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Li Q, Xiao T, Li J, Niu Y, Zhang G. The diagnosis and management of multiple ground-glass nodules in the lung. Eur J Med Res 2024; 29:305. [PMID: 38824558 PMCID: PMC11143686 DOI: 10.1186/s40001-024-01904-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/27/2024] [Indexed: 06/03/2024] Open
Abstract
The prevalence of low-dose CT (LDCT) in lung cancer screening has gradually increased, and more and more lung ground glass nodules (GGNs) have been detected. So far, a consensus has been reached on the treatment of single pulmonary ground glass nodules, and there have been many guidelines that can be widely accepted. However, at present, more than half of the patients have more than one nodule when pulmonary ground glass nodules are found, which means that different treatment methods for nodules may have different effects on the prognosis or quality of life of patients. This article reviews the research progress in the diagnosis and treatment strategies of pulmonary multiple lesions manifested as GGNs.
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Affiliation(s)
- Quanqing Li
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Tianjiao Xiao
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jindong Li
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yan Niu
- Jilin University, Changchun, Jilin Province, China
| | - Guangxin Zhang
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun, Jilin Province, China.
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2
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Wang Z, Zhang Q, Wang C, Herth FJF, Guo Z, Zhang X. Multiple primary lung cancer: Updates and perspectives. Int J Cancer 2024. [PMID: 38783577 DOI: 10.1002/ijc.34994] [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: 10/18/2023] [Revised: 02/14/2024] [Accepted: 03/28/2024] [Indexed: 05/25/2024]
Abstract
Management of multiple primary lung cancer (MPLC) remains challenging, partly due to its increasing incidence, especially with the significant rise in cases of multiple lung nodules caused by low-dose computed tomography screening. Moreover, the indefinite pathogenesis, diagnostic criteria, and treatment selection add to the complexity. In recent years, there have been continuous efforts to dissect the molecular characteristics of MPLC and explore new diagnostic approaches as well as treatment modalities, which will be reviewed here, with a focus on newly emerging evidence and future perspectives, hope to provide new insights into the management of MPLC and serve as inspiration for future research related to MPLC.
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Affiliation(s)
- Ziqi Wang
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Henan International Joint Laboratory of Diagnosis and Treatment for Pulmonary Nodules, Zhengzhou, Henan, China
| | - Quncheng Zhang
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Henan International Joint Laboratory of Diagnosis and Treatment for Pulmonary Nodules, Zhengzhou, Henan, China
| | - Chaoyang Wang
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Henan International Joint Laboratory of Diagnosis and Treatment for Pulmonary Nodules, Zhengzhou, Henan, China
| | - Felix J F Herth
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Henan International Joint Laboratory of Diagnosis and Treatment for Pulmonary Nodules, Zhengzhou, Henan, China
- Department of Pneumology and Critical Care Medicine Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Zhiping Guo
- Department of Health Management, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Henan Provincial Key Laboratory of Chronic Diseases and Health Management, Zhengzhou, Henan, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Henan International Joint Laboratory of Diagnosis and Treatment for Pulmonary Nodules, Zhengzhou, Henan, China
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3
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Chen F, Li J, Li L, Tong L, Wang G, Zou X. Multidimensional biological characteristics of ground glass nodules. Front Oncol 2024; 14:1380527. [PMID: 38841161 PMCID: PMC11150621 DOI: 10.3389/fonc.2024.1380527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/07/2024] [Indexed: 06/07/2024] Open
Abstract
The detection rate of ground glass nodules (GGNs) has increased in recent years because of their malignant potential but relatively indolent biological behavior; thus, correct GGN recognition and management has become a research focus. Many scholars have explored the underlying mechanism of the indolent progression of GGNs from several perspectives, such as pathological type, genomic mutational characteristics, and immune microenvironment. GGNs have different major mutated genes at different stages of development; EGFR mutation is the most common mutation in GGNs, and p53 mutation is the most abundant mutation in the invasive stage of GGNs. Pure GGNs have fewer genomic alterations and a simpler genomic profile and exhibit a gradually evolving genomic mutation profile as the pathology progresses. Compared to advanced lung adenocarcinoma, GGN lung adenocarcinoma has a higher immune cell percentage, is under immune surveillance, and has less immune escape. However, as the pathological progression and solid component increase, negative immune regulation and immune escape increase gradually, and a suppressive immune environment is established gradually. Currently, regular computer tomography monitoring and surgery are the main treatment strategies for persistent GGNs. Stereotactic body radiotherapy and radiofrequency ablation are two local therapeutic alternatives, and systemic therapy has been progressively studied for lung cancer with GGNs. In the present review, we discuss the characterization of the multidimensional molecular evolution of GGNs that could facilitate more precise differentiation of such highly heterogeneous lesions, laying a foundation for the development of more effective individualized treatment plans.
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Affiliation(s)
- Furong Chen
- Department of Oncology, The First People’s Hospital of Shuangliu District/West China (Airport) Hospital, Sichuan University, Chengdu, China
| | - Jiangtao Li
- Department of Oncology, The First People’s Hospital of Shuangliu District/West China (Airport) Hospital, Sichuan University, Chengdu, China
| | - Lei Li
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
- Department of State Key Laboratory of Respiratory Health and Multimobidity, West China Hospital, Sichuan University, Chengdu, China
| | - Lunbing Tong
- Department of Respiratory Medicine, Chengdu Seventh People’s Hospital/Affiliated Cancer Hospital of Chengdu Medical College, Chengdu, China
| | - Gang Wang
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
- Department of State Key Laboratory of Respiratory Health and Multimobidity, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelin Zou
- Department of Respiratory Medicine, Chengdu Seventh People’s Hospital/Affiliated Cancer Hospital of Chengdu Medical College, Chengdu, China
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4
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Cheng B, Li C, Li J, Gong L, Liang P, Chen Y, Zhan S, Xiong S, Zhong R, Liang H, Feng Y, Wang R, Wang H, Zheng H, Liu J, Zhou C, Shao W, Qiu Y, Sun J, Xie Z, Liang Z, Yang C, Cai X, Su C, Wang W, He J, Liang W. The activity and immune dynamics of PD-1 inhibition on high-risk pulmonary ground glass opacity lesions: insights from a single-arm, phase II trial. Signal Transduct Target Ther 2024; 9:93. [PMID: 38637495 PMCID: PMC11026465 DOI: 10.1038/s41392-024-01799-z] [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: 11/24/2023] [Revised: 02/26/2024] [Accepted: 03/10/2024] [Indexed: 04/20/2024] Open
Abstract
Immune checkpoint inhibitors targeting the programmed cell death-1 (PD-1) protein significantly improve survival in patients with advanced non-small-cell lung cancer (NSCLC), but its impact on early-stage ground-glass opacity (GGO) lesions remains unclear. This is a single-arm, phase II trial (NCT04026841) using Simon's optimal two-stage design, of which 4 doses of sintilimab (200 mg per 3 weeks) were administrated in 36 enrolled multiple primary lung cancer (MPLC) patients with persistent high-risk (Lung-RADS category 4 or had progressed within 6 months) GGOs. The primary endpoint was objective response rate (ORR). T/B/NK-cell subpopulations, TCR-seq, cytokines, exosomal RNA, and multiplexed immunohistochemistry (mIHC) were monitored and compared between responders and non-responders. Finally, two intent-to-treat (ITT) lesions (pure-GGO or GGO-predominant) showed responses (ORR: 5.6%, 2/36), and no patients had progressive disease (PD). No grade 3-5 TRAEs occurred. The total response rate considering two ITT lesions and three non-intent-to-treat (NITT) lesions (pure-solid or solid-predominant) was 13.9% (5/36). The proportion of CD8+ T cells, the ratio of CD8+/CD4+, and the TCR clonality value were significantly higher in the peripheral blood of responders before treatment and decreased over time. Correspondingly, the mIHC analysis showed more CD8+ T cells infiltrated in responders. Besides, responders' cytokine concentrations of EGF and CTLA-4 increased during treatment. The exosomal expression of fatty acid metabolism and oxidative phosphorylation gene signatures were down-regulated among responders. Collectively, PD-1 inhibitor showed certain activity on high-risk pulmonary GGO lesions without safety concerns. Such effects were associated with specific T-cell re-distribution, EGF/CTLA-4 cytokine compensation, and regulation of metabolism pathways.
