Prospective study of thoracoscopic limited resection for ground-glass opacity selected by computed tomography
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Keywords:
Atypical adenomatous hyperplasia
Ground-glass opacity
Wedge resection
High-resolution computed tomography
Objective
To explore clinical characteristics of the lung cancer with ground glass opacity (GGO) and to guide the early clinical detection, diagnosis and treatment of lung cancer.
Methods
The clinical manifestation, imaging and morphological characteristics, treatment and prognosis of 56 patients diagnosed with lung cancer by histopathology and high resolution computed tomography (HRCT) showing GGO in General Hospital of Ningxia Medical University from January 2010 to December 2016 were retrospectively analyzed.Chi-square test or t test was used to analyse the clinical and imaging manifestation in different pathological classification.
Results
The incidence of GGO was more common in women and non-smokers.There was no difference in ages among four pathological groups.These cases had no special presentation.The 56 cases confirmed with lung cancer by pathology after surgery included four cases of the atypical adenomatous hyperplasia (AAH), ten cases of adenocarcinoma in situ(AIS), 15 cases of minimally invasive adenocarcinoma (MIA) and 27 cases of invasive adenocarcinoma (IAC). There was significant difference in the diameter of the lesion among different pathological groups (χ2=19.246, P<0.05). The diameter of IAC group was greatly larger than that of AAH group.The lesion in invasive group (MIA+ IAC) was larger than that in preinvasive group (AAH+ AIS). There was also significant difference in GGO content among different pathological groups (χ2=20.001, P<0.05). The content of GGO in AAH group was significantly higher than that in MIA group and AIC group, and it was significantly higher in preinvasive group (AAH+ AIS) compared with invasive group (MIA+ IAC). There was no significant difference in the location of the lesion and the edge structure, internal structure and adjacent structure of lesion.
Conclusions
The lung cancer with GGO has few specific clinical symptoms.The GGO with imaging findings, such as lobulation, burr, cavitation, air-bronchogram, pleural indentation and vascular cluster, should be highly suspected malignant lesion.The pathological test should be performed timely.The larger diameter and less content of GGO are predictors of the malignant tumor.After surgery of lung cancer with GGO, the patient will have a longer lifetime and better prognosis.
Key words:
Ground glass opacity; Lung cancer; High resolution computed tomography; Clinical characteristics
Atypical adenomatous hyperplasia
Ground-glass opacity
Histopathology
Precancerous lesion
High-resolution computed tomography
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Atypical adenomatous hyperplasia
Nodule (geology)
Ground-glass opacity
Solitary pulmonary nodule
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Ground-glass opacity (GGO) nodules noted at thin-section computed tomography (CT) scan have been shown to have a histopathologic relationship with atypical adenomatous hyperplasia, bronchioloalveolar carcinoma (BAC, or adenocarcinoma in situ), and adenocarcinoma with a predominant BAC component (minimally invasive adenocarcinoma). Patients harboring GGO nodules of BAC or adenocarcinoma with a predominant BAC component demonstrate negative results for malignancy at positron emission tomography. In peripheral adenocarcinoma of a part-solid (mixed GGO and solid attenuation) nodular nature, both the degree of disappearance of GGO area, when the lung window is changed to a mediastinal window image at CT scanning, and the maximum standardized uptake value at positron emission tomography correlate well with histopathologic BAC and non-BAC ratios. However, a high non-BAC ratio appears to be the only independent prognosis-determining factor. Epidermal growth factor receptor mutations are positively correlated with the GGO ratio at a thin-section CT scan in lung adenocarcinomas. As patients with a GGO nodule of BAC or adenocarcinoma with a predominant BAC component have a good prognosis, a wedge resection is recommended as a treatment option, in preference to lobectomy. Even for multiple malignant pure GGO nodules, minimally invasive surgery (including multiple resections) with the preservation of lung volume and adequate imaging follow-up studies are the recommended diagnostic and therapeutic measures.
