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Omindo WW. Management of screening-detected ground glass nodules: a narrative review. Indian J Thorac Cardiovasc Surg 2024; 40:205-212. [PMID: 38389756 PMCID: PMC10879480 DOI: 10.1007/s12055-023-01595-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 02/24/2024] Open
Abstract
Wide-scale application of low-dose computed tomography (LDCT) in lung cancer screening has led to an increased detection of ground glass nodule (GGN) lesions. However, there is still no clear management plan for these lesions after detection. Clinicians are usually faced with a dilemma in choosing the best initial management approach that not only limits overtreatment but also avoids the possibility of lesions growing into invasive carcinoma. Most current and past guidelines favor surveillance with computed tomography (CT) as the initial management approach based on the notion that the majority of GGN lesions are indolent tumors. Immediate surgery is generally considered overtreatment and is usually only recommended when the lesion grows in size, persists, or increases its solid component during follow-up CT surveillance. However, due to evolution of surgery to minimal invasive procedures, such as uniportal video-assisted thoracic surgery, and the development of enhanced recovery after thoracic surgery protocols, modern surgery is now safer and associated with less postoperative mortality. Additionally, intraoperative frozen sections can be used to guide resection, making initial management via surgery more attractive than before. Based on these developments, this review recommends that immediate surgery should be considered at the same level as follow-up CT surveillance when making multidisciplinary team decisions for screening-detected GGNs, as it provides both a diagnostic and treatment role.
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Affiliation(s)
- Willis Wasonga Omindo
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030 Hubei China
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Beddok A, Chabi-Charvillat ML, Kennel T, de Wolf J, Pricopi C, Crequit P, Girard N, Otz J, Vallée A, Longchampt E, Sage E, Glorion M. Prospective Radiologic-Pathologic Correlation of Macroscopic Volume and Microscopic Extension of Nonsolid Lung Nodules on Thin-section CT Images for Sublobar Resection and Stereotactic Radiotherapy Planning. Clin Lung Cancer 2023; 24:98-106. [PMID: 36509664 DOI: 10.1016/j.cllc.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The objective of this study was to determine whether computed tomography (CT) could be a useful tool for nonsolid lung nodule (NSN) treatment planning, surgery or stereotactic body radiation therapy (SBRT), by assessing the macroscopic and microscopic extension of these nodules. METHODS The study prospectively included 23 patients undergoing anatomic resection at the Foch Hospital in 2020/2021 for NSN with a ground-glass component of more than 50%. Firstly, for each patient, both the macroscopic dimensions of the NSN were assessed on CT and during pathologic analysis. Secondly, the microscopic extension was assessed during pathologic examination. Wilcoxon sign rank tests were used to compare these dimensions. Spearman correlation test and Bland-Altman analysis were used to evaluate the agreement between radiological and pathologic measurements. RESULTS On CT, the median largest diameter and volume of NSN were 21 mm and 3780 cc, while on pathologic analysis, they were 15 mm and 1800 cc, respectively. Therefore, the largest diameter and volume of the NSN were significantly higher on CT than on pathological analysis. For microscopic extension, the median largest diameter and volume of NSN were 17 mm and 2040 cc, respectively. No significant difference was observed between the macroscopic size and the microscopic extension assessed during pathologic analysis. Moreover, correlation analysis and Bland-Altman plots showed that radiological and pathologic measurements could provide equivalent precision. CONCLUSION Our study showed that CT did not underestimate the macroscopic size and microscopic extension of NSN and confirmed that CT can be used for NSN treatment planning.
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Affiliation(s)
- Arnaud Beddok
- Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, Institut Curie, PSL Research University, Orsay, France; Laboratory of Translational Imaging in Oncology (LITO), Institut Curie, PSL Research University, University Paris Saclay, Inserm, Orsay, France.