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Affiliation(s)
- Bo Cheng
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Caichen Li
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jianfu Li
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Longlong Gong
- Medical Department, Genecast Biotechnology Co., Ltd, Wuxi, China
| | - Peng Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Ying Chen
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Shuting Zhan
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Shan Xiong
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Ran Zhong
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Yi Feng
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Runchen Wang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Haixuan Wang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Hongbo Zheng
- Medical Department, Genecast Biotechnology Co., Ltd, Wuxi, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Chengzhi Zhou
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Wenlong Shao
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Yuan Qiu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jiancong Sun
- Department of Radiation Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhanhong Xie
- Department of Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Zhu Liang
- Department of Cardiothoracic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Chenglin Yang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Xiuyu Cai
- Department of VIP Inpatient, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Sun Yat-sen University, Guangzhou, China
| | - Chunxia Su
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Wang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China.
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, China.
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5
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Cardillo G, Petersen RH, Ricciardi S, Patel A, Lodhia JV, Gooseman MR, Brunelli A, Dunning J, Fang W, Gossot D, Licht PB, Lim E, Roessner ED, Scarci M, Milojevic M. European guidelines for the surgical management of pure ground-glass opacities and part-solid nodules: Task Force of the European Association of Cardio-Thoracic Surgery and the European Society of Thoracic Surgeons. Eur J Cardiothorac Surg 2023; 64:ezad222. [PMID: 37243746 DOI: 10.1093/ejcts/ezad222] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/10/2023] [Accepted: 05/26/2023] [Indexed: 05/29/2023] Open
Affiliation(s)
- Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Unicamillus-Saint Camillus University of Health Sciences, Rome, Italy
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Sara Ricciardi
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Akshay Patel
- Department of Thoracic Surgery, University Hospitals Birmingham, England, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Joshil V Lodhia
- Department of Thoracic Surgery, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Michael R Gooseman
- Department of Thoracic Surgery, Hull University Teaching Hospitals NHS Trust, and Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Joel Dunning
- James Cook University Hospital Middlesbrough, United Kingdom
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shangai, China
| | - Dominique Gossot
- Department of Thoracic Surgery, Curie-Montsouris Thoracic Institute, Paris, France
| | - Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Eric Lim
- Academic Division of Thoracic Surgery, The Royal Brompton Hospital and Imperial College London, United Kingdom
| | - Eric Dominic Roessner
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Marco Scarci
- Division of Thoracic Surgery, Imperial College NHS Healthcare Trust and National Heart and Lung Institute, Hammersmith Hospital, London, United Kingdom
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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Liu Y, Yu H, Dong Y, Zhang D. Case Report: A case of synchronous right upper lobe adenocarcinoma and left lower lobe squamous cell carcinoma treated with immune checkpoint inhibitor plus chemotherapy. Front Oncol 2023; 13:1062138. [PMID: 36761949 PMCID: PMC9905415 DOI: 10.3389/fonc.2023.1062138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/13/2023] [Indexed: 01/26/2023] Open
Abstract
Globally, lung cancer is the leading cause of cancer-related mortality. Multiple primary lung cancers (MPLC) account for a very small portion of all primary lung cancer cases. Importantly, a quick and precise differentiation between MPLC and intrapulmonary metastases is directly related to patient prognoses as treatment strategies vary according to pathological type. Synchronous MPLC are most commonly seen in the same lung. Here, we report a rare case of a patient with synchronous MPLC of both lungs. A 67-year-old man, with a 1-month cough and expectoration history, was admitted in our hospital. Computed tomography (CT) chest scan revealed a lower lobe nodule in the left lung and an upper lobe nodule in the right lung. He underwent successive fiberoptic bronchoscopy and CT-guided percutaneous pulmonary aspiration biopsy of both lungs. The pathological diagnosis was squamous cell carcinoma of the left lung and adenocarcinoma of the right lung.
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Affiliation(s)
- Yujiao Liu
- State Key Laboratory of Separation Membranes and Membrane Processes, School of Chemistry, Tiangong University, Tianjin, China
| | - Han Yu
- Department of Pathology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Youhong Dong
- Department of Oncology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Dongdong Zhang
- Department of Oncology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, China,*Correspondence: Dongdong Zhang,
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Yoon HJ, Choi J, Kim E, Um SW, Kang N, Kim W, Kim G, Park H, Lee HY. Deep learning analysis to predict EGFR mutation status in lung adenocarcinoma manifesting as pure ground-glass opacity nodules on CT. Front Oncol 2022; 12:951575. [PMID: 36119545 PMCID: PMC9478848 DOI: 10.3389/fonc.2022.951575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 11/28/2022] Open
Abstract
Background Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) showed potency as a non-invasive therapeutic approach in pure ground-glass opacity nodule (pGGN) lung adenocarcinoma. However, optimal methods of extracting information about EGFR mutation from pGGN lung adenocarcinoma images remain uncertain. We aimed to develop, validate, and evaluate the clinical utility of a deep learning model for predicting EGFR mutation status in lung adenocarcinoma manifesting as pGGN on computed tomography (CT). Methods We included 185 resected pGGN lung adenocarcinomas in the primary cohort. The patients were divided into training (n = 125), validation (n = 23), and test sets (n = 37). A preoperative CT-based deep learning model with clinical factors as well as clinical and radiomics models was constructed and applied to the test set. We evaluated the clinical utility of the deep learning model by applying it to 83 GGNs that received EGFR-TKI from an independent cohort (clinical validation set), and treatment response was regarded as the reference standard. Results The prediction efficiencies of each model were compared in terms of area under the curve (AUC). Among the 185 pGGN lung adenocarcinomas, 122 (65.9%) were EGFR-mutant and 63 (34.1%) were EGFR-wild type. The AUC of the clinical, radiomics, and deep learning with clinical models to predict EGFR mutations were 0.50, 0.64, and 0.85, respectively, for the test set. The AUC of deep learning with the clinical model in the validation set was 0.72. Conclusions Deep learning approach of CT images combined with clinical factors can predict EGFR mutations in patients with lung adenocarcinomas manifesting as pGGN, and its clinical utility was demonstrated in a real-world sample.
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Affiliation(s)
- Hyun Jung Yoon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Radiology, Veterans Health Service Medical Center, Seoul, South Korea
| | - Jieun Choi
- Department of Artificial Intelligence, Sungkyunkwan University, Suwon, South Korea
| | - Eunjin Kim
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Health Science and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Noeul Kang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Wook Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Geena Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyunjin Park
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, South Korea
- School of Electronic and Electrical Engineering, Sungkyunkwan University, Suwon, South Korea
- *Correspondence: Ho Yun Lee, ; Hyunjin Park,
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Health Science and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- *Correspondence: Ho Yun Lee, ; Hyunjin Park,
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8
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Zhang J, Han Y, Zhang Y, Dong D, Cao Y, Chen X, Li H. Considerations for the Surgical Management of Thoracic Cancers During the COVID-19 Pandemic: Rational Strategies for Thoracic Surgeons. Front Surg 2022; 9:742007. [PMID: 35615657 PMCID: PMC9124784 DOI: 10.3389/fsurg.2022.742007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 03/23/2022] [Indexed: 01/08/2023] Open
Abstract
Objective The novel Coronavirus Disease 2019 (COVID-19) has resulted in a global health crisis since first case was identified in December 2019. As the pandemic continues to strain global public health systems, elective surgeries for thoracic cancer, such as early-stage lung cancer and esophageal cancer (EC), have been postponed due to a shortage of medical resources and the risk of nosocomial transmission. This review is aimed to discuss the influence of COVID-19 on thoracic surgical practice, prevention of nosocomial transmission during the pandemic, and propose modifications to the standard practices in the surgical management of different thoracic cancer. Methods A literature search of PubMed, Medline, and Google Scholar was performed for articles focusing on COVID-19, early-stage lung cancer, and EC prior to 1 July 2021. The evidence from articles was combined with our data and experience. Results We review the challenges in the management of different thoracic cancer from the perspectives of thoracic surgeons and propose rational strategies for the diagnosis and treatment of early-stage lung cancer and EC during the COVID-19 pandemic. Conclusions During the COVID-19 pandemic, the optimization of hospital systems and medical resources is to fight against COVID-19. Indolent early lung cancers, such as pure ground-glass nodules/opacities (GGOs), can be postponed with a lower risk of progression, while selective surgeries of more biologically aggressive tumors should be prioritized. As for EC, we recommend immediate or prioritized surgeries for patients with stage Ib or more advanced stage and patients after neoadjuvant therapy. Routine COVID-19 screening should be performed preoperatively before thoracic surgeries. Prevention of nosocomial transmission by providing appropriate personal protective equipment (PPE), such as N-95 respirator masks with eye protection to healthcare workers, is necessary.
