Characteristics of Subsolid Pulmonary Nodules Showing Growth During Follow-up With CT Scanning

Matsuguma, Haruhisa; Mori, Kiyoshi; Nakahara, Rie; Suzuki, Haruko; Kasai, Takashi; Kamiyama, Yukari; Igarashi, Seiji; Kodama, Tetsuro; Yokoi, Kohei

doi:10.1378/chest.11-3306

Cited by 126 publications

(107 citation statements)

References 22 publications

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“…According to the follow-up data, approximately 30% of patients have multiple lung lesions (23). During the following up of GGOs, some retain their status, and others change in size or density on thin-section CT (23,(44)(45)(46)(47)(48). As mentioned above, the pathological invasive part correlates with the solid part on Figure 1 Multifocal GGO which were diagnosed to be combination of adenocarcinomas pathologically.…”

Section: Management Of Multiple Lung Nodulesmentioning

confidence: 89%

Whack-a-mole strategy for multifocal ground glass opacities of the lung

Suzuki¹

2017

J. Thorac. Dis.

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Ground glass opacity (GGO) is a good prognostic indicator for lung cancer and is useful for physicians to predict prognosis. Due to recent advances in computed tomography (CT), the chance to encounter GGO is rapidly increasing in clinical practice. Based on the studies on radiological pathological correlation, GGO represents pathological lepidic growth and consolidation on CT represents pathologically invasive components. Thus, consolidation tumor ratio 0.5 or less means pathological less invasiveness for lung cancer. Not a few studies have shown that sublobar resection is equivalent to lobectomy for radiological early lung cancers. Additionally, observation of GGO is one of the options for physicians. Indication of surgical intervention remains unclear. Physician observing GGO in practice should know the natural history of GGO to reach an optimal treatment decision. For multifocal GGO lesions clinical management is surely challenging. Whack-a-mole strategy, which means sublobar resection for radiological invasive cancer is one of the most promising strategies for such lesions.

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Section: Management Of Multiple Lung Nodulesmentioning

confidence: 89%

Whack-a-mole strategy for multifocal ground glass opacities of the lung

Suzuki¹

2017

J. Thorac. Dis.

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“…There is currently no consensus for the optimal management of concurrent GGNs identified during preoperative or postoperative follow-up CT after the resection of primary non-small cell lung cancer. A history of primary lung cancer is a well-established predictor of GGN growth (23,24). Barsky et al (25) demonstrated the increasing incidence of lepidic-type tumors, with 25% showing multifocality; most of these tumors have shown independent clonality upon genetic analyses.…”

Section: Discussionmentioning

confidence: 99%

“…The frequency of pure GGN growth in the literature is in the range of 0-46% (23,(27)(28)(29)(30). Several authors have reported that a history of lung cancer, attenuation value, initial nodule size, and a newly developed solid portion can be helpful in predicting future GGN growth (23,28,29). Chang et al (28) demonstrated that 91.7% of growing GGNs were confirmed as lung cancer upon surgical pathology.…”

Section: Discussionmentioning

confidence: 99%

The impact of chemotherapy on persistent ground-glass nodules in patients with lung adenocarcinoma

Cham

et al. 2017

J. Thorac. Dis.

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Backgrounds:To evaluate the response of persistent ground glass nodules (GGNs) in patients with lung adenocarcinoma treated with platinum-based chemotherapy on computed tomography (CT). Methods:We retrospectively studied patients with GGNs that met the following criteria: (I) GGNs found in patients with lung adenocarcinoma, which persist for more than 3 months; (II) patients treated with platinum-based (cisplatin or carboplatin) chemotherapy for at least 2 cycles; (III) ground glass proportion ≥50%. For each patient, if more than two CTs satisfied the inclusion criteria, then the baseline and last CTs were used for analysis, defined as CT1 and CT2. A total of 91 persistent pulmonary GGNs in 51 patients fulfilled the inclusion criteria. We defined growth as a nodule ≥2 mm increase in diameter or showing up a solid portion. GGN response to therapy was assessed and compared with the baseline CT. Differences in CT findings were analyzed using a paired t-test and Pearson χ 2 test. Conclusions:The clinical course of GGNs in patients with lung adenocarcinoma is predominantly indolent, and platinum-based chemotherapy may have no effect on the growth of persistent GGNs.