| | | | - Titouan Kennel
- Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation (DRCI), Foch hospital, Suresnes, France
| | - Julien de Wolf
- Department of Thoracic Surgery, Hôpital Foch, Suresnes, France
| | - Ciprian Pricopi
- Department of Thoracic Oncology, Hôpital Foch, Suresnes, France
| | - Perrine Crequit
- Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation (DRCI), Foch hospital, Suresnes, France
| | | | - Joelle Otz
- Radiation Oncology Department, Institut Curie, Saint-Cloud, France
| | - Alexandre Vallée
- Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation (DRCI), Foch hospital, Suresnes, France
| | | | - Edouard Sage
- Department of Thoracic Surgery, Hôpital Foch, Suresnes, France
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Matsumura Y, Yano M, Yoshida J, Koike T, Kameyama K, Shimamoto A, Nishio W, Yoshimoto K, Utsumi T, Shiina T, Watanabe A, Yamato Y, Watanabe T, Takahashi Y, Sonobe M, Kuroda H, Oda M, Inoue M, Tanahashi M, Adachi H, Saito M, Hayashi M, Otsuka H, Mizobuchi T, Moriya Y, Takahashi M, Nishikawa S, Suzuki H. Early and late recurrence after intentional limited resection for cT1aN0M0, non-small cell lung cancer: from a multi-institutional, retrospective analysis in Japan. Interact Cardiovasc Thorac Surg 2016; 23:444-9. [PMID: 27226401 DOI: 10.1093/icvts/ivw125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/08/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In 2015, we reported the outcomes of patients undergoing intentional limited resection (ILR) for non-small-cell lung cancer (NSCLC) from a retrospective, multi-institutional large database in Japan. Here, we analyse the clinicopathological characteristics of the patients extracted from this database with late recurrence and compare them with those with early recurrence. METHODS Of 1538 patients in the database with cT1aN0M0 NSCLC, 92 (6%) had recurrence. In this study, early recurrence was defined as recurrence within 5 years and late recurrence as recurrence beyond 5 years after surgery. We compared the clinicopathological characteristics and post-recurrence survival (PRS) between patients with early and late recurrence. RESULTS Of the 92 patients with recurrence, 21 (23%) had late recurrence. Compared with the early recurrence group, there were significantly more adenocarcinomas and local recurrences in the late recurrence group (P = 0.04 for both). The 3- and 5-year PRS rates were 53 and 24%, respectively, and the median PRS period was 38 months. There were no significant differences in the PRS curves between patients with early and late recurrence (P = 0.12). Only 3 patients (0.2%) had recurrence more than 10 years after ILR. Of the 21 late-recurrence patients, 17 (81%) had tumours with a consolidation/tumour ratio (CTR) >0.25. CONCLUSIONS Late recurrence occurred in 21 (23%) of 92 patients with recurrence after ILR for cT1aN0M0 NSCLC. Late recurrence was more likely to involve adenocarcinoma and local recurrence. It is thus considered reasonable to follow patients with a CTR >0.25 for 10 years after ILR.
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Affiliation(s)
- Yuki Matsumura
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan Division of Chest Surgery, Fukushima Medical University, Fukushima, Japan
| | - Motoki Yano
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Junji Yoshida
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Terumoto Koike
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Kotaro Kameyama
- Department of Thoracic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Akira Shimamoto
- Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Wataru Nishio
- Department of General Thoracic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Kentaro Yoshimoto
- Department of Thoracic Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Tomoki Utsumi
- Department of Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Takayuki Shiina
- Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Atsushi Watanabe
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yasushi Yamato
- Department of Thoracic Surgery, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Takehiro Watanabe
- Department of Thoracic Surgery, National Hospital Organization Nishi-Niigata Chuo National Hospital, Niigata, Japan
| | - Yusuke Takahashi
- Department of General Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Tokyo, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Makoto Oda
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Masayoshi Inoue
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Tanahashi
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Hirofumi Adachi
- Department of Thoracic Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Masao Saito
- Department of Thoracic Surgery, Tenri Hospital, Nara, Japan
| | - Masataro Hayashi
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hajime Otsuka
- Department of Chest Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Teruaki Mizobuchi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | - Mamoru Takahashi
- Department of Chest Surgery, Fukui Red Cross Hospital, Fukui, Japan
| | - Shigeto Nishikawa
- Division of Thoracic Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Hiroyuki Suzuki
- Division of Chest Surgery, Fukushima Medical University, Fukushima, Japan
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Yoshida J, Ishii G, Hishida T, Aokage K, Tsuboi M, Ito H, Yokose T, Nakayama H, Yamada K, Nagai K. Limited resection trial for pulmonary ground-glass opacity nodules: case selection based on high-resolution computed tomography--interim results. Jpn J Clin Oncol 2015; 45:677-81. [DOI: 10.1093/jjco/hyv057] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/27/2015] [Indexed: 11/13/2022] Open
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Ueda K, Hayashi M, Tanaka N, Hoshii Y, Tanaka T, Hamano K. Surgery for undiagnosed ground glass pulmonary nodules: decision making using serial computed tomography. World J Surg 2015; 39:1452-9. [PMID: 25651958 DOI: 10.1007/s00268-015-2979-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although long-term observation of ground glass nodules on computed tomography facilitates the ability to distinguish malignant lesions from benign lesions, the resulting treatment delay can increase the rate of cancer recurrence. We reviewed our surgical cases of pathologically undiagnosed lung nodules possessing ground glass to clarify the clinical impact of selecting surgical candidates based on serial computed tomography, not preoperative biopsy results. METHODS A consecutive series of 100 patients with clinically suspected lung cancer possessing ground glass among our prospective database of 262 surgical cases of suspected lung cancer were retrospectively reviewed. RESULTS Surgical indication was determined based on the interval change in the outer diameter or internal attenuation of the lesions in 53 patients (increasing lesions), while that was determined based on the specific marginal or internal features of the lesions in 47 patients (non-increasing lesions). The length of preoperative follow-up was significantly longer in the patients with increasing lesions than in the patients with non-increasing lesions (27 vs. 3 months, P < 0.001). The final pathological diagnoses consisted of 97 adenocarcinomas and three non-malignant lesions. All increasing lesions were adenocarcinomas. Surgical biopsy contributed in avoiding futile lobectomy in patients with non-malignant lesions, while that caused false-negative result in one patient with an increasing lesion. Postoperative recurrence occurred in two patients. CONCLUSIONS In a surgical series, serial computed tomography-diagnosed ground glass lesions are highly suggestive of adenocarcinoma, especially increasing lesions. Despite spending a long-term preoperative follow-up period without a pathological diagnosis, the surgical outcome is satisfactory. Surgical biopsy for increasing lesions is generally futile.
