Limited resection trial for pulmonary ground-glass opacity nodules: Fifty-case experience

Nagai, Kanji; Yokose, Tomoyuki; Nishimura, Mitsuyo; Kakinuma, Ryutaro; Ohmatsu, Hironobu; Nishiwaki, Yutaka

doi:10.1016/j.jtcvs.2004.07.038

Cited by 166 publications

(131 citation statements)

References 19 publications

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“…In the trial reported by YOSHIDA et al [61], this intra-operative assessment took ,1 h. There was agreement with the definitive post-operative pathological study in all specimens but one, which was changed from Noguchi's type B to C. However, other authors have reported difficulties in assessing the difference between BAC, atypical adenomatous hyperplasia, peripheral carcinoid tumours and other lesions [65]. If the intra-operative diagnosis of BAC is certain to the best of the pathologist's knowledge, then, according to the results of the series shown in table 2, a sublobar resection with no nodal dissection may be enough to ensure complete resection.…”

Section: Combined Therapiesmentioning

confidence: 97%

“…Table 2 summarises the data from nine Japanese reports focused on the surgical treatment of small BACs, currently f2 cm in diameter or less, although two series include larger tumours [13,[55][56][57][58][59][60][61][62]. In most reports, these small BACs represent ,2% of the lung cancer series, and were treated by either lobectomy or sublobar resection.…”

Section: Combined Therapiesmentioning

confidence: 99%

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Sublobar resection for lung cancer

Rami–Porta

Tsuboi²

2008

European Respiratory Journal

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Sublobar resection for small lung cancers has been debated frequently and is still a controversial issue. The only randomised trial comparing lobectomy with sublobar resections found a significantly higher recurrence rate for the latter, but failed to show significant differences in survival, although survival was better for the lobectomy group. One meta-analysis and several nonrandomised comparisons have confirmed these results. In general, lobectomy and sublobar resections have similar 5-yr survival rates. Local recurrence after wedge resection is higher than after segmentectomy. However, for patients aged .71 yrs, lobectomy and wedge resection are associated with similar survival. For tumours of f2 cm, segmentectomy is equivalent to lobectomy, but survival after segmentectomy is worse if performed for larger tumours. For both segmentectomy and wedge resection, tumour margins should be o1 cm wide to avoid recurrence. For pure bronchioloalveolar carcinoma of f2 cm, diagnosed intraoperatively with certainty, sublobar resection seems equivalent to lobectomy, and because there is no nodal involvement, systematic nodal dissection may not be necessary. In case of doubt, however, lobectomy with systematic nodal dissection will ensure complete resection and adequate staging. More randomised trials are needed to confirm all these issues.

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Section: Combined Therapiesmentioning

confidence: 97%

Section: Combined Therapiesmentioning

confidence: 99%

Sublobar resection for lung cancer

Rami–Porta

Tsuboi²

2008

European Respiratory Journal

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“…The authors stated that they had reviewed 11 thousand citations from which they selected 312 that 'met specified eligibility.' The citations supporting their notion, interestingly, have been presented as series of bronchioloalveolar carcinomas or small adenocarcinomas (o2 cm) [29][30][31][32][33][34][35][36][37][38][39][40][41] (Table 5). In some of these, the actual size of the tumor has been at best vague leaving the impression that some of these lesions may not even qualify as adenocarcinoma, but would rather have to be classified as atypical adenomatous hyperplasia (tumors with lepidic growth and size r0.5 cm).…”

Section: Discussionmentioning

confidence: 98%

Early-stage pulmonary adenocarcinoma (T1N0M0): a clinical, radiological, surgical, and pathological correlation of 104 cases. The MD Anderson Cancer Center Experience

et al. 2013

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The recent proposal for histological subtyping of pulmonary adenocarcinoma by predominant pattern and introduction of the terms adenocarcinoma in situ and minimally invasive adenocarcinoma to replace the term bronchioloalveolar carcinoma by the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society has led us to conduct a study of 104 patients with early-stage primary pulmonary adenocarcinoma (T1N0M0), with a view to histological subtype as defined by the new proposal and clinical outcome. None of the clinical parameters of our patient population (type of surgery, age, gender, tumor size, and comorbidities) showed any statistically significant correlation with outcome, except for associated malignancies, which not surprisingly appeared to have a negative impact on survival. In addition, statistical analyses of the histological characteristics to include tumor differentiation and the percentage of a lepidic or bronchioloalveolar component did not show any statistically significant values in terms of survival. Our results failed to show any statistically significant difference of survival between those T1N0M0 adenocarcinomas with a lepidic component and those without, thus questioning the use of terms such as in situ or minimally invasive adenocarcinoma. On the basis of our results, we consider that the outcome for patients with T1N0M0 disease is still best determined by appropriate staging rather than by changes in the pathology nomenclature of adenocarcinoma. The number of deaths due to lung cancer among this group was approximately 158 thousand. Also according to SEER, the age group more commonly affected is individuals between the ages of 55 and 74 years, with a median age at diagnosis of 71 years. Although lung cancer is also seen in younger age groups, people under 45 years of age represent approximately 2% of the total number of cases, while those people between the ages of 45 and 54 years represent approximately 9% of the total number of cases. It is also suggested that factors such as smoking, dietary habits, family history, and chemical exposure to compounds such as asbestos, radon, and silica among many others may play a role in lung cancer pathogenesis. Of all the different types of lung cancer, adenocarcinoma is currently the most frequent.In an effort to better define clinical behavior regarding small size adenocarcinomas, various studies have used different ways to address this issue.

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“…The standard of care for early stage lung ADC is lobectomy, but segmentectomies and wedge resections are now more common alternatives, particularly for small (<2 cm) lesions (42). Radiologic evidence has shown the wedge/ segmentectomy may be appropriate for small tumors with a ground glass or predominantly ground glass appearance (43,44). These tumors for the most part correspond to AIS and MIA (38).…”

Section: Treatment Implications Of the New Classification Systemmentioning

confidence: 99%

“…These tumors for the most part correspond to AIS and MIA (38). While pure ground glass tumors have a 100% DFS survival after limited resection there are instances, albeit rare, where recurrences have occurred at the resection margin (44).…”

Section: Treatment Implications Of the New Classification Systemmentioning

confidence: 99%

Surgical pathology of early stage non-small cell lung carcinoma

2016

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While limited resection appears to be suitable for tumors with a ground glass radiographic appearance, which typically correspond to adenocarcinoma in situ (MIS) or minimally invasive adenocarcinoma (MIA) histologically, the role of sublobar resection in radiographic solid tumors is not as clear, and the impact of histologic subtypes with a poor prognosis needs further evaluation. Squamous cell carcinoma (SCC) has not been as extensively studied and the current classification lacks subclassification with significant prognostic information.

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Limited resection trial for pulmonary ground-glass opacity nodules: Fifty-case experience

Abstract: Noguchi type A and B tumors may well be in situ carcinomas, and frozen-section examination was highly accurate. Neither local recurrence nor distant metastases have been found to date. Limited resection initial results appear promising.

Cited by 166 publications

References 19 publications

Sublobar resection for lung cancer

Sublobar resection for lung cancer

Early-stage pulmonary adenocarcinoma (T1N0M0): a clinical, radiological, surgical, and pathological correlation of 104 cases. The MD Anderson Cancer Center Experience

Surgical pathology of early stage non-small cell lung carcinoma

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