Pulmonary Lesions: Types, Treatment, and Thoracic Surgery’s Role

For patients with primary tumors located in the lungs, the approach to managing pulmonary lesions should be tailored to the individual’s overall condition.

Key factors include cardiopulmonary function, the number of lesions, and their distribution within the lungs.

When new pulmonary lesions are identified, a comprehensive assessment becomes even more essential to determine the most appropriate and effective treatment plan.

Overview of Pulmonary Lesion Management

Condition	Type	Management Approach	Follow-up Method
Solitary Pulmonary Lesion	Newly Diagnosed Primary Lung Cancer	Surgical resection + further treatment based on pathological staging	Regular follow-up for stage I; systemic therapy added for stage II and above
	Recurrent Lung Cancer	Surgical resection + targeted therapy based on genetic testing	Follow-up evaluation every 3 months
Multiple Pulmonary Lesions in One Lung	Newly Diagnosed Multiple Primary Lung Cancers	Surgical resection of all lesions	Further treatment determined by pathological staging
	Recurrent Lung Cancer	Surgical resection + targeted therapy based on genetic testing	Follow-up evaluation every 3 months
Multiple Pulmonary Lesions in Both Lungs	Oligometastatic Lung Disease	Surgical resection of one side depending on condition; further treatment based on response	Targeted therapy based on genetic testing
	Non-oligometastatic Lung Disease	Systemic therapy initiated after obtaining pathological diagnosis	Consider local control based on treatment response

Pulmonary Lesions: How Is a Solitary Lesion Treated?

★ Histological type differs from previous tumor

If positron emission tomography (PET) and brain magnetic resonance imaging (MRI) reveal no evidence of other metastases, and the histological type differs from the previous tumor, the lesion may represent a new primary lung cancer.

Patients will first undergo a cardiopulmonary function assessment.

If there are no contraindications for lung surgery, surgical resection and mediastinal lymph node dissection may be considered.

Further Treatment and Follow-Up Planning Based on Pathological Staging:

Further Treatment – Solitary Primary Pulmonary Lesion

• Stage I: Regular postoperative follow-up visits
• Stage II and above: Consider systemic therapy to reduce the risk of recurrence

★ Histological type is the same as the previous tumor

From a clinical perspective, the lesion is considered a recurrence of the previous tumor.

Before initiating treatment, further evaluation with positron emission tomography (PET) and brain magnetic resonance imaging (MRI) is required to assess the extent of disease throughout the body.

Treatment Recommendations

• Surgical resection for lung cancer may be performed to achieve maximum tumor debulking.
• Genetic testing of the tumor tissue should be conducted to guide subsequent targeted therapy.
• Regular follow-up: Disease status should be evaluated every three months.

Unilateral Multiple Pulmonary Lesions

★ Different histology from previous tumor (possible second primary lung cancer)

PET and brain MRI show no other metastases → possible new primary lung cancer

Treatment Recommendations:

1. Perform a cardiopulmonary function assessment first.
2. If there are no surgical contraindications, consider resecting all lesions.
3. Determine further treatment and follow-up plans based on pathological staging.

★ Same histology as previous tumor

Treatment principles are the same as for solitary lesions.

1. Evaluate with positron emission tomography (PET) and brain magnetic resonance imaging (MRI).
2. If no distant metastasis is confirmed, consider surgical resection of all lesions.
3. Perform genetic testing to guide the selection of targeted therapy.
4. Conduct follow-up visits every three months to monitor disease progression.

Bilateral Multiple Pulmonary Lesions

These patients have a high risk of recurrence, and the management approach should be based on recurrence principles.

★ Oligometastasis (limited metastasis)

Normal cardiopulmonary function：

• Surgically resect the more severe pulmonary lesions on one side first.
• Perform genetic testing based on the pathological specimen.
• Determine systemic therapy according to the results of genetic testing.
• Decide whether to resect contralateral lesions based on imaging evaluation.

Impaired cardiopulmonary function：

• Perform a biopsy on the largest lesion to confirm the diagnosis.
• Determine subsequent systemic therapy based on the results of genetic testing.

★ Non-oligometastatic disease (multiple metastases)

• Obtain sufficient tissue from the pulmonary lesions to confirm the diagnosis.
• Determine subsequent drug therapy based on the results of genetic testing.
• Consider local control measures depending on the response to systemic treatment.

Thoracic Surgery’s Role in Pulmonary Lesion Management

Different types of pulmonary lesions require different treatment strategies, highlighting the importance of accurate diagnosis and personalized therapy.

In clinical practice, thoracic surgery plays a critical role. With advanced surgical techniques, thoracic surgeons provide patients with the most appropriate treatment options–whether it involves resection of a solitary lesion or comprehensive management of multiple lesions.

Moreover, with advances in genetic testing and imaging technologies, medical teams are now able to design more precise treatment plans, reduce the risk of recurrence, and improve patients’quality of life.

As such, the management of pulmonary lesions should involve a multidisciplinary approach–combining thoracic surgery, medical oncology, and radiologic diagnostics–to ensure patients receive the most comprehensive and effective care.