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Affiliation(s)
| | | | | | | | | | | | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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9
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Zhou D, Liu QX, Li MY, Hou B, Yang GX, Lu X, Zheng H, Jiang L, Dai JG. Utility of whole exome sequencing analysis in differentiating intrapulmonary metastatic multiple ground-glass nodules (GGNs) from multiple primary GGNs. Int J Clin Oncol 2022; 27:871-881. [PMID: 35171361 PMCID: PMC9023437 DOI: 10.1007/s10147-022-02134-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/31/2022] [Indexed: 11/05/2022]
Abstract
Purpose Clinical evidence of metastasis with ground-glass nodules (GGNs) has been reported, including pulmonary metastasis and distant metastasis. However, the clonal relationships of multiple GGNs at the genetic level remain unclear. Experimental design Sixty tissue specimens were obtained from 19 patients with multiple GGN lung cancer who underwent surgery in 2019. Whole exome sequencing (WES) was performed on tissue samples, and genomic profiling and clone evolution analysis were conducted to investigate the genetic characteristics and clonality of multiple GGNs. Results A total of 15,435 nonsynonymous mutations were identified by WES, and GGNs with shared nonsynonymous mutations were observed in seven patients. Copy number variant (CNV) analysis showed that GGNs in ten patients had at least one shared arm-level CNV. Mutational spectrum analysis showed that GGNs in three patients had similar six substitution profiles and GGNs in fou patients had similar 96 substitution profiles. According to the clone evolution analysis, we found that GGNs in five patients had shared clonal driver gene mutations. Taken together, we identified that 5 patients may have multiple primary GGNs without any similar genetic features, 2 patients may have intrapulmonary metastatic GGNs with ≥ 3 similar genetic features, and the other 12 patients cannot be determined due to insufficient evidences in our cohort. Conclusions Our findings suggest that the intrapulmonary metastasis exist in multiple GGNs, but the number of GGNs was not associated with the probability of metastasis. Application of genomic profiling may prove to be important to precise management of patients with multiple GGNs. Supplementary Information The online version contains supplementary material available at 10.1007/s10147-022-02134-8.
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Affiliation(s)
- Dong Zhou
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Quan-Xing Liu
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Man-Yuan Li
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Bin Hou
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Gui-Xue Yang
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Xiao Lu
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Hong Zheng
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Li Jiang
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China.
| | - Ji-Gang Dai
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China.
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10
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Lee K, Kim HR, Park SI, Kim DK, Kim YH, Choi S, Lee GD. Natural Progression of Ground-glass Nodules after Curative Resection for Non-small Cell Lung Cancer. J Korean Med Sci 2021; 36:e266. [PMID: 34751007 PMCID: PMC8575765 DOI: 10.3346/jkms.2021.36.e266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/03/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This retrospective study investigated the natural course of synchronous ground-glass nodules (GGNs) that remained after curative resection for non-small-cell lung cancer (NSCLC). METHODS Prospectively collected retrospective data were reviewed concerning 2,276 patients who underwent curative resection for NSCLC between 2008 and 2017. High-resolution computed tomography or thin-section computed tomography data of 82 patients were included in the study. Growth in size was considered the most valuable outcome, and patients were grouped according to GGN size change. Patient demographic data (e.g., age, sex, and smoking history), perioperative data (e.g., GGN characteristics, histopathology and pathological stage of the resected tumours), and other medical history were evaluated in a risk factor analysis concerning GGN size change. RESULTS The median duration of follow-up was 36.0 months (interquartile range, 23.0-59.3 months). GGN size decreased in 6 patients (7.3%), was stationary in 43 patients (52.4%), and increased in 33 patients (40.2%). In univariate analysis, male sex, the GGN size on initial CT, part-solid GGN and smoking history (≥ 10 pack-years) were significant risk factors. Among them, multivariate analysis revealed that lager GGN size, part-solid GGN and smoking history were independent risk factors. CONCLUSION During follow-up, 40.2% of GGNs increased in size, emphasising that patients with larger GGNs, part-solid GGN or with a smoking history should be observed.
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Affiliation(s)
- Kanghoon Lee
- Department of Thoracic and Cardiovascular Surgery, International St. Mary's Hospital, Catholic Kwandong University, College of Medicine, Incheon, Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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11
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Qu R, Tu D, Hu S, Wang Q, Ping W, Hao Z, Cai Y, Zhang N, Wang J, Fu X. ENB-guided microwave ablation combined with uniportal VATS for multiple ground glass opacities. Ann Thorac Surg 2021; 113:1307-1315. [PMID: 33964257 DOI: 10.1016/j.athoracsur.2021.04.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/08/2021] [Accepted: 04/21/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND An increasing number of patients are being diagnosed with multiple ground glass opacities (GGOs), but a consensus on the treatment of these patients is still lacking. The aim of this study was to investigate the safety and feasibility of a novel technique, electromagnetic navigation bronchoscopy (ENB)-guided microwave ablation combined with uniportal video-assisted thoracoscopic surgery (Uni-VATS), in patients with multiple GGOs. METHODS The clinical, radiographic, surgical, and pathological data of patients with multiple GGOs who underwent ENB-guided microwave ablation combined with Uni-VATS from October 2018 to December 2019 were reviewed. RESULTS Eleven patients with multiple GGOs underwent ENB-guided microwave ablation combined with Uni-VATS, including 6 males and 5 females with a mean age of 61.3±5.1 (53-68) years. Thirty-seven lesions were observed in the 11 patients, 21 of which were microwave ablated and 16 of which were surgically resected. Only one patient developed postoperative pneumothorax and subcutaneous emphysema and was successfully discharged from the hospital after symptomatic treatment. The success rate and efficiency of microwave ablation under ENB guidance were 100%, with no other serious complications or procedure-related deaths occurring. No local metastasis or recurrence occurred in any patients during the follow-up period. CONCLUSIONS ENB-guided microwave ablation combined with Uni-VATS is safe and feasible in patients with multiple GGOs suspected of having multiple primary lung cancers, and may represent an alternative approach for more patients, particularly patients who cannot tolerate the simultaneous resection of multiple tumors.