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Affiliation(s)
- Kazuhiro Ueda
- Division of Chest Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan,
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Sim HJ, Choi SH, Chae EJ, Kim HR, Kim YH, Kim DK, Park SI. Surgical management of pulmonary adenocarcinoma presenting as a pure ground-glass nodule. Eur J Cardiothorac Surg 2014; 46:632-6; discussion 636. [PMID: 24566849 DOI: 10.1093/ejcts/ezu007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES With recent advances in radiology, the detection of ground-glass nodules (GGNs) has become increasingly common. However, there still is no consensus on management, especially on the need for systemic lymph node (LN) dissection. The purpose of this study was to evaluate the surgical outcomes on the basis of the extent of resection of the primary lesion and mediastinal LN dissection and to carefully suggest appropriate treatment strategies in the patients with pulmonary adenocarcinoma presenting as pure ground-glass opacities. METHODS From January 2006 to December 2010, 1267 patients with pulmonary adenocarcinoma, including adenocarcinoma in situ, underwent curative-intent surgical resection. Among these patients, pure GGNs were confirmed in 48 patients on preoperative chest computed tomography (CT) by an experienced radiologist, and 42 underwent systemic LN dissection or sampling. We retrospectively reviewed the perioperative data and postoperative outcomes. RESULTS The median age of the patients was 56 (range, 35-78) years, and 26 (54.2%) patients were male. The median size of the nodules was 12 (5-30) mm, and 8 (16.7%) had multiple lesions at the time of operation. The median duration between the initial diagnosis and operation was 4 (0-45) months. Preoperative positron emission tomography/CT was taken in 36 (75.0%) patients, which showed no significant metabolic uptake. For curative resection, lobectomy was performed in 32 (66.7%) patients, segmentectomy in 4, and wedge resection in 12. Clear resection margins were reported in all patients. Forty-two patients underwent systemic mediastinal LN dissection or sampling, and the median number of dissected LNs was 23 (7-53). No LN was reported as positive for malignancy. The median follow-up duration after the first operation was 39 (23-77) months, and there were no cases of late mortality, local recurrence or nodal recurrence. Recurrent GGNs have been developed in 6 (12.5%) patients. CONCLUSIONS For pure GGNs, limited resection can be performed when complete resection is obtained, as it was sufficient for cure and especially because there is high probability of multiple lesions. We were unable to demonstrate any additional therapeutic benefit with mediastinal LN dissection in patients with pure GGNs.
