Lung nodules — small, round growths often discovered by chance during scans — are a common but sometimes worrying finding in medical imaging. While most are harmless, some may signal early signs of lung cancer, requiring careful medical evaluation and follow-up.
According to senior cardiothoracic surgeon Professor Dr Anand Sachithanandan, most lung nodules are benign, caused by scar tissue, inflammation, or past infections. However, determining their nature depends on multiple factors — including size, growth rate, shape, and patient risk profile.
“We look at the patient’s age, smoking status, family and cancer history, ethnicity, and nodule features,” Dr Anand said. “Based on this, we decide the next step.”
Lung disease remains a leading cause of hospitalisation and death in Malaysia, with lung cancer ranking second among men and third among women, according to the Malaysian Cancer Registry Report (2017–2021). Alarmingly, most cases — 76% of men and 94% of women — are only diagnosed at advanced stages (Stage 3 or 4), when treatment options are limited.
Public awareness and early detection, particularly during Lung Cancer Awareness Month, are crucial for improving survival outcomes.
Traditionally, nodules smaller than 1cm are difficult to biopsy or remove. Doctors often must wait several months to monitor growth — a delay that causes anxiety and could risk cancer progression.
To overcome this, surgeons are now using indocyanine green (ICG) — a fluorescent dye that glows bright green under near-infrared light — to pinpoint even the smallest nodules during minimally invasive keyhole surgery (VATS).
In this technique, an interventional radiologist injects the ICG dye near the lung nodule under CT guidance a few hours before surgery. During the operation, a video telescope equipped with infrared imaging allows the surgeon to see the glowing green area, guiding precise removal of the affected tissue without damaging surrounding lung structures.
“The injected area lights up, allowing us to target it safely and quickly,” Dr Anand explained. “Within 15 minutes, the pathologist can tell us if it’s cancerous, so we can decide immediately whether to remove more tissue or nearby lymph nodes.”
Unlike the liver, lung tissue does not regenerate, but Dr Anand said patients can still lead active lives even after partial lung removal (lobectomy).
“We only need one healthy lung to live well. Many patients return to normal activities — even hiking — after recovery,” he said.
So far, about 15 patients in Malaysia have undergone this ICG-guided surgery, including two with prior cancers — one of the colon and one of the cervix. In both cases, the lung nodules turned out to be metastatic tumours, detected early through routine PET scans.
“These surgeries were diagnostic, staging, and therapeutic — all done in one sitting,” Dr Anand said.
He noted that the new technology represents a multi-disciplinary breakthrough, combining the expertise of surgeons, radiologists, pathologists, and anaesthetists, ensuring faster diagnosis, minimal trauma, and quicker recovery.
“This innovation highlights the importance of teamwork in improving cancer care,” he concluded.