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Affiliation(s)
- Rirong Qu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Dehao Tu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Shaojie Hu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Qi Wang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wei Ping
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Zhipeng Hao
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yixin Cai
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Ni Zhang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jianing Wang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
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12
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Ye X, Fan W, Wang Z, Wang J, Wang H, Wang J, Wang C, Niu L, Fang Y, Gu S, Tian H, Liu B, Zhong L, Zhuang Y, Chi J, Sun X, Yang N, Wei Z, Li X, Li X, Li Y, Li C, Li Y, Yang X, Yang W, Yang P, Yang Z, Xiao Y, Song X, Zhang K, Chen S, Chen W, Lin Z, Lin D, Meng Z, Zhao X, Hu K, Liu C, Liu C, Gu C, Xu D, Huang Y, Huang G, Peng Z, Dong L, Jiang L, Han Y, Zeng Q, Jin Y, Lei G, Zhai B, Li H, Pan J. [Expert Consensus for Thermal Ablation of Pulmonary Subsolid Nodules (2021 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 24:305-322. [PMID: 33896152 PMCID: PMC8174112 DOI: 10.3779/j.issn.1009-3419.2021.101.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
局部热消融技术在肺部结节治疗领域正处在起步与发展阶段,为了肺结节热消融治疗的临床实践和规范发展,由“中国医师协会肿瘤消融治疗技术专家组”“中国医师协会介入医师分会肿瘤消融专业委员会”“中国抗癌协会肿瘤消融治疗专业委员会”“中国临床肿瘤学会消融专家委员会”组织多学科国内有关专家,讨论制定了“热消融治疗肺部亚实性结节专家共识(2021年版)”。主要内容包括:①肺部亚实性结节的临床评估;②热消融治疗肺部亚实性结节技术操作规程、适应证、禁忌证、疗效评价和相关并发症;③存在的问题和未来发展方向。
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Affiliation(s)
- Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
| | - Weijun Fan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510050, China
| | - Zhongmin Wang
- Department of Interventional Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China
| | - Hui Wang
- Interventional Center, Jilin Provincial Cancer Hospital, Changchun 170412, China
| | - Jun Wang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
| | - Chuntang Wang
- Department of Thoracic Surgery, Dezhou Second People's Hospital, Dezhou 253022, China
| | - Lizhi Niu
- Department of Oncology, Affiliated Fuda Cancer Hospital, Jinan University, Guangzhou 510665, China
| | - Yong Fang
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Shanzhi Gu
- Department of Interventional Radiology, Hunan Cancer Hospital, Changsha 410013, China
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Baodong Liu
- Department of Thoracic Surgery, Xuan Wu Hospital Affiliated to Capital Medical University, Beijing 100053, China
| | - Lou Zhong
- Thoracic Surgery Department, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Yiping Zhuang
- Department of Interventional Therapy, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Jiachang Chi
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Xichao Sun
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Nuo Yang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Zhigang Wei
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
| | - Xiao Li
- Department of Interventional Therapy, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiaoguang Li
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, Beijing 100730, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, China
| | - Chunhai Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Yan Li
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Afliated to Shandong First Medical University, Jinan 250101, China
| | - Wuwei Yang
- Department of Oncology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing 100071, China
| | - Po Yang
- Interventionael & Vascular Surgery, The Fourth Hospital of Harbin Medical University, Harbin 150001, China
| | - Zhengqiang Yang
- Department of Interventional Therapy, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yueyong Xiao
- Department of Radiology, Chinese PLA Gneral Hospital, Beijing 100036, China
| | - Xiaoming Song
- Department of Thoracic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
| | - Kaixian Zhang
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou 277500, China
| | - Shilin Chen
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Weisheng Chen
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian 350011, China
| | - Zhengyu Lin
- Department of Intervention, The First Affiliated Hospital of Fujian Medical University, Fujian 350005, China
| | - Dianjie Lin
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Zhiqiang Meng
- Minimally Invasive Therapy Center, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Xiaojing Zhao
- Department of Thoracic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Kaiwen Hu
- Department of Oncology, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100078, China
| | - Chen Liu
- Department of Interventional Therapy, Beijing Cancer Hospital, Beijing 100161, China
| | - Cheng Liu
- Department of Radiology, Shandong Medical Imaging Research Institute, Jinan 250021, China
| | - Chundong Gu
- Department of Thoracic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Dong Xu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310022, China
| | - Yong Huang
- Department of Imaging, Affiliated Cancer Hospital of Shandong First Medical University, Jinan 250117, China
| | - Guanghui Huang
- Department of Oncology, Shandong Provincial Hospital Afliated to Shandong First Medical University, Jinan 250101, China
| | - Zhongmin Peng
- Department of Thoracic Surgery , Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Liang Dong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
| | - Lei Jiang
- Department of Radiology, The Convalescent Hospital of East China, Wuxi 214063, China
| | - Yue Han
- Department of Interventional Therapy, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qingshi Zeng
- Department of Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
| | - Yong Jin
- Interventionnal Therapy Department, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Guangyan Lei
- Department of Thoracic Surgery, Shanxi Provincial Cancer Hospital, Xi'an 710061, China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Hailiang Li
- Department of Interventional Radiology, Henan Cancer Hospital, Zhengzhou 450003, China
| | - Jie Pan
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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13
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Izumi M, Oyanagi J, Sawa K, Fukui M, Ogawa K, Matsumoto Y, Tani Y, Suzumura T, Watanabe T, Kaneda H, Mitsuoka S, Asai K, Ohsawa M, Yamamoto N, Koh Y, Kawaguchi T. Mutational landscape of multiple primary lung cancers and its correlation with non-intrinsic risk factors. Sci Rep 2021; 11:5680. [PMID: 33707471 PMCID: PMC7952588 DOI: 10.1038/s41598-021-83609-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/01/2020] [Indexed: 12/31/2022] Open
Abstract
Multiple primary lung cancers (MPLCs) harbour various genetic profiles among the tumours, even from individuals with same non-intrinsic risk factors. Paired mutational analyses were performed to obtain a census of mutational events in MPLC and assess their relationship with non-intrinsic risk factors. Thirty-eight surgical specimens from 17 patients diagnosed as MPLC were used. Extracted DNAs were sequenced for somatic mutations in 409 cancer-associated genes from a comprehensive cancer panel. We statistically analysed the correlation between each driver mutation frequency and non-intrinsic risk factors using Fisher's exact test, and whether genetic mutations occurred concomitantly or randomly in MPLC using an exact test. Comprehensive genetic analyses suggested different mutation profiles in tumours within the same individuals, with some exceptions. EGFR, KRAS, TP53, or PARP1 mutations were concomitantly detected in some MPLC cases. EGFR mutations were significantly more frequent in never or light smokers and females. Concomitant EGFR or KRAS mutations in MPLCs were significantly more frequent than expected by chance (P = .0023 and .0049, respectively) suggesting a more prominent role of non-intrinsic risk factors in EGFR and KRAS mutations than other mutations, which occurred more randomly. Concomitant EGFR or KRAS mutations were particularly prominent in never or light smokers and males.
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Affiliation(s)
- Motohiro Izumi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-cho, Abeno-ku, Osaka, 545-8585, Japan
- Internal Medicine III, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Jun Oyanagi
- Internal Medicine III, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-cho, Abeno-ku, Osaka, 545-8585, Japan
| | - Mitsuru Fukui
- Laboratory of Statistics, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Koichi Ogawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-cho, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-cho, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tomohiro Suzumura
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-cho, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-cho, Abeno-ku, Osaka, 545-8585, Japan
| | - Masahiko Ohsawa
- Department of Pathology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Nobuyuki Yamamoto
- Internal Medicine III, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Yasuhiro Koh
- Internal Medicine III, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan.
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-cho, Abeno-ku, Osaka, 545-8585, Japan.
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
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14
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The impact of postoperative EGFR-TKIs treatment on residual GGO lesions after resection for lung cancer. Signal Transduct Target Ther 2021; 6:73. [PMID: 33611336 PMCID: PMC7897326 DOI: 10.1038/s41392-020-00452-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/24/2020] [Indexed: 11/22/2022] Open
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15
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Cheng B, Deng H, Zhao Y, Zhu F, Liang H, Li C, Zhong R, Li J, Xiong S, Chen Z, Liang W, He J. Management for Residual Ground-Glass Opacity Lesions After Resection of Main Tumor in Multifocal Lung Cancer: A Case Report and Literature Review. Cancer Manag Res 2021; 13:977-985. [PMID: 33568943 PMCID: PMC7868271 DOI: 10.2147/cmar.s290830] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/13/2021] [Indexed: 12/26/2022] Open
Abstract
There are increasing numbers of synchronous multiple primary lung cancer (SMPLC) patients in clinical practice, with most lesions presenting as ground-glass opacity (GGO). For SMPLC patients, surgical resection should be a prior option for all lesions suspected of being malignant, if medically and technically feasible. However, it is frequently a dilemma for the management of residual GGO lesions that were unresected simultaneously with the main tumor in SMPLC patients. We report a case of SMPLC, in which the patient underwent surgical resection of the major lesion with EGFR mutation and then received compelling EGFR-TKI treatment for one enlarging residual GGO lesion after 12 months since operation. Furthermore, a comprehensive literature review about the risk for the progress of GGOs unresected simultaneously with the main lesion and the management of these residual GGOs was also summarized. With the treatment of EGFR-TKI gefitinib for 3 months, the biggest residual GGO lesion (more than 10mm) achieved a complete response (CR), three lesions reduced in size, and the other three lesions remained stable in this case. Surgical resection for major lesion and EGFR-TKI treatment on unresected GGOs might bring favorable outcome for patients with EGFR-mutated multifocal lung cancer. This strategy is safe and effective, which could be a promising therapeutic approach for unresectable GGO lesions in EGFR-mutated SMPLC patients after primary surgery. Notably, folate receptor-positive circulating tumor cell (FR+-CTC) for therapeutic monitoring was more sensitive for GGO-featured lung adenocarcinoma than serum markers.