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Affiliation(s)
- Hee Je Sim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Republic of Korea
| | - Se Hoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Republic of Korea
| | - Eun Jin Chae
- Department of Radiology, Asan Medical Center, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Republic of Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Republic of Korea
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Kim HK, Sung HK, Lee HJ, Choi YH. The feasibility of a Two-incision video-assisted thoracoscopic lobectomy. J Cardiothorac Surg 2013; 8:88. [PMID: 23587171 PMCID: PMC3660169 DOI: 10.1186/1749-8090-8-88] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 04/12/2013] [Indexed: 11/28/2022] Open
Abstract
Background This study is to evaluate the feasibility and safety of video-assisted thoracoscopic (VATS) lobectomy with two incisions. Methods A total of 73 patients (male 47, female 26; mean age 61.2 ± 12.00 years old) who underwent major pulmonary resection, through VATS, using two incisions were included in this study. The thoracoscopy port was placed at the 7th or the 8th intercostal space in the mid-axillary line, and the working port, 3~5 cm long, at the 5th intercostal space, on the operator’s side. Results The preoperative diagnosis was benign lung disease in 8 patients (11.0%) and malignant lung disease in 65 (89.0%). Two patients (3.1%) needed a third port during surgery due to severe pleural adhesion, and conversion to thoracotomy was needed in 5 (6.8%), due to bleeding at pulmonary arterial branch (n = 3), anthracofibrotic lymph nodes around pulmonary artery (n = 1), and severe pleural adhesion (n = 1). The mean duration of the operation in the 66 patients, completed by a two-incision VATS lobectomy, was 163.4 ± 30.40 minutes. In 56 cases, which were completed by a two-incision VATS lobectomy for primary lung cancer, a total number of dissected lymph nodes per patient were 20.2 ± 11.2. The chest tube was removed on postoperative day 5.4 ± 2.8, and there was no occurrence of major perioperative morbidity and mortality. Conclusions Two-incision VATS lobectomy is applicable in the selected cases, and may obtain similar results with the conventional VATS lobectomy, through a certain period of learning curve.
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Affiliation(s)
- Hyun Koo Kim
- Departments of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, 97 Guro-donggil, Seoul, Guro-gu 152-703, Korea.
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Naidich DP, Bankier AA, MacMahon H, Schaefer-Prokop CM, Pistolesi M, Goo JM, Macchiarini P, Crapo JD, Herold CJ, Austin JH, Travis WD. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology 2012; 266:304-17. [PMID: 23070270 DOI: 10.1148/radiol.12120628] [Citation(s) in RCA: 702] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This report is to complement the original Fleischner Society recommendations for incidentally detected solid nodules by proposing a set of recommendations specifically aimed at subsolid nodules. The development of a standardized approach to the interpretation and management of subsolid nodules remains critically important given that peripheral adenocarcinomas represent the most common type of lung cancer, with evidence of increasing frequency. Following an initial consideration of appropriate terminology to describe subsolid nodules and a brief review of the new classification system for peripheral lung adenocarcinomas sponsored by the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS), six specific recommendations were made, three with regard to solitary subsolid nodules and three with regard to multiple subsolid nodules. Each recommendation is followed first by the rationales underlying the recommendation and then by specific pertinent remarks. Finally, issues for which future research is needed are discussed. The recommendations are the result of careful review of the literature now available regarding subsolid nodules. Given the complexity of these lesions, the current recommendations are more varied than the original Fleischner Society guidelines for solid nodules. It cannot be overemphasized that these guidelines must be interpreted in light of an individual's clinical history. Given the frequency with which subsolid nodules are encountered in daily clinical practice, and notwithstanding continuing controversy on many of these issues, it is anticipated that further refinements and modifications to these recommendations will be forthcoming as information continues to emerge from ongoing research.
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Affiliation(s)
- David P Naidich
- Department of Radiology, New York University Medical Center, 560 First Ave, New York, NY 10016, USA.
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Whitson BA, Groth SS, Andrade RS, Mitiek MO, Maddaus MA, D’Cunha J. Invasive adenocarcinoma with bronchoalveolar features: A population-based evaluation of the extent of resection in bronchoalveolar cell carcinoma. J Thorac Cardiovasc Surg 2012; 143:591-600.e1. [DOI: 10.1016/j.jtcvs.2011.10.088] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 09/24/2011] [Accepted: 10/05/2011] [Indexed: 11/30/2022]
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Shimada Y, Yoshida J, Hishida T, Nishimura M, Ishii G, Nagai K. Predictive factors of pathologically proven noninvasive tumor characteristics in T1aN0M0 peripheral non-small cell lung cancer. Chest 2011; 141:1003-1009. [PMID: 21852293 DOI: 10.1378/chest.11-0017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND We retrospectively analyzed preoperative factors that may predict pathologically invasive tumor characteristics, including lymph node involvement, and pleural and vessel invasion in patients with cT1aN0M0 peripheral non-small cell lung cancer (NSCLC), in an attempt to identify candidates for pulmonary resection less than lobectomy. METHODS We reviewed the charts of 363 patients in whom cT1aN0M0 lung cancer in the lung periphery had been diagnosed or was suspected, based on high-resolution CT scan of 1- or 2-mm-slice intervals, within 1 month of surgical resection, and examined the relationships between preoperative clinical information and pathologic invasive tumor characteristics, corresponding to lymph node involvement and pleural and vessel invasion. RESULTS Multivariate analysis showed that a tumor disappearance ratio (TDR) < 0.5, the presence of spiculation, and an absence of air bronchograms were statistically significant independent predictors of pathologic invasiveness. Most TDR ≥ 0.5 tumors were noninvasive (98.7%), and only one patient had a recurrence within 5 years after surgical resection. Of the tumors with a TDR ≥ 0.5 without spiculation, 98.3% were noninvasive, and all those patients remained recurrence-free for 5 years after surgery. CONCLUSION The combination of a TDR ≥ 0.5 and the absence of spiculation was highly predictive of noninvasive or minimally invasive NSCLC. Future studies should evaluate whether limited resection of these tumors provides acceptable outcomes.
