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Ryutaro Kakinuma
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MS 24 - Management of GGO-Containing Nodule (ID 546)
- Event: WCLC 2017
- Type: Mini Symposium
- Track: Radiology/Staging/Screening
- Presentations: 1
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MS 24.01 - Natural History of GGO-Containing Tumors (ID 7754)
14:30 - 16:15 | Presenting Author(s): Ryutaro Kakinuma
- Abstract
- Presentation
Abstract:
The natural history of GGO-containing tumors, i.e., subsolid nodules (SSNs), is a major concern not only in CT lung cancer screening, but in daily clinical practice. SSNs are classified into pure ground-glass nodules (GGNs) and part-solid GGNs on the basis of their consistency. SSNs are classified according to their status as transient or persistent. Articles in the literature related to the natural history or long-term follow-up results of SSNs are summarized in Table. In the largest CT lung cancer screening cohort reported to date, nonsolid nodules (synonymous with pure GGNs) and part-solid nodules were detected in 4.2% (2392 of 57,496) and 5.0% (2892 of 57,496), respectively, of the participants at baseline (Table). The numbers of SSNs reported in the articles ranged from 19 to 3433 (median, 139). The median follow-up periods ranged from 1.1 years to 12 years (median, 2.9 years). The percentages of pure GGNs that grew ranged from 3% to 58% (median, 15%). The percentages of lung cancers among the SSNs ranged from 1% to 71% (median, 7%). An inherent limitation of studies of the natural history of SSNs is that not all of the SSNs are pathologically confirmed. The changes in persistent SSNs on sequential thin-section CT images in the Research Center for Cancer Prevention and Screening (RCCPS) examinations have tentatively been classified into six types; increasing type, stable type, decreasing type, fluctuating type, sudden onset type, and overtaking type. Some of the SSNs were evaluated on the basis of semiautomatic volumetry. Although the natural history of SSNs had gradually been clarified, the complete natural history of SSNs as a whole remains unknown. In the current era of ultralow-dose chest CT at a chest x-ray equivalent dose, a lifelong follow-up study should be considered.
Footnotes. ¶ SSN, subsolid nodule; * PGGN, pure ground-glass nodule; ** PSN, part-solid nodule; n/a, not available. † This study did not report the numbers of pure and part-solid GGNs separately. ≠ Growth was calculated by comparing actual mass to mass when first detected and is expressed as a percentage. $ A synonym of PGG.; ^ Baseline; ^^ Annual repeat screening. ø Follow-up period of the “grew” group. [1 ]Among the 1764 cases in which the nonsolid nodules were stable or growing, the median time to pathologic diagnosis was 1.7 years; the median follow-up time in the cases without a pathologic diagnosis was 1.4 years. [2] The median time from the initial identification of the nonsolid nodules to pathologic diagnosis was 1.2 years; the median follow-up time in the cases without a pathologic diagnosis was 1.7 years. [&] This study did not report the number of SSNs that grew and number of stable SSNs separately. ***HGGN, heterogeneous GGN. [3] Among the 2325 cases in which the PSNs were stable or growing, the median time to pathologic diagnosis was 0.5 years; the median follow-up time in the cases without a pathologic diagnosis was 1.1 years. [4] The median time from the initial identification of the PSN to pathologic diagnosis was 0.8 years; the median follow-up time of 0.7 years for cases without pathologic diagnosis. § Fifty-seven patients had stopped receiving follow-up examinations after a median of 5.6 years because of the presence of stable disease in 42 and reduced disease in 15. # Forty-five patients were continuing to undergo follow-up examinations, and their median follow-up period was 12 years; 40 were stable and 5 showed growth.SSNs¶ Grew Lung Cancer Author Journal Year Total Consistency,n Follow-up Period (yr.) n (%) n (%) Kodama Ann Thorac Surg 2002 19 PGGN*, 19 Median, 2.7 11 (58) 5 (26) Hiramatsu J Thorac Oncol 2008 125 PGGN, 95 Median, 2.9 14 (15) 8 (6) PSN**, 30 12 (40) Silva J Thorac Oncol 2012 76 PGGN, 48 Mean, 4.2 8 (17) 4 (5) PSN, 28 12 (43) Takahashi Jpn J Radiol 2012 150 PGGN, 150 Mean, 5.5 19 (13) 8 (5) Chang Chest 2013 122 PGGN, 122 Mean, 4.9 12 (10) 11 (9) Kobayashi J Thorac Oncol 2013 108 PGGN, 82 Median, 4.2 29†(27) 25 (23) PSN, 26 Matsuguma Chest 2013 174 PGGN, 98 Mean, 2.4 14 (14) 53 (30) PSN, 76 27 (36) Lee Respir Med 2013 175 PGGN, 143 Median, 3.8 28 (20) 26 (15) PSN, 32 18 (56) Attina Radiol Med 2013 146 PGGN, 140 Mean, 2.3 41 (29) 5 (3) PSN, 6 6 (100) Kim Ann Thorac Surg 2013 139 PGGN, 69 Mean, 3.7 2 (3) 7 (5) PSN, 70 21 (30) Tamura J Thorac Oncol 2014 63 PGGN, 63 Mean, 2.2 29 (46) 45 (71) Eguchi Lung Cancer 2014 124 PGGN, 124 Median, 4.8 64 (52) 32 (26) Scholten Eur Respir J 2015 117 PGGN, 69 Median, 7.9 33≠ 28 (24) PSN, 48 46≠ Kakinuma Radiology 2015 439 PGGN, 439 Median, 6.0 45 (10) 4 (1) Silva Diagn Interv Radiol 2015 95 PGGN, 95 Median,1.7ø 18 (19) n/a Yankelevitz Radiology 2015 2877 Nonsolid$,2392^ Median[1] 1764[&] 84 (3) Nonsolid,485^^ Median[2] 163[&] Lee Eur Radiol 2016 213 PGGN, 136 Median, 2.3 18 (13) 49 (23) PSN, 77 24 (31) Zhao Br J Radiol 2016 70 PGGN, 62 Median, 2.1 6† (9) 5 (7) PSN, 8 Kakinuma J Thorac Oncol 2016 1231 PGGN, 1046 Mean, 4.3 116 (11) 85 (7) HGGN***, 81 23 (28) PSN, 104 45 (43) Cho J Thorac Oncol 2016 453 PGGN, 438 Median, 6.4 11 (3) 7 (2) PSN, 15 4 (27) Henschke AJR 2016 3433 PSN, 2892^ Median[3] 2325[&] 107 (3) PSN, 541^^ Median[4] 164[&] Sawada Chest 2017 226 PGGN, 166 §, # 39†(17) 124(55) PSN, 60 Mets Eur Radiol 2017 89 PGGN, 63 Median, 1.6 35†(39) n/a PSN, 26
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