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Affiliation(s)
- Bo Cheng
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Hongsheng Deng
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Yi Zhao
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Feng Zhu
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Caichen Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Ran Zhong
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Jianfu Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Shan Xiong
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Zhuxing Chen
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
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16
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Xia T, Cai M, Zhuang Y, Ji X, Huang D, Lin L, Liu J, Yang Y, Fu G. Risk Factors for The Growth of Residual Nodule in Surgical Patients with Adenocarcinoma Presenting as Multifocal Ground-glass Nodules. Eur J Radiol 2020; 133:109332. [PMID: 33152625 DOI: 10.1016/j.ejrad.2020.109332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE We aim to investigate the risk factors influencing the growth of residual nodule (RN) in surgical patients with adenocarcinoma presenting as multifocal ground-glass nodules (GGNs). METHOD From January 2014 to June 2018, we enrolled 238 patients with multiple GGNs in a retrospective review. Patients were categorized into growth group 63 (26.5%), and non-growth group 175 (73.5%). The median follow-up time was 28.2 months (range, 6.3-73.0 months). To obtain the time of RN growth and find the risk factors for growth, data such as age, gender, history of smoking, history of malignancy, type of surgery, pathology and radiological characteristics were analyzed to use Kaplan-Meier method with the log-rank test and Cox regression analysis. RESULTS The median growth time of RN was 56.0 months (95% CI, 45.0-67.0 months) in all 238 patients. Roundness (HR 4.62, 95% CI 2.20-9.68), part-solid nodule (CTR ≥ 50%) (HR 4.39, 95% CI 2.29-8.45), vascular convergence sign (HR 2.32, 95% CI 1.36-3.96) of RN, and age (HR 1.04, 95% CI 1.01-1.07) were independent predictors of further nodule growth. However, radiological characteristics and pathology of domain tumour (DT) cannot be used as indicators to predict RN growth. CONCLUSIONS RN showed an indolent growth pattern in surgical patients with multifocal GGNs. RN with a higher roundness, presence of vascular convergence sign, more solid component, and in the elder was likely to grow. However, the growth of RN showed no association with the radiological features and pathology of DT.
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Affiliation(s)
- Tianyi Xia
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China
| | - Mengting Cai
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China
| | - Yuandi Zhuang
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China
| | - Xiaowei Ji
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China
| | - Dingpin Huang
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China
| | - Liaoyi Lin
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China
| | - Jinjin Liu
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China
| | - Yunjun Yang
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China.
| | - Gangze Fu
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China.
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Ohtsuka T. Importance of Ground-Glass Opacity in Long-Term Survivors of Lung Adenocarcinoma: A Leopard Cannot Change Its Spots. Ann Surg Oncol 2020; 28:14-15. [PMID: 32924085 DOI: 10.1245/s10434-020-09129-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Takashi Ohtsuka
- Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
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Treatment options for pulmonary multifocal ground glass opacity type adenocarcinoma: Surgery combine thermal ablation? J Interv Med 2020; 3:180-183. [PMID: 34805931 PMCID: PMC8562276 DOI: 10.1016/j.jimed.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives To retrospectively analyze the clinical results of the treatment of pulmonary multifocal adenocarcinoma presenting as ground glass opacity (GGO) by surgery and thermal ablation. Methods 87 GGO-type pulmonary adenocarcinomas of 48 patients (14 males and 34 females; mean age: 59.7 years old ±9.9, range: 33–79 years old) had been treated from March 2015 to March 2019. Treatment means included 43 wedge resections, 7 segmentectomy, 17 lobectomies, and 20 thermal ablations. The indication selected for treatment means, safety, and local tumor progression rate were evaluated. Results No operation-related death occurred in all patients. 42 times of surgery were performed and 67 carcinomas were resected in 42 patients. 23 times of single-port Video-assisted thoracoscopic surgery (VATS), 8 times of two-port VATS and 11 times of three-port VATS were performed in total. There were 2 cases of air leak (exceeding 1 week), 1 case of chylothorax and 1 case of massive pleural effusion. Time duration of surgery was between 60 and 300mins (mean: 167mins). Intra-operative blood loss was between 5 and 300 mL (mean: 44 mL). Time of chest drainage was between 2 and 23d (mean 4.9d). Chest drainage volume was between 14 and 4633 mL (mean: 872 mL). Post-operation LOS (length of stay) was between 3 and 25d (mean: 6.2d). 15 times of thermal ablation were performed (1 case of air leak) and 20 carcinomas were ablated in 14 patients. The ablation time was between 30 and 120min (mean: 43min); post-operation LOS was between 1 and 10d (mean: 3.5d). During the mean follow-up period (16 months ± 13) (range: 5–60 months), no local tumor progression occurred. Conclusions Surgery and thermal ablation are safe and effective options for the treatment of pulmonary multifocal GGO-type adenocarcinoma.
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Liu B, Ye X. Computed tomography-guided percutaneous microwave ablation: A novel perspective to treat multiple pulmonary ground-glass opacities. Thorac Cancer 2020; 11:2385-2388. [PMID: 32748566 PMCID: PMC7471011 DOI: 10.1111/1759-7714.13601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Baodong Liu
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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20
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Liu B. [Diagnosis and Treatment of Pulmonary Multifocal Ground-glass Nodules]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:679-684. [PMID: 32741190 PMCID: PMC7467986 DOI: 10.3779/j.issn.1009-3419.2020.102.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In recent years, with the development of the high resolution computed tomography (HRCT) screening program for lung cancer, the multifocal ground-glass nodule (GGN) has been discovered more and more. Because there are still many uncertainties in the diagnosis and treatment of multifocal GGN in lung, this paper reviews the clinical concerns such as the follow-up interval and time, the relationship between main focus and other focuses, diagnosis, treatment and follow-up of residual nodules.
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Affiliation(s)
- Baodong Liu
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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21
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Profiles of Lung Adenocarcinoma With Multiple Ground-Glass Opacities and the Fate of Residual Lesions. Ann Thorac Surg 2020; 109:1722-1730. [PMID: 32057816 DOI: 10.1016/j.athoracsur.2019.12.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/18/2019] [Accepted: 12/23/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND We aimed to clarify clinical profiles of patients with adenocarcinoma presenting as multifocal ground-glass opacities (MGGOs) to assess their prognosis and the optimal management method for residual satellite lesions. METHODS We identified 190 patients with cN0 MGGOs (MGGO cohort) and 1426 patients with solitary lung adenocarcinoma (control cohort) who underwent complete resection between 2004 and 2016. Propensity score matching was performed to adjust for differences in baseline characteristics of both cohorts for survival analyses. MGGOs consist of a main tumor and satellite lesions and were subdivided into 3 groups: the PG group, with multifocal pure GGOs; the GD group, in which the main tumor presented as GGO dominant; and the SD group, where the main tumor presented as solid dominant. RESULTS No significant differences in recurrence-free survival were observed between the 2 cohorts before and after the propensity score matching. For patients with MGGOs, 22 were in the PG group, 47 in the GD group, and 121 in the SD group. Type of MGGOs was a significant factor for recurrence-free survival recurrence-free survival both in the entire population (SD vs PG-GD, P = .008) and in p-stage I cohorts (P = .004) on multivariable analysis. Among 116 patients (61.1%) with residual satellite lesions, 38 patients had progressed lesions and 69 stable lesions. Although the emergence of new lesions during the follow-up period was an independent predictor for satellite lesion progression, neither progressed lesions nor the emergence of new lesions influenced survival. CONCLUSIONS Patients with MGGOs and solitary adenocarcinoma had a similar prognosis. The biologic behavior of main tumors dominates clinical outcomes in patients with MGGOs.
