Long-Term Follow-Up of Ground-Glass Nodules After 5 Years of Stability

Abstract

Introduction: Small ground-glass nodules (GGNs) or those with an indeterminate risk on low-dose computed tomography (LDCT) of the chest are recommended at 5-year follow-up, but the rationale for follow-up beyond 5 years is unclear. Methods: An observational study was conducted to investigate the natural course of GGNs that had been stable for 5 years by LDCT over 10 years. All eligible GGNs were detected during regular health checkups. Baseline characteristics were compared between GGNs with and without growth. Risk factors for GGN growth were evaluated. Results: A total of 208 GGNs were detected in 160 participants. GGN growth was identified in 27 (13.0%) GGNs during a follow-up of 136 months on LDCT scans. In approximately 95% of these GGNs, the initial size was less than 6 mm, with 3.2 mm of growth over 8.5 years. Biopsies were performed in 3 of 27 GGNs, revealing adenocarcinoma. In 8 of 27 cases, GGN growth preceded the development of a new solid component. In a multivariate analysis, bubble lucency (p ¼ 0.001), a history of cancer other than lung cancer (p ¼ 0.036), and development of a new solid component (p < 0.001) were significant risk factors for GGN growth. Conclusions: GGNs should not be ignored, even when smaller than 6 mm and stable for 5 years, especially when a new solid component appears during follow-up.

Single-cell transcriptome atlas of lung adenocarcinoma featured with ground glass nodules

“…The more accepted surgical indications for GGNs are changes in the property of GGNs, such as an increase in size of lesions, pleural depression, or changes in GGN components (pure GGN becomes mixed GGN or mixed GGN becomes solid nodules). Recent studies reported that patients with GGN had excellent long-term overall survival, which suggested that these patients had low-grade malignancies and excellent prognoses 5,41 . The majority of patients with GGNs receive routine CT examinations.…”

“…GGNs that persist for years present slow growth 4 . A follow-up study on GGNs reported that 208/351 GGNs remained stable within the first 5 years, and even after 5 years, only 27 GGNs showed signs of growth, while no deaths were found in the cohort during the long-term follow-up 5 . Overall, GGNs have low malignant potential and present a good prognosis, which is between benign lesions and malignant tumors.…”

What’s New on Quantitative CT Analysis as a Tool to Predict Growth in Persistent Pulmonary Subsolid Nodules? A Literature Review

“…According to some authors [3,15], Eguchi et al [25] observed a strong correlation with smoking history. Differently, as reported in other studies [47,53,54] Tamura et al [24] and Borghesi et al [29] found that an oncological history (lung or other cancers) was a significant risk factor for growth.…”

“…Furthermore, due to the typical indolent course of SSNs and their slow growth rate, it is possible that most SSNs will never become active cancer [8,[11][12][13][14][15]. Therefore, it is not yet clear which persistent SSNs should be surgically removed and for how many years stable SSNs should be monitored [8,[47][48][49].…”

Commentary: Preoperative localization of “hard-to-find” pulmonary ground-glass opacity: There are more than one way to find the target

“…Looking into the future, there is no doubt there will be an ever-increasing demand for surgical management of GGOs in the decades to come. Thoracic surgeons not only need to master the nuances of the pre-, intra-, and postoperative management of this complex form of pulmonary neoplasms but should also participate in and ideally lead translational research and technology development to facilitate care for this patient population, for instance, understanding the natural history of GGOs, 6 identifying radiologic features of invasiveness, 7 and developing tumor-specific and noninvasive tumor localization technology-molecular imaging, 8 to name a few. Moreover, only by forming a close collaboration with other relevant specialties can we, as clinicians, move the field forward.…”