3 lymph node metastases and distant metastases In some cases, patients may have multiple lung cancer lesions with the same histological type, but they may be located in different lobes.
At this point, we need to further observe the anatomical location of these lesions to ensure that they are not from the same lobe.
In addition, we need to pay attention to whether these lesions are accompanied by N2, N3 lymph node metastases and distant metastases.
If none of these lesions are present, then we can consider them to be simultaneous multiple primary lung cancer.
2. Diagnostic criteria for metachronous multiple primary lung cancer.
Different histological types or sites of origin or molecular genetic characteristics are different from simultaneous multiple primary lung cancer, which refers to the occurrence of multiple lung cancer foci in a period of time.
In this case, we need to focus on the differences between these lesions, such as histological type, site of origin, and molecular genetic characteristics.
It is only when there are significant differences between these lesions that we can consider it as metachronous multiple primary lung cancer.
With the same histological type but a 4-year interval between lung cancer findings and no extrapulmonary metastases, some patients may have no lung cancer lesions for a long time and at some point suddenly develop multiple lung lesions.
In this case, we need to focus on the time interval between these lesions.
If there is an interval of 4 years between the two lung cancer detections and the patient does not have extrapulmonary metastases, then we can consider it to be metachronous multiple primary lung cancer.
However, if there is a short interval between lung cancer detections, or if the patient has extrapulmonary metastases, then further testing is required to rule out the possibility of primary lung cancer.
In conclusion, the ACCP criteria provide more detailed guidance for the differential diagnosis of multisite lung tumor-like nodules.
In practice, we need to analyze and judge according to the specific situation of the patient, combined with the ACCP criteria, so as to provide patients with more accurate and timely diagnosis and recommendations.