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Li M, Wan Y, Zhang L, Zhou LN, Shi Z, Zhang R, Hou YL, Wu N. Synchronous multiple lung cancers presenting as multifocal pure ground glass nodules: are whole-body positron emission tomography/computed tomography and brain enhanced magnetic resonance imaging necessary? Transl Lung Cancer Res 2019; 8:649-657. [PMID: 31737500 DOI: 10.21037/tlcr.2019.09.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Multifocal ground glass nodules (GGNs) represent a special radiological pattern indicative of synchronous multiple lung cancers (SMLCs), especially adenocarcinoma. However, the necessity of performing whole-body positron emission tomography/computed tomography (PET-CT) scanning and brain enhanced magnetic resonance imaging (MRI) as a staging workup for multifocal pure GGN (pGGN) patients remains unclear. The purpose of this study was to determine the utility of these two imaging scans for patients with multifocal pGGNs. Methods This retrospective study was reviewed and approved by the ethics committee of the Cancer Hospital of the Chinese Academy of Medical Sciences. The study cohort was retrospectively selected from patients with multifocal pGGNs who underwent whole-body PET-CT examinations and/or brain enhanced MRIs between January 2010 and February 2019 at our institution. The additional value of the two exams for detecting nodal and distant metastases was evaluated. Results In total, 73 patients (male-to-female ratio, 20:53; median age, 57 years) with multifocal pGGNs who underwent whole-body PET-CT (55 patients) and/or brain enhanced MRI (25 patients) were enrolled. No clearly metastatic lesions were detected. Among the enrolled patients, 53 (128 pGGNs) underwent complete surgical resection. All pGGNs were adenocarcinomas and/or preneoplasias, and no lymph node metastases were found on final pathology. Whole-body PET-CT and brain enhanced MRI added no definite benefit compared with chest CT alone before surgery. Conclusions Whole-body PET-CT scans and brain enhanced MRIs are not necessary for patients with multifocal pGGNs.
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Affiliation(s)
- Meng Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yuan Wan
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Li Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Li-Na Zhou
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhuo Shi
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Rui Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yan-Lei Hou
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ning Wu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.,PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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23
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Yang Y, Wang WW, Ren Y, Jin XQ, Zhu QD, Peng CT, Liu HQ, Zhang JH. Computerized texture analysis predicts histological invasiveness within lung adenocarcinoma manifesting as pure ground-glass nodules. Acta Radiol 2019; 60:1258-1264. [PMID: 30818977 DOI: 10.1177/0284185119826536] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Yang Yang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Wei-Wei Wang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Yan Ren
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Xian-Qiao Jin
- Department of Respiration, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Quan-Dong Zhu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Cheng-Tao Peng
- Department of Electronic Engineering and Information Science, University of Science and Technology of China, Hefei, PR China
| | - Han-Qiu Liu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
- Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, PR China
- Academy for Engineering and Technology, Fudan University, Shanghai, PR China
| | - Jun-Hai Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
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Yoon HY, Bae JY, Kim Y, Shim SS, Park S, Park SY, Kim SJ, Ryu YJ, Chang JH, Lee JH. Risk factors associated with an increase in the size of ground-glass lung nodules on chest computed tomography. Thorac Cancer 2019; 10:1544-1551. [PMID: 31155851 PMCID: PMC6610277 DOI: 10.1111/1759-7714.13098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The detection rate of ground-glass nodules (GGNs) in the lung has increased with the increased use of low-dose computed tomography (CT) of the chest for cancer screening; however, limited data is available on the natural history, follow-up, and treatment of GGNs. The aim of this study was to identify factors associated with an increase in the size of GGNs. METHODS A total of 338 patients (mean ages, 59.8 years; males, 35.5%) with 689 nodules who underwent chest CT at our institute between June 2004 and February 2014 were included in this study. The cut-off date of follow-up was August 2018. We analyzed the size, solidity, number, and margins of the nodules compared with their appearance on previous chest CT images. The Cox proportional hazard model was used to identify risk factors associated with nodule growth. RESULTS The median follow-up period was 21.8 months. Of the 338 patients, 38.5% had a history of malignancy, including lung cancer (8.9%). Among the 689 nodules, the median size of the lesions was 6.0 mm (IQR, 5-8 mm), and the proportion of nodules with size ≥10 mm and multiplicity was 17.1% and 66.3%, respectively. Compared to the nodules without an increase in size, the 79 nodules with an increase in size during the follow-up period were initially larger (growth group, 7.0 mm vs. non-growth group, 6.0 mm; P = 0.027), more likely to have a size ≥10 mm (26.6% vs. 15.9%; P = 0.018), and had less frequent multiplicity (54.4% vs. 67.9%, P = 0.028). In the multivariate analysis, nodule size ≥10 mm (hazard ratio [HR], 2.044; P = 0.005), a patient history of lung cancer (HR: 2.190, P = 0.006), and solitary nodule (HR: 2.499, P < 0.001) were independent risk factors for nodule growth. CONCLUSION Careful follow-up of GGNs is warranted in patients with a history of malignancy, a large , or a solitary nodule.
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Affiliation(s)
- Hee-Young Yoon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Ji-Yun Bae
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Yookyung Kim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Sung Shin Shim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Sojung Park
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - So-Young Park
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Soo Jung Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Yon Ju Ryu
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Jung Hyun Chang
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
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Shimada Y, Ikeda N. Gap between clinical and basic researches in multifocal synchronous lung adenocarcinoma studies. J Thorac Dis 2019; 10:S4021-S4022. [PMID: 30631544 DOI: 10.21037/jtd.2018.09.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yoshihisa Shimada
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
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26
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Sihoe ADL, Petersen RH, Cardillo G. Multiple pulmonary ground glass opacities: is it time for new guidelines? J Thorac Dis 2018; 10:5970-5973. [PMID: 30622765 DOI: 10.21037/jtd.2018.10.67] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Alan D L Sihoe
- Department of Surgery, The University of Hong Kong, Hong Kong, China.,Department of Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen 518053, China
| | - Rene H Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
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Yu H, Liu S, Zhang C, Li S, Ren J, Zhang J, Xu W. Computed tomography and pathology evaluation of lung ground-glass opacity. Exp Ther Med 2018; 16:5305-5309. [PMID: 30542487 DOI: 10.3892/etm.2018.6886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/03/2017] [Indexed: 01/15/2023] Open
Abstract
The aim of this study was to investigate the pathogenesis of lung ground-glass opacity (GGO) and the diagnostic value of computed tomography scan for lung GGO. Computed tomography (CT) images of 106 lung GGO cases were analyzed retrospectively, and the type, location, size, structure, boundaries and surrounding lung fields were evaluated. There were 12 cases of GGO with a diameter <1.0 cm, 36 cases with diameter of 1.0-1.5 cm, 25 cases with diameter of 1.6-2.0 cm, 19 cases with diameter of 2.0-2.5 cm and 14 cases with diameter of 2.5-3.0 cm. There were 20 lesions with a round shape and 68 lesions with an oval shape. There were 56 lesions with spinous processes, 18 lesions with air bronchograms and 37 lesions with surrounding pleural indentation. The diagnosis and differential diagnosis of GGO would be improved with combined CT scan and pathology results.
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Affiliation(s)
- Hualong Yu
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266101, P.R. China
| | - Shihe Liu
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266101, P.R. China
| | - Chuanyu Zhang
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266101, P.R. China
| | - Shaoke Li
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266101, P.R. China
| | - Jianan Ren
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266101, P.R. China
| | - Jingli Zhang
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266101, P.R. China
| | - Wenjian Xu
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266101, P.R. China
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Song Y, Liang N, Li S. [The Clinical and Molecular Characteristics of Adenocarcinoma Presented
by Multi-focal GGO]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:163-167. [PMID: 29587932 PMCID: PMC5973028 DOI: 10.3779/j.issn.1009-3419.2018.03.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
随着人们对肺癌早期筛查的重视,肺多发磨玻璃影(multiple ground glass opacities, GGOs)的检出率逐年增高,以GGOs为表现的多灶肺腺癌也逐渐成为临床研究热点。其更多见于女性、非吸烟者,且无论是自然病程还是手术后的患者均有极佳预后。独特的临床特征提示其很可能是相对独立的一种疾病形式。从分子遗传学路径对其的探究发现,同一个体内的多个病灶间极可能有截然不同的克隆性特征,因此遗传异质性(genetic heterogeneity)是以GGOs为表现多灶肺腺癌最显著的分子遗传学特征。此特征可辅助原发多灶肺腺癌与肺癌肺内转移的鉴别诊断,也提示了对病灶进行分子遗传学检测的治疗意义。部分呈现出遗传相似性的GGOs病灶为气腔播散转移(spread through air spaces, STAS)理论提供了新的证据。
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Affiliation(s)
- Yang Song
- Department of Thoracic Surgery, Chinese Academy of Medical Sciences & Peking Union Medical Colledge Hospital, Beijing 100730, China.,School of Medicine, Tsinghua University, Beijing 100084, China
| | - Naixin Liang
- Department of Thoracic Surgery, Chinese Academy of Medical Sciences & Peking Union Medical Colledge Hospital, Beijing 100730, China
| | - Shanqing Li
- Department of Thoracic Surgery, Chinese Academy of Medical Sciences & Peking Union Medical Colledge Hospital, Beijing 100730, China
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Lee CT. Multifocal ground-glass opacities: multifocal origin versus intrapulmonary metastasis. J Thorac Dis 2018; 10:1253-1255. [PMID: 29708176 DOI: 10.21037/jtd.2018.03.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Choon-Taek Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, Korea
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30
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Dai J, Yu G, Yu J. Can CT imaging features of ground-glass opacity predict invasiveness? A meta-analysis. Thorac Cancer 2018; 9:452-458. [PMID: 29446528 PMCID: PMC5879054 DOI: 10.1111/1759-7714.12604] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 01/10/2023] Open
Abstract
Background A meta‐analysis was conducted to investigate the diagnostic performance of computed tomography (CT) imaging features of ground‐glass opacity (GGO) to predict invasiveness. Methods Two reviewers independently searched PubMed, Medline, Web of Science, Cochrane Embase and CNKI for relevant studies. CT imaging signs of bubble lucency, speculation, lobulated margin, and pleural indentation were used as diagnostic references to discriminate pre‐invasive and invasive disease. The sensitivity, specificity, diagnostic odds ratio (DOR), summary receiver operating characteristic (SROC) curves, and the area under the SROC curve (AUC) were calculated to evaluate diagnostic efficiency. Results Twelve studies were finally included. Diagnostic performance ranged from 0.41 to 0.52 for sensitivity and 0.56 to 0.63 for specificity. The diagnostic positive and negative likelihood ratios ranged from 1.03 to 2.13 and 0.52 to 1.05, respectively. The DORs of the GGO CT features for discriminating invasive disease ranged from 1.02 to 4.00. The area under the ROC curve was also low, with a range of 0.60 to 0.67 for discriminating pre‐invasive and invasive disease. Conclusion The diagnostic value of a single CT imaging sign of GGO, such as bubble lucency, speculation, lobulated margin, or pleural indentation is limited for discriminating pre‐invasive and invasive disease because of low sensitivity, specificity, and AUC.
