Outcomes of Unresected Ground-Glass Nodules with Cytology Suspicious for Adenocarcinoma

Gulati, Caroline M.; Schreiner, Andrew M.; Libby, Daniel M.; Port, Jeffrey L.; Altorki, Nasser K.; Gelbman, Brian D.

doi:10.1097/jto.0000000000000143

Cited by 24 publications

(10 citation statements)

References 25 publications

(7 reference statements)

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“…Case series of more than 100 SSNs, whether all resected or managed by follow-up and resection of selected nodules, report few deaths due to cancer109 110 115 One study found that even when SSNs with suspicious cytology are observed, the outcome is still good 127. These observations have led some authors to suggest that less aggressive treatment is more appropriate.…”

Section: Management Of Ssnsmentioning

confidence: 99%

British Thoracic Society guidelines for the investigation and management of pulmonary nodules: accredited by NICE

Callister

Baldwin

Akram

et al. 2015

Thorax

710

724

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Section: Management Of Ssnsmentioning

confidence: 99%

British Thoracic Society guidelines for the investigation and management of pulmonary nodules: accredited by NICE

Callister

Baldwin

Akram

et al. 2015

Thorax

710

724

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“…For example, the selection of patients for limited surgical resection in ongoing clinical trials is largely restricted to lesion size, highlighting the need for accurate and consistent interpretation tools 32 . Ideally, treatment strategies including standard lobectomy, limited local resection (wedge or segmentectomy), stereotactic body radiation therapy and watchful waiting 33, 34 should be individualized based on the aggressiveness of the lesion.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Risk Stratification of Lung Adenocarcinoma using Quantitative Computed Tomography

Raghunath

Maldonado

Rajagopalan

et al. 2014

Journal of Thoracic Oncology

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Introduction Lung cancer remains the leading cause of cancer-related deaths in the US and worldwide. Adenocarcinoma is the most common type of lung cancer and encompasses lesions with widely variable clinical outcomes. In the absence of noninvasive risk stratification, individualized patient management remains challenging. Consequently a subgroup of pulmonary nodules of the lung adenocarcinoma spectrum is likely treated more aggressively than necessary. Methods Consecutive patients with surgically resected pulmonary nodules of the lung adenocarcinoma spectrum (lesion size ≤ 3 cm, 2006–2009) and available pre-surgical high-resolution computed tomography (HRCT) imaging were identified at Mayo Clinic Rochester. All cases were classified using an unbiased Computer-Aided Nodule Assessment and Risk Yield (CANARY) approach based on the quantification of pre-surgical HRCT characteristics. CANARY-based classification was independently correlated to postsurgical progression-free survival. Results CANARY analysis of 264 consecutive patients identified three distinct subgroups. Independent comparisons of 5-year disease-free survival (DFS) between these subgroups demonstrated statistically significant differences in 5-year DFS, 100%, 72.7% and 51.4%, respectively (p = 0.0005). Conclusions Non-invasive CANARY based risk stratification identifies subgroups of patients with pulmonary nodules of the adenocarcinoma spectrum characterized by distinct clinical outcomes. This technique may ultimately improve the current expert opinion-based approach to the management of these lesions by facilitating individualized patient management.

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“…In a recent study [36], similar outcomes were observed for subjects with SSNs and biopsy-proven early adenocarcinoma who elected to be followed instead of undergoing immediate resection. This study was, however, small and biased by selection.…”

Section: @Erspublicationsmentioning

confidence: 49%

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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Outcomes of Unresected Ground-Glass Nodules with Cytology Suspicious for Adenocarcinoma

Abstract: Ground-glass lesions that were observed after biopsy did not demonstrate any increased rates of metastasis or cancer-related deaths and delayed resection does not seem to have a negative effect on outcomes.

Cited by 24 publications

References 25 publications

British Thoracic Society guidelines for the investigation and management of pulmonary nodules: accredited by NICE

British Thoracic Society guidelines for the investigation and management of pulmonary nodules: accredited by NICE

Noninvasive Risk Stratification of Lung Adenocarcinoma using Quantitative Computed Tomography

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

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