Predictive Value of One-Dimensional Mean Computed Tomography Value of Ground-Glass Opacity on High-Resolution Images for the Possibility of Future Change

Tamura, Masaya; Shimizu, Yosuke; Yamamoto, Toru; Yoshikawa, Jun; Hashizume, Yasuo

doi:10.1097/jto.0000000000000117

Cited by 54 publications

(66 citation statements)

References 18 publications

(8 reference statements)

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“…KIM et al [31] reported an error margin of -18% to +19% for automated mass measurements of SSNs, which is comparable with the results of SCHOLTEN et al [8]. An increase in mass of <30% may be a reliable indicator of an indolent lesion so, clearly, reliable automated measurements of SSN volume and mass would be desirable, but it seems that clinically significant progression of SSNs may still be grossly estimated even without volumetric software in a community setting [25,32,33].…”

Section: @Erspublicationssupporting

confidence: 70%

“…Several reports indicate that a history of previous lung cancer, increasing age and smoking history, but especially whole nodule size and the size of its solid component are major risk factors for progression during follow-up [24][25][26][27]. Progression can manifest itself as an increase in nodule size, the appearance of a new solid component, an increase in the size of an already existing one or more than one of these; rarely, the nodule may shrink while a solid core appears, reflecting tumour invasion into the stroma or, in some cases, nodule density increases (i.e.…”

Section: @Erspublicationsmentioning

confidence: 99%

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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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Section: @Erspublicationssupporting

confidence: 70%

Section: @Erspublicationsmentioning

confidence: 99%

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

Infante

2015

Eur Respir J

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“…The association between adenocarcinoma, which accounts for virtually all subsolid lung cancers, and smoking is weaker than the association between small cell or squamous cell carcinomas and smoking, and the incidence of adenocarcinoma in nonsmokers is increasing, with female nonsmokers being affected significantly more often than male nonsmokers (75,77). However, the degree to which smoking affects the risk for lung adenocarcinoma has not been clearly defined; thus, our recommendations for management of subsolid nodules are independent of customary risk categories (78).…”

Section: Tobacco and Other Inhaled Carcinogensmentioning

confidence: 99%

“…Cigarette smoking has been established as the major risk factor for lung cancer since the 1960s, with a 10-to 35-fold increased risk when compared with that in nonsmokers, and exposure to secondhand smoke is a proven, albeit lesser, risk factor (75)(76)(77). The association between adenocarcinoma, which accounts for virtually all subsolid lung cancers, and smoking is weaker than the association between small cell or squamous cell carcinomas and smoking, and the incidence of adenocarcinoma in nonsmokers is increasing, with female nonsmokers being affected significantly more often than male nonsmokers (75,77).…”

Section: Tobacco and Other Inhaled Carcinogensmentioning

confidence: 99%

Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

et al. 2017

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The Fleischner Society Guidelines for management of solid nodules were published in 2005, and separate guidelines for subsolid nodules were issued in 2013. Since then, new information has become available; therefore, the guidelines have been revised to reflect current thinking on nodule management. The revised guidelines incorporate several substantive changes that reflect current thinking on the management of small nodules. The minimum threshold size for routine follow-up has been increased, and recommended follow-up intervals are now given as a range rather than as a precise time period to give radiologists, clinicians, and patients greater discretion to accommodate individual risk factors and preferences. The guidelines for solid and subsolid nodules have been combined in one simplified table, and specific recommendations have been included for multiple nodules. These guidelines represent the consensus of the Fleischner Society, and as such, they incorporate the opinions of a multidisciplinary international group of thoracic radiologists, pulmonologists, surgeons, pathologists, and other specialists. Changes from the previous guidelines issued by the Fleischner Society are based on new data and accumulated experience. Table. These are followed by graded ratings of each recommendation using the American College of Chest Physicians recommendations for evidence grading in clinical guidelines (9). Additional explanations are provided regarding the rationale for each recommendation, which is based on the consensus of a multidisciplinary team and a systematic review of the literature, further details of which are included in Appendix E1 [online]. The minimum threshold size for recommending follow-up is based on an estimated cancer risk in a nodule on the order of 1% or greater. This criterion is necessarily arbitrary, and we recognize that a higher threshold may be considered appropriate in some environments and that this threshold will ultimately depend on social and economic factors. Several general considerations regarding technical aspects of using these recommendations are also presented. Finally, in Appendix E1 (online), additional information regarding methods and risk factors is given. detected at CT in adult patients who are at least 35 years old. Separate guidelines have been issued for lung cancer screening, such as those from the American College of Radiology (ACR), and we support the use of those guidelines when interpreting the results of CT screening (8). Specific recommendations are provided for patients with multiple solid and subsolid nodules, and several other commonly encountered clinical situations are addressed.These guidelines are not intended for use in patients with known primary cancers who are at risk for metastases, nor are they intended for use in immunocompromised patients who are at risk for infection; in these patients, treatment should be based on the specific clinical situation. Also, because lung cancer is rare in children and adults younger than 35 years, these guidelines are no...

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“…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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Predictive Value of One-Dimensional Mean Computed Tomography Value of Ground-Glass Opacity on High-Resolution Images for the Possibility of Future Change

Abstract: The m-CT value of GGO lesions is a risk factor associated with their future change. The interval of follow-up CT scanning or treatment policy should be determined considering the m-CT value.

Cited by 54 publications

References 18 publications

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

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

Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

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

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