Surgical resection of nodular ground-glass opacities without percutaneous needle aspiration or biopsy

Abstract

BackgroundPercutaneous needle aspiration or biopsy (PCNA or PCNB) is an established diagnostic technique that has a high diagnostic yield. However, its role in the diagnosis of nodular ground-glass opacities (nGGOs) is controversial, and the necessity of preoperative histologic confirmation by PCNA or PCNB in nGGOs has not been well addressed.MethodsWe here evaluated the rates of malignancy and surgery-related complications, and the cost benefits of resecting nGGOs without prior tissue diagnosis when those nGGOs were highly suspected for malignancy based on their size, radiologic characteristics, and clinical courses. Patients who underwent surgical resection of nGGOs without preoperative tissue diagnosis from January 2009 to October 2013 were retrospectively analyzed.ResultsAmong 356 nGGOs of 324 patients, 330 (92.7%) nGGOs were resected without prior histologic confirmation. The rate of malignancy was 95.2% (314/330). In the multivariate analysis, larger size was found to be an independent predictor of malignancy (odds ratio, 1.086; 95% confidence interval, 1.001-1.178, p =0.047). A total of 324 (98.2%) nGGOs were resected by video-assisted thoracoscopic surgery (VATS), and the rate of surgery-related complications was 6.7% (22/330). All 16 nGGOs diagnosed as benign nodules were resected by VATS, and only one patient experienced postoperative complications (prolonged air leak). Direct surgical resection without tissue diagnosis significantly reduced the total costs, hospital stay, and waiting time to surgery.ConclusionsWith careful selection of nGGOs that are highly suspicious for malignancy, surgical resection of nGGOs without tissue diagnosis is recommended as it reduces costs and hospital stay.

Control Study between CT Signs and Pathological Subtypes and Differentiation Degree in Lung Adenocarcinoma

“…The study indicated that with the increase of differentiation degree of invasive adenocarcinoma, the density and size of the lesions gradually increased, which were consistent with the Ref. [28][29] .…”

Long-Term Follow-up of Small Pulmonary Ground-Glass Nodules Stable for 3 Years: Implications of the Proper Follow-up Period and Risk Factors for Subsequent Growth

“…This is because GGNs ≥ 15 mm, especially part-solid GGNs > 8 mm or their solid components ≥ 5mm have high malignant potential and thus are the candidates of surgical resection after prompt evaluation. [9][10][11][12] In conclusion, 3.3% of GGNs that had been stable during initial 3 years showed subsequent …”

“…12 Image data were reconstructed with a thickness of 1 to 3 mm. Images were obtained using a lung window setting with a level of -600 Hounsfield units (HU) and a width of 1500 HU, and a mediastinal window setting with a level of 30 HU and a width of 400 HU.…”

Preoperative nomogram for identifying invasive pulmonary adenocarcinoma in patients with pure ground-glass nodule: A multi-institutional study

“…The resection criteria were as follows: (1) In pure GGNs < 10 mm, surgical resection should be considered if there is an increase in size ≥ 2 mm during 6 months of follow-up. (2) In pure GGNs ≥ 10 mm without significant changes in the initial 3 months of follow-up, we recommended surgical excision for GGNs ≥ 15 mm, whereas we recommended chest CT follow-up for one year or surgical excision for GGNs measuring 10-15 mm in size [22]. Each surgical specimen (entire tumor) was formalin fixed and stained with haematoxylin-eosin in accordance with routine regulations of the five hospitals, which were reviewed according to the new IASLC/ATS/ERS classification criteria, and tumor histologic subtypes were recorded.…”