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Affiliation(s)
- Yoshihisa Shimada
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Junji Yoshida
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Tomoyuki Hishida
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Mitsuyo Nishimura
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Genichiro Ishii
- Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kanji Nagai
- Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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Nishiyama N, Iwata T, Nagano K, Izumi N, Tsukioka T, Tei K, Yamamoto R, Suehiro S. Lung metastases from various malignancies combined with primary lung cancer. Gen Thorac Cardiovasc Surg 2010; 58:538-41. [PMID: 20941570 DOI: 10.1007/s11748-009-0563-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 10/18/2009] [Indexed: 11/29/2022]
Abstract
Various tumors metastasize to the lung, and they are often detected as multiple nodules. We report on two cases of such multiple lung metastases combined with primary lung cancer: a myxoid liposarcoma in the right thigh and a colon cancer. In each case, a pulmonary metastasectomy revealed that one of the tumors was primary lung cancer. Regardless of recent advances in computed tomography for detecting small pulmonary nodules and ground-glass opacity components, which indicate possible primary lung cancer, the preoperative differential diagnosis for either metastatic or primary lung cancers is usually difficult because they are too small to obtain enough tissue for diagnosis, except by surgery. When nodules are removed and diagnosed as lung metastasis combined with primary lung cancer, additional treatment should be considered depending on the prognosis of each disease.
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Affiliation(s)
- Noritoshi Nishiyama
- Department of Thoracic Surgery, Osaka City University Graduate School of Medicine, Japan.
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Possible Delayed Cut-End Recurrence After Limited Resection for Ground-Glass Opacity Adenocarcinoma, Intraoperatively Diagnosed as Noguchi Type B, in Three Patients. J Thorac Oncol 2010; 5:546-50. [DOI: 10.1097/jto.0b013e3181d0a480] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aokage K, Yoshida J, Ishii G, Hishida T, Nishimura M, Nagai K. Subcarinal lymph node in upper lobe non-small cell lung cancer patients: is selective lymph node dissection valid? Lung Cancer 2010; 70:163-7. [PMID: 20236727 DOI: 10.1016/j.lungcan.2010.02.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Revised: 01/29/2010] [Accepted: 02/21/2010] [Indexed: 11/19/2022]
Abstract
Little is known about selective lymph node dissection in non-small cell lung cancer (NSCLC) patients. We sought to gain insight into subcarinal node involvement for its frequency and impact on outcome to evaluate whether it is valid to omit subcarinal lymph node dissection in upper lobe NSCLC patients. We reviewed node metastases distribution according to node region, tumor location, and histology among 1099 patients with upper lobe NSCLC. We paid special attention to subcarinal metastases patients without superior mediastinal node metastases, because their pathological stages would have been underdiagnosed if subcarinal node dissection had been omitted. We also assessed the outcome and the pattern of failure among subcarinal metastases patients. To identify subcarinal node involvement predictors, we analyzed 7 clinical factors. Subcarinal node metastases were found in 20 patients and were least frequent among squamous cell carcinoma patients (0.5%). Two of them were free from superior mediastinal metastases but died of the disease at 1 month and due to an unknown cause at 18 months, respectively. Seventeen of the 20 patients developed multi-site recurrence within 37 months. The 5-year survival rate of the 20 patients with subcarinal metastases was 9.0%, which was significantly lower than 32.0% of patients with only superior mediastinal metastases. Clinical diagnosis of node metastases was significantly predictive of subcarinal metastases. Subcarinal node metastases from upper lobe NSCLC were rare and predicted an extremely poor outcome. It appears valid to omit subcarinal node dissection in upper lobe NSCLC patients, especially in clinical N0 squamous cell carcinoma patients.
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Affiliation(s)
- Keiju Aokage
- Division of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
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Lemarié E. [You said"ground glass"?]. Rev Mal Respir 2008; 24:1255-6. [PMID: 18216745 DOI: 10.1016/s0761-8425(07)78503-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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