Atypical adenomatous hyperplasia
Ground-glass opacity
Wedge resection
Nodule (geology)
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Atypical adenomatous hyperplasia
Ground-glass opacity
Nodule (geology)
Resection margin
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Atypical adenomatous hyperplasia
Ground-glass opacity
Wedge resection
High-resolution computed tomography
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To identify epidermal growth factor receptor (EGFR) mutation status between different lesions in lung adenocarcinoma presenting as multiple ground-glass opacity (GGO) lesions and analyse its association with clinical characteristics.Seventy-eight patients with lung adenocarcinoma presenting as multiple GGO lesions were identified to investigate EGFR mutation in exon 18-21. Lesions with the largest size in diameter were defined as the primary lesions; the others were defined as the secondary lesions. One hundred and fifty-nine lesions of these patients were classified into pure GGO and mixed GGO by computed tomography scan images.The EGFR mutation rate in the patients was 48.7% (38 of 78). Patients with high frequency of EGFR mutation were females and non-smokers. The EGFR mutation rate of invasive adenocarcinoma was higher than that of atypical adenomatous hyperplasia/adenocarcinoma in situ and minimally invasive adenocarcinoma (P = 0.001). Although 19-deletion and L858R were the most common EGFR mutations, there was no difference of EGFR mutation in pathological subtypes of adenocarcinoma. Of the 38 paired lesions in patients harbouring EGFR mutation, the discordance rate of EGFR mutation was 92.1%.The study showed different EGFR mutational profiles in multiple GGO lesions, suggesting that lesions seem to arise as independent events. It would offer useful information for determining the appropriate treatment strategy for lung adenocarcinoma presenting as multiple GGO lesions.
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Ground-glass opacity
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Objective To investigate the characteristic CT features in differentiation of pulmonary neoplastic diseases which appear as focal ground-glass opacity.Methods Forty-five cases of neoplastic diseases(including 17 cases of adenocarcinomas,19 cases of bronchioloalveolar carcinoma,5 cases of lymphoma,and 4 cases of atypical adenomatous hyperplasia) which appeared as focal ground-glass opacity were collected,and their CT manifestations including type of GGO,location,size,internal structure,margin and surrounding change,were analyzed.Results Pure GGO was mostly seen in atypical adenomatous hyperplasia(n=4) and bronchioloalveolar carcinoma(n=6);mixed GGO was mostly seen in adenocarcinoma(n=13) and bronchioloalveolar carcinoma(n=13).All the lesions were classified into two groups including ≤1 cm and 1 cm in size.There was significant difference in constituent ratio of different nature of lesion between two groups(χ2=9.12,P0.05).In ≤1 cm group,the common nature of disease was atypical adenomatous hyperplasia and bronchioloalveolar carcinoma,while in 1 cm group,the common diseases were adenocarcinoma and bronchioloalveolar carcinoma.All the lesions were classified into two groups including 50% group and ≤50% group according to the percentage of GGO in the entire lesion.There was significant difference in constituent ratio of different nature of lesion between two groups(χ2=8.24,P0.05).In 50% group,the common diseases were atypical adenomatous hyperplasia and bronchioloalveolar carcinoma,while in ≤50% group,the common disease was adenocarcinoma.Conclusion Comprehensively analyzing the type,internal structure,margin and size is very helpful for differentiation of focal GGO.In the pulmonary tumor which appears as GGO,small pure GGO is common in atypical adenomatous hyperplasia,air bronchogram is common in bronchioloalveolar carcinoma,and mixed GGO which had large area of solid lesion is common in adenocarcinoma.
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Ground-glass opacity
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Objective: Pulmonary ground glass opacity (GGO) nodules represent a significant dilemma in oncology since its diagnosis in clinical practice has increased because of growing application of low dose computed tomography and screening program. The aim of this study is to analyze the clinical and pathological features, the overall survival (OS) and disease-free interval (DFI) in surgically resected solitary ground glass nodules in order to assess the surgical treatment of choice. Methods: We retrospectively analyzed 49 patients (M/F=25/24) with a mean age of 67.7 (range, 40–81) years who underwent lung resection for solitary GGO nodules among 570 reviewed CT of patients who were treated for lung neoplasms between 2010 and 2016. The cohort included 22 pure GGO nodules and 27 part solid GGOs (also called mixed GGOs). Results: Median maximum diameter of GGOs, defined as the largest axial diameter of the lesion on the lung-window setting, was 17 (range, 5–30) mm. GGO nodules were removed by wedge resection, segmentectomy, or lobectomy in 17 (35%), 9 (18%), and 23 (47%) cases, respectively. Pathologic diagnosis was atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), invasive adenocarcinoma (IA) or multifocal adenocarcinoma (MAC) in 4 (8.2%), 9 (18.4%), 11 (22.4%), 22 (44.9%) and 3 (6.1%) cases, respectively. With a median follow up of 47 months the OS and DFI of the entire cohort was 46.3 and 43 months, respectively. The histotype (P=0.008), the dimension of GGO (P=0.014) and the PET-SUV max (P=0.001) were independent prognostic factors of worse survival. Sex, age, previous lung surgery, type of surgical resection and the mediastinal lymph-node evaluation did not impact on OS and DFI. Analyzing the 22 pure GGO nodules, we found a 3-year OS and DFI of 98% and 100% respectively, significantly different from 80% and 75% respectively of part-solid GGOs (log-rank P=0.043 and P=0.011). Conclusion: Our data suggest an indolent behaviour of tumour presenting as solitary GGO nodules, especially in case of pure GGOs. In our series wedge resections guarantee the same results in terms of OS and DFI when compared to lobectomies. Sublobar resections without mediastinal lymph-nodes evaluation represent the treatment of choice for pure-GGO. More studies are needed to assess its role for part-solid GGO nodules.
