Whack-a-mole strategy for multifocal ground glass opacities of the lung

Abstract

Ground glass opacity (GGO) is a good prognostic indicator for lung cancer and is useful for physicians to predict prognosis. Due to recent advances in computed tomography (CT), the chance to encounter GGO is rapidly increasing in clinical practice. Based on the studies on radiological pathological correlation, GGO represents pathological lepidic growth and consolidation on CT represents pathologically invasive components. Thus, consolidation tumor ratio 0.5 or less means pathological less invasiveness for lung cancer. Not a few studies have shown that sublobar resection is equivalent to lobectomy for radiological early lung cancers. Additionally, observation of GGO is one of the options for physicians. Indication of surgical intervention remains unclear. Physician observing GGO in practice should know the natural history of GGO to reach an optimal treatment decision. For multifocal GGO lesions clinical management is surely challenging. Whack-a-mole strategy, which means sublobar resection for radiological invasive cancer is one of the most promising strategies for such lesions.

Computed tomography‐guided percutaneous microwave ablation: A novel perspective to treat multiple pulmonary ground‐glass opacities

“…The treatment strategies and prognosis are not different in terms of the nodule number or size. [11][12][13] Kim et al 14 reported that 73 patients underwent pulmonary resection for bronchioloalveolar carcinoma, of whom 23 had multiple GGOs seen on preoperative CT. In the 18 patients who did not have all GGO lesions resected, none of the residual GGO lesions progressed in size or solidity during followup for a median of 40.3 months.…”

Bilateral uniportal video-assisted thoracic surgery segmentectomy S3: an unusual case

“…The presence of ground glass opacity (GGO) in a chest computed tomography scan (CT Scan) is a radiological entity that has been booming, mostly after the initiation of screening tests for lung cancer (1)(2)(3). Particularly the GGO lesions have been related with non-small cell lung cancers (NSCLCs) specifically the lepidic component of adenocarcinomas (1,2).…”

“…Particularly the GGO lesions have been related with non-small cell lung cancers (NSCLCs) specifically the lepidic component of adenocarcinomas (1,2). It is necessary to classify this according to its radiological characteristics.…”

“…It is necessary to classify this according to its radiological characteristics. The pathological-radiological correlation allows to make an adequate treatment (1,4,5), observing that the presence of the GGO component is a prognostic factor of cancer in early stages (6)(7)(8). Likewise, the appropriate follow-up in combination with the resections of this type of lesions actually is a challenge for thoracic surgeons, even more in cases of persistent or multiples GGOs (9).…”

Molecular (pathologic) markers of tumor invasiveness = more or less (clinical) malignant adenocarcinomas? Wait a second, we are not there yet!

“…The management of GGO-associated adenocarcinoma is more nuanced. 3 There is little controversy that surgical resection is indicated for part-solid GGO, because the solid component is invasive cancer nested within the noninvasive lepidic adenocarcinoma (lepidic-positive adenocarcinoma). The magnitude of lung resection is influenced by tumor characteristics (sizes and the proportions of solid component within the GGO, consolidation tumor ratio) as well as patients' underlying conditions.…”