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MO02 - General Thoracic and Minimally Invasive Surgery (ID 99)
- Event: WCLC 2013
- Type: Mini Oral Abstract Session
- Track: Surgery
- Presentations: 1
MO02.02 - Size decrease of ground-glass nodules should not be end of follow-up, but may be optimal timing of curative surgery (ID 2234)
10:30 - 12:00 | Author(s): Y. Taniguchi
As observed in colon carcinogenesis, recent reports support an atypical adenomatous hyperplasia (AAH)–adenocarcinoma sequence in lung carcinogenesis. Recent accumulating experiences based on pathologic–radiologic correlation show that most cases of AAH, adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and lepidic predominant adenocarcinoma can be detected by ground-glass nodules (GGNs)—the radiographic appearance of hazy lung opacity not associated with obscuration of underlying vessels. In this study, we retrospectively reviewed radiological and pathological characteristics of resected GGNs that were radiologically observed for at least 12 months before surgery, and discuss optimal timing of curative surgery.
We retrospectively reviewed clinical charts and chest computed tomography (CT) of patients on whom pulmonary resection was performed between January 2006 and March 2013 at the Kansai Medical University Hirakata Hospital. The definitions of pure GGNs and part-solid nodules were based on the tumor shadow disappearance rate. The histologic classification of adenocarcinoma followed the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification of lung adenocarcinoma. We evaluated the radiologic findings, such as size change of whole tumor and appearance of solid component, and pathological findings. All statistical tests were performed with JMP software.
A total of 568 patients underwent pulmonary resection during the study periods and 404 cases were adenocarcinoma (ADA), including 207 tumors with lepidic growth pattern. Total 32 GGNs of 31 patients were observed in chest CT before surgery for at least 12 months. Mean GGN size before surgery was 18.6 mm and mean follow-up period was 25.8 months. Pathological findings of 32 tumors were 6 AISs, 4 MIAs, 8 lepidic predominant ADA, 13 papillary predominant ADA, 1 acinar predominant ADA. On last CT before surgery, 15 lesions showed pure GGNs and 17 showed part-solid nodules. Thirteen of the 17 tumors showed slight size reduction of GGNs during the follow-up, mostly just before or just after appearance of solid component inside GGNs.
Some GGNs showed size reduction during the follow-up with chest CT. Even when mild collapse of the GGNs are observed, you should neither diagnose non-malignant tumors, such as inflammatory nodules, nor decide cessation of follow-up. And instead, we recommend rather careful follow-up in order to identify solid component inside the GGNs. If you confirm appearance of the solid component, the finding would be a sign of progression from AAH/AIS to invasive adenocarcinoma and may be optimal timing of pulmonary resection as curative treatment.
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