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Affiliation(s)
- Jian Dai
- Department of Radiology, Cixi People's Hospital, Cixi, Zhejiang, China
| | - Guoyou Yu
- Department of Radiology, Shangyu Hospital of Traditional Chinese Medicine Hospital Shaoxing, Shaoxing, Zhejiang, China
| | - Jianqiang Yu
- Department of Radiology, Fenghua Peoples' Hospital, Ningbo, Zhejiang, China
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Chen K, Chen W, Cai J, Yang F, Lou F, Wang X, Zhang J, Zhao M, Zhang J, Wang J. Favorable prognosis and high discrepancy of genetic features in surgical patients with multiple primary lung cancers. J Thorac Cardiovasc Surg 2018; 155:371-379.e1. [DOI: 10.1016/j.jtcvs.2017.08.141] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/16/2017] [Accepted: 08/09/2017] [Indexed: 12/17/2022]
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Lu W, Cham MD, Qi L, Wang J, Tang W, Li X, Zhang J. The impact of chemotherapy on persistent ground-glass nodules in patients with lung adenocarcinoma. J Thorac Dis 2017; 9:4743-4749. [PMID: 29268545 DOI: 10.21037/jtd.2017.10.50] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Backgrounds To evaluate the response of persistent ground glass nodules (GGNs) in patients with lung adenocarcinoma treated with platinum-based chemotherapy on computed tomography (CT). Methods We retrospectively studied patients with GGNs that met the following criteria: (I) GGNs found in patients with lung adenocarcinoma, which persist for more than 3 months; (II) patients treated with platinum-based (cisplatin or carboplatin) chemotherapy for at least 2 cycles; (III) ground glass proportion ¡Ý50%. For each patient, if more than two CTs satisfied the inclusion criteria, then the baseline and last CTs were used for analysis, defined as CT1 and CT2. A total of 91 persistent pulmonary GGNs in 51 patients fulfilled the inclusion criteria. We defined growth as a nodule ¡Ý2 mm increase in diameter or showing up a solid portion. GGN response to therapy was assessed and compared with the baseline CT. Differences in CT findings were analyzed using a paired t-test and Pearson ¦Ö2 test. Results Between 2010 and 2015, 25 of the 51 (49%) were male and 26 of the 51 (51%) were female. The average age at time of detection of a GGN was 63.8 (range, 36-84) years. Mean follow-up duration was 24.1¡À17.9 months. During the follow-up periods, on a per-nodule basis, 94.5% of GGNs (n=86) remained unchanged in size. Only 5.5% GGNs (n=5) in 5 patients increased in size. The nodules CT feature in each lung adenocarcinoma clinical stage show no difference. No significant difference was found in the size, attenuation, volume, and mass of GGN between baseline and post-treatment measurements, regardless of the type of chemotherapy (P>0.05). Conclusions The clinical course of GGNs in patients with lung adenocarcinoma is predominantly indolent, and platinum-based chemotherapy may have no effect on the growth of persistent GGNs.
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Affiliation(s)
- Wenwen Lu
- Department of Diagnostic Radiology, National cancer center, Cancer Hospital/Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100021, China.,Peking University Eye Center, The Third Hospital of Peking University, Beijing 100191, China
| | - Matthew D Cham
- Department of Radiology Box 1234/Icahn School of Medicine at Mount Sinai, New York, USA
| | - Linlin Qi
- Department of Diagnostic Radiology, National cancer center, Cancer Hospital/Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100021, China
| | - Jianwei Wang
- Department of Diagnostic Radiology, National cancer center, Cancer Hospital/Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100021, China
| | - Wei Tang
- Department of Diagnostic Radiology, National cancer center, Cancer Hospital/Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100021, China
| | - Xiaolu Li
- Department of Diagnostic Radiology, National cancer center, Cancer Hospital/Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100021, China
| | - Jie Zhang
- Radiology Department, Dongzhimen Hospital/Beijing University of Chinese Medicine, Beijing 100700, China
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Survival and risk factors for progression after resection of the dominant tumor in multifocal, lepidic-type pulmonary adenocarcinoma. J Thorac Cardiovasc Surg 2017; 154:2092-2099.e2. [PMID: 28863952 DOI: 10.1016/j.jtcvs.2017.07.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 06/28/2017] [Accepted: 07/16/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND It remains unclear whether a dominant lung adenocarcinoma that presents with multifocal ground glass opacities (GGOs) should be treated by local therapy. We sought to address survival in this setting and to identify risk factors for progression of unresected GGOs. METHODS Retrospective review of 70 patients who underwent resection of a pN0, lepidic adenocarcinoma, who harbored at least 1 additional GGO. Features associated with GGO progression were determined using logistic regression and survival was evaluated using the Kaplan-Meier method. RESULTS Subjects harbored 1 to 7 GGOs beyond their dominant tumor (DT). Mean follow-up was 4.1 ± 2.8 years. At least 1 GGO progressed after DT resection in 21 patients (30%). In 11 patients (15.7%), this progression prompted resection (n = 5) or stereotactic radiotherapy (n = 6) at mean 2.8 ± 2.3 years. Several measures of the overall tumor burden were associated with GGO progression (all P values < .03) and with progression prompting intervention (all P values < .01). In logistic regression, greater DT size (odds ratio, 1.07; 95% confidence interval, 1.01-1.14) and an initial GGO > 1 cm (odds ratio, 4.98; 95% confidence interval, 1.15-21.28) were the only factors independently associated with GGO progression. Survival was not negatively influenced by GGO progression (100% with vs 80.7% without; P = .1) or by progression-prompting intervention (P = .4). CONCLUSIONS At 4.1-year mean follow-up, 15.7% of patients with unresected GGOs after resection of a pN0 DT underwent subsequent intervention for a progressing GGO. Some features correlated with GGO growth, but neither growth, nor need for an intervention, negatively influenced survival. Thus, even those at highest risk for GGO progression should not be denied resection of a DT.
