Ms. San discovered a tiny 7x7 mm lung nodule 8 months ago. It was initially monitored without immediate intervention. A recent check-up showed the nodule had grown to 7x9 mm, classified as Lung RADS 4B, indicating a 30-50% risk of malignancy.

Doctor Le Chi Hieu, from the Center for Thoracic and Vascular Surgery at Tam Anh General Hospital, TP HCM, explained that the nodule was too small. A needle biopsy might miss the target or not yield sufficient tissue, potentially overlooking malignant cells. Ms. San's age, obesity (BMI 27,30), and the thick layer of fat in her chest wall and surgical area, coupled with the nodule being less than 1 cm, made direct observation on the lung surface difficult.

Following a consultation, the surgical team decided to remove the lesion using the Da Vinci Xi robot, which integrates fluorescence imaging technology (ICG). This eliminated the need for a separate device to inject fluorescent dye into the patient, a step previously required.

Surgeons observe the surgical monitor to pinpoint the location of the cancerous lung nodule. *Photo: Tam Anh General Hospital*

Doctor Nguyen Anh Dung, Head of the Department of Thoracic and Vascular Surgery at the Center for Thoracic and Vascular Surgery, Tam Anh General Hospital, TP HCM, explained that after a slow injection of 10 ml of fluorescent dye via a peripheral intravenous line, the lung region containing the tumor and healthy tissue became clearly distinguishable.

Doctor Dung skillfully guided the robotic arms through the narrow confines of the chest cavity, maneuvering past adipose tissue to reach the target location. The lung nodule was excised and sent for frozen section biopsy. After 30 minutes, the results confirmed malignancy, prompting the robotic arms to assist the team in resecting the affected lung lobe and performing lymph node dissection.

Subsequent pathology results confirmed the tumor was malignant, but all lymph nodes were benign, and malignant cells had not metastasized distantly. This led to a diagnosis of stage 1B lung cancer. Thanks to the radical surgery, Ms. San did not require chemotherapy, radiation therapy, or other adjuvant therapies, only scheduled follow-up appointments.

Early-stage lung cancer often presents without noticeable symptoms such as coughing, chest pain, or shortness of breath. Therefore, detecting small lesions typically relies on imaging diagnostics.

According to Doctor Dung, several lung cancer screening methods are available: chest X-rays, bronchoscopy, low-dose computed tomography (ldct), and tumor marker tests. ldct is recommended for long-term smokers, individuals working in hazardous environments, those with a family history of lung cancer, or individuals aged 50 and above with risk factors. Doctors may suggest different screening intervals based on age, smoking history, and other risk factors.

Doctors advise adults not to smoke, to limit exposure to secondhand smoke, and to protect their lungs if working in dusty or chemically hazardous environments. Upon discovering a lung nodule, patients should adhere to scheduled follow-up appointments so doctors can monitor changes in tumor size and morphology, and intervene promptly.

Thu Ha

*Patient's name has been changed