Ground glass opacities management in the lung cancer screening era

Abstract

Pulmonary ground glass opacity (GGO) is becoming an important clinical dilemma in oncology as its diagnosis in clinical practice is increasing due to the introduction of low dose computed tomography (CT) scan and screening. The incidence of cancer in GGO has been reported as high as 63%. The purpose of this manuscript is to review best available evidence papers on management of GGO in lung cancer to address the following questions: (I) how to correlate CT findings with malignancy; (II) when and who operate? (III) how to perform intraoperative detection of intrapulmonary GGO? (IV) wedge, segmentectomy or lobectomy? Taking a cue from a clinical scenario, a review on PubMed was conducted. The words search included: "Lung ground glass opacity". The research was limited to human and adults. We considered all published articles from 1990 to April 2017, which reported on at least sufficient data, to be eligible. The literature search was limited to articles in English. A total of 1,211 articles have been found. Interestingly, while in 1991, only one paper was published on low-dose high-resolution CT, in 2016, 126 papers have been published. Most cited and recent papers have been chosen for discussion. Many recent papers have been published from Asian groups. It is clearly not possible to conclude from these data what is the best strategy for GGO in the lung cancer screening era. Certainly, when there is uncertainty, personal opinion and experience should not influence decision making, on the contrary decision should be taken by a multidisciplinary team.

Clinical characteristics of resected solitary ground‐glass opacities: Comparison between benign and malignant nodules

“…Previous studies also suggested that an increase in size or solid component might predict a malignant tendency. 13,14 In our study, we did not observe a significant increase in size (P = 0.087). This might be because the follow-up time in our study was shorter than that in other studies, which were usually long-term studies.…”

The Epidemiology of Ground Glass Opacity Lung Adenocarcinoma: A Network-Based Cumulative Meta-Analysis

“…The GGO manifestation generally correlates with a lepidic, in situ, non-invasive growth pattern of cells along preexisting alveolar structures (4). A previous study has reported that GGO lung cancer may have several unique features, including an insignificant association with smoking history and a low degree of invasive biological characteristics (3). As the importance of GGO lung cancer is increasing, more researches have focused on the diagnosis and treatment of this early stage lung cancer; however, the epidemiology of lung cancer with GGO manifestation has not yet been fully elucidated.…”

“…Due to the introduction of low-dose computed tomography (CT) and screening procedures, the number of diagnoses of pulmonary ground glass opacity (GGO) lung cancer in clinical practice is increasing (1,2). The GGO manifestation is generally caused by local airspace filling as a result of inflammation or neoplastic proliferation, and some studies reported that the malignancy rate of GGO was 63%, which has a higher malignant potential than solid nodules (3,4). The GGO manifestation generally correlates with a lepidic, in situ, non-invasive growth pattern of cells along preexisting alveolar structures (4).…”

Value of TSCT Features for Differentiating Preinvasive and Minimally Invasive Adenocarcinoma From Invasive Adenocarcinoma Presenting as Subsolid Nodules Smaller Than 3 cm

“…Therapeutic strategies depend on the subtype of adenocarcinoma classification. Patients with pre/MIA are more amenable to sublobar resection (wedge resection or segmentectomy) to preserve more pulmonary function to be able withstand further pulmonary resection if a second primary lung cancer develops in the future (15,16). However, patients with IA should more preferably undergo lobectomy (17).…”