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“…For this reason, they are often considered for immediate resection. Nonetheless, recent reports [6,7] suggest that long-term observation of these patients may be appropriate.…”

Section: @Erspublicationsmentioning

confidence: 99%

“…For this reason, they are often considered for immediate resection. Nonetheless, recent reports [6,7] suggest that long-term observation of these patients may be appropriate.In this issue of the European Respiratory Journal (ERJ), the clinical course of 108 patients with persistent SSNs detected in the NELSON trial is reported [8], and a long-term follow-up approach is proposed on the grounds that the risk of progression of SSNs towards clinically significant lung cancer is extremely low. In principle, despite the high probability of SSNs being histologically malignant, their clinical behaviour tends to be indolent and surgical resection of all of them would therefore lead to a great number of lung resections with little real benefit, i.e.…”

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confidence: 99%

A conservative approach for subsolid lung nodules: is it safe enough?

Infante

2015

Eur Respir J

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@ERSpublicationsA long-term follow-up strategy may be reasonable for subsolid nodules at low risk of progression based on CT features http://ow.ly/HasGFWith the foreseen dissemination of lung cancer screening with low-dose spiral computed tomography (LDCT), a great number of subjects will come to medical attention harbouring small, indeterminate pulmonary nodules [1]. Subsolid lung nodules (SSNs), also called ground-glass opacities or ground-glass nodules (GGNs), are identified in 2-3% of subjects receiving a screening LDCT [2,3]. Many of them have a benign aetiology and resolve spontaneously over time. However, unlike solid nodules that represent true lung cancer in a tiny fraction of patients, nonresolving SSNs are found to be histologically malignant in 30-70% of the cases [4,5]. For this reason, they are often considered for immediate resection. Nonetheless, recent reports [6,7] suggest that long-term observation of these patients may be appropriate.In this issue of the European Respiratory Journal (ERJ), the clinical course of 108 patients with persistent SSNs detected in the NELSON trial is reported [8], and a long-term follow-up approach is proposed on the grounds that the risk of progression of SSNs towards clinically significant lung cancer is extremely low. In principle, despite the high probability of SSNs being histologically malignant, their clinical behaviour tends to be indolent and surgical resection of all of them would therefore lead to a great number of lung resections with little real benefit, i.e. to overdiagnosis and overtreatment. However, given that progression may actually occur over time, a management plan should be devised and discussed on a case by case basis.Since the mid-1990s, when the association of subsolid nodules with early-stage bronchioloalveolar carcinoma was first reported [9,10], numerous publications have addressed the clinical significance of SSNs and their relationship with the spectrum of lung adenocarcinoma [11]. A good correlation between the aspect of SSNs on computed tomography (CT), their histological features of malignancy and clinical aggressiveness was observed in Japan a long time ago [12,13] and still has practical value today, although the pathology terms have been changed for the spectrum of lung adenocarcinoma.Pure GGNs of <10 mm are most likely benign atypical adenomatous hyperplasia or, more rarely, adenocarcinoma in situ (AIS). Pure GGNs measuring 10-30 mm reflect AIS or minimally invasive lepidic adenocarcinoma. A solid component in a GGN often reflects tumour invasion of the interstitium; the larger the solid part on CT, the larger the area of invasion [14,15]. The relative and absolute sizes of the solid component are also known to correlate with the probability of nodal metastasis, recurrence after surgery and death. Pure GGNs have virtually no probability of nodal involvement, whereas for part-solid nodules, the risk rises to about 15%, and to ∼30% for solid nodules [15,16].In a recent report on 145 patients with resected stage I lung adenocarcinom...

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Characteristics of Subsolid Pulmonary Nodules Showing Growth During Follow-up With CT Scanning

Cited by 126 publications

References 22 publications

Whack-a-mole strategy for multifocal ground glass opacities of the lung

Whack-a-mole strategy for multifocal ground glass opacities of the lung

The impact of chemotherapy on persistent ground-glass nodules in patients with lung adenocarcinoma

A conservative approach for subsolid lung nodules: is it safe enough?

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