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Ground-glass opacity
Wedge resection
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Objective To discuss the pathological classification and imaging characteristics of lung adenocarcinoma with pure ground-glass opacity (pGGO).Methods Ninety-four lesions with pGGO on CT of eighty-eight patients with T1 N0M0 lung adenocarcinoma were retrospectively recruited from January 2010 to December 2012.There were 33 males and 55 females,the age ranged from 26 to 78 years with average age of (53 ± 10) years.All lesions were resected and confirmed pathologically.Among these 94 lesions,there were 21 preinvasive lesions [atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS)],35 minimally invasive adenocarcinoma (MIA)and 38 invasive adenocarcinoma.CT manifestations were analyzed including lesion location,size,density,uniformity,shape (round,oval,polygonal,irregular),margin (smooth,lobular,spiculated,lobular and spiculated),tumor-lung interface,internal and surrounding malignant signs (bubble sign,air bronchogram,pleural tag,notch).Lesion size and density were compared between different pathologic types using analysis of variance (AVOVA).Gender of patients,lesion location and CT manifestations were compared using x2-test and Wilcoxon test.The sizes of preinvasive and invasivelesions were assessed using ROC curves.Results There were no significant statistical differences ingender,lesion location and density between pathological types (P ＞ 0.05).Mean size of each group was (1.24±0.68),(1.75 ± 0.58) and (1.60 ± 0.52) cm for preinvasive lesion,MIA and invasive adenocarcinoma respectively.Lesion size of different pathologic types was significantly different (F =5.08,P =0.008).There was a significant statistical difference in lesion uniformity between pathological types (x2 =19.42,P =0.001).Three lesions of invasive adenocarcinoma(3/38)and 8 of preinvasive lesions (8/21) were of homogeneous uniformity.Thus,the more invasive the lesion was the more heterogeneity it showed.There was a significant statistical difference in margin between different pathological types (x2 =15.80,P =0.02).Preinvasive lesion always showed smooth margin(7/21),while MIA (8/35) and invasive adenocarcinoma (14/38)were more inclined to present as lobulated and speculated.Tumor-lung interface between different pathological types was significantly different (x2 =16.70,P =0.001).Well defined tumorlung interface in three groups showed as follows:38.10％ (7/21)for preinvasive lesion,77.14％ (27/35)for MIA and 86.84％ (33/38)for invasive adenocarcinoma.There was a significant difference in air bronchogram between different pathological types (x2 =6.06,P =0.048).The air bronchogram was demonstrated in 9.52％ (2/21) of preinvasive lesion,20.00％ (7/35) of MIA,and 36.84％ (14/38) of invasive adenocarcinoma.The ROC curve showed that when diameter of lesion was more than 1.05cm,the sensitivity,specificity and accuracy was 86.30％,61.90％ and 80.85％ respectively.Conclusion The lesion size,uniformity,tumor-lung interface and the air bronchogram can help predict the invasive lesion of lung adenocarcinoma with pGGO less than 3 cm.
Key words:
Lung neoplasms ; Adenocarcinoma; Pathology ; Tomography,X-ray computed
Atypical adenomatous hyperplasia
Ground-glass opacity
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Atypical adenomatous hyperplasia
Ground-glass opacity
Wedge resection
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