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Nagatani Y, Takahashi M, Ikeda M, Yamashiro T, Koyama H, Koyama M, Moriya H, Noma S, Tomiyama N, Ohno Y, Murata K, Murayama S, Moriya H, Sakuma K, Koyama M, Honda O, Tomiyama N, Koyama H, Ohno Y, Sugimura K, Sakamoto R, Nishimoto Y, Noma S, Tada A, Kato K, Miyara T, Yamashiro T, Kamiya H, Kamiya A, Tanaka Y, Murayama S, Nagatani Y, Nitta N, Takahashi M, Murata K. Sub-solid Nodule Detection Performance on Reduced-dose Computed Tomography with Iterative Reduction: Comparison Between 20 mA (7 mAs) and 120 mA (42 mAs) Regarding Nodular Size and Characteristics and Association with Size-specific Dose Estimate. Acad Radiol 2017; 24:995-1007. [PMID: 28606593 DOI: 10.1016/j.acra.2017.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to compare sub-solid nodule detection performances (SSNDP) on chest computed tomography (CT) with Adaptive Iterative Dose Reduction using Three Dimensional Processing (AIDR 3D) between 7 mAs (0.21 mSv) and 42 mAs (1.28 mSv) in total and in subgroups classified by nodular size, characteristics, and location, and analyze the association of SSNDP with size-specific dose estimate (SSDE). MATERIALS AND METHODS As part of the Area-detector Computed Tomography for the Investigation of Thoracic Diseases Study, a Japanese multicenter research project, 68 subjects underwent chest CT with 120 kV, 0.35 seconds per rotation, and three tube currents: 240 mA (84 mAs), 120 mA (42 mAs), and 20 mA (7 mAs). The research committee of the study project outlined and approved our study protocols. The institutional review board of each institution approved this study. Axial 2-mm-thick CT images were reconstructed using AIDR 3D. Standard reference was determined by CT images at 84 mAs. Four radiologists recorded SSN presence by continuously distributed rating on CT at 7 mAs and 42 mAs. Receiver operating characteristic analysis was used to evaluate SSNDP at both doses in total and in subgroups classified by nodular longest diameter (LD) (≥5 mm), characteristics (pure and part-solid), and locations (ventral, intermediate, or dorsal; central or peripheral; and upper, middle, or lower). Detection sensitivity was compared among five groups of SSNs classified based on particular SSDE to nodule on CT with AIDR 3D at 7 mAs. RESULTS Twenty-two part-solid and 86 pure SSNs were identified. For larger SSNs (LD ≥ 5 mm) as well as subgroups classified by nodular locations and part-solid nodules, SSNDP was similar in both methods (area under the receiver operating characteristics curve: 0.96 ± 0.02 in CT at 7 mAs and 0.97 ± 0.01 in CT at 42 mAs), with acceptable interobserver agreements in five locations. For larger SSNs (LD ≥ 5 mm), on CT at 42 mAs, no significant differences in detection sensitivity were found among the five groups classified by SSDE, whereas on CT with 7 mAs, four groups with SSDE of 0.65 or higher were superior in detection sensitivity to the other group, with SSDE less than 0.65 mGy. CONCLUSIONS For SSNs with 5 mm or more in cases with normal range of body habitus, CT at 7 mAs was demonstrated to have comparable SSNDP to CT at 42 mAs regardless of nodular location and characteristics, and SSDE higher than 0.65 mGy is desirable to obtain sufficient SSNDP.
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Liu C, Cui Y. [Lung Nodules Assessment--Analysis of Four Guidelines]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:490-498. [PMID: 28738966 PMCID: PMC5972948 DOI: 10.3779/j.issn.1009-3419.2017.07.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
近20年来,随着计算机断层扫描(computed tomography, CT)技术的提高和肺癌高危人群筛查的普及,越来越多的肺部小结节被发现,然而肺结节的定性诊断仍有很多困难。肺结节是临床上一种常见的现象,恶性结节早期发病比较隐匿,如果不进行早期干预,其病程迅速、恶性程度强、预后差。如果能在早期阶段对病灶进行手术切除,将会明显改善肺癌患者的预后。目前针对肺结节的处理指南层出不穷,但各大指南均未达成统一的共识。本文拟对在国内影响最大的四个指南:美国国家综合癌症网络非小细胞肺癌(non-small cell lung cancer, NSCLC)临床实践指南、美国胸科医师协会肺癌诊疗指南、Fleischner-Society肺结节处理策略指南、肺结节的评估亚洲共识指南所推荐的肺结节诊断和处理策略进行介绍和分析。
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Affiliation(s)
- Chunquan Liu
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yong Cui
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Wang Q, Jiang W, Xi J. [Surgery for Pulmonary Multiple Ground Glass Opacities]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 19:355-8. [PMID: 27335296 PMCID: PMC6015193 DOI: 10.3779/j.issn.1009-3419.2016.06.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
肺部磨玻璃影(ground glass opacity, GGO)的发病率近年来日益增高,很多患者发现有多发GGO,但多发GGO的诊疗还存在争议。肺部GGO是一种影像学表现,包含了多种病理类型,其中有一部分GGO是早期肺癌。GGO是一种惰性结节,只有少数GGO会发生变化,且随访不会影响外科治疗的效果。多发GGO的手术时机主要由主病灶决定,主病灶中实性成分大于5 mm时建议外科干预。手术方式可以选择肺叶切除或亚肺叶切除,除主病灶以外,其他GGO不必全部切除。具有高危因素的多发GGO需要纵隔淋巴结清扫或采样。
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Affiliation(s)
- Qun Wang
- Department of Thoracic Surgery, Zhongshan Hodpital, Fudan University, Shanghai 200032, China
| | - Wei Jiang
- Department of Thoracic Surgery, Zhongshan Hodpital, Fudan University, Shanghai 200032, China
| | - Junjie Xi
- Department of Thoracic Surgery, Zhongshan Hodpital, Fudan University, Shanghai 200032, China
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Cox ML, Yang CFJ, Speicher PJ, Anderson KL, Fitch ZW, Gu L, Davis RP, Wang X, D'Amico TA, Hartwig MG, Harpole DH, Berry MF. The Role of Extent of Surgical Resection and Lymph Node Assessment for Clinical Stage I Pulmonary Lepidic Adenocarcinoma: An Analysis of 1991 Patients. J Thorac Oncol 2017; 12:689-696. [PMID: 28082103 DOI: 10.1016/j.jtho.2017.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 12/12/2016] [Accepted: 01/02/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study examined the association of extent of lung resection, pathologic nodal evaluation, and survival for patients with clinical stage I (cT1-2N0M0) adenocarcinoma with lepidic histologic features in the National Cancer Data Base. METHODS The association between extent of surgical resection and long-term survival for patients in the National Cancer Data Base with clinical stage I lepidic adenocarcinoma who underwent lobectomy or sublobar resection was evaluated using Kaplan-Meier and Cox proportional hazards regression analyses. RESULTS Of the 1991 patients with cT1-2N0M0 lepidic adenocarcinoma who met the study criteria, 1544 underwent lobectomy and 447 underwent sublobar resection. Patients treated with sublobar resection were older, more likely to be female, and had higher Charlson/Deyo comorbidity scores, but they had smaller tumors and lower T status. Of the patients treated with lobectomy, 6% (n = 92) were upstaged because of positive nodal disease, with a median of seven lymph nodes sampled (interquartile range 4-10). In an analysis of the entire cohort, lobectomy was associated with a significant survival advantage over sublobar resection in univariate analysis (median survival 9.2 versus 7.5 years, p = 0.022, 5-year survival 70.5% versus 67.8%) and after multivariable adjustment (hazard ratio = 0.81, 95% confidence interval: 0.68-0.95, p = 0.011). However, lobectomy was no longer independently associated with improved survival when compared with sublobar resection (hazard ratio = 0.99, 95% confidence interval: 0.77-1.27, p = 0.905) in a multivariable analysis of a subset of patients in which only those patients who had undergone a sublobar resection including lymph node sampling were compared with patients treated with lobectomy. CONCLUSIONS Surgeons treating patients with stage I lung adenocarcinoma with lepidic features should cautiously utilize sublobar resection rather than lobectomy, and they must always perform adequate pathologic lymph node evaluation.
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Affiliation(s)
- Morgan L Cox
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Chi-Fu Jeffrey Yang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Paul J Speicher
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kevin L Anderson
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Zachary W Fitch
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Lin Gu
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | | | - Xiaofei Wang
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Thomas A D'Amico
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Matthew G Hartwig
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - David H Harpole
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California.
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Ikeda K, Shiraishi K, Yoshida A, Shinchi Y, Sanada M, Motooka Y, Fujino K, Mori T, Suzuki M. Synchronous Multiple Lung Adenocarcinomas: Estrogen Concentration in Peripheral Lung. PLoS One 2016; 11:e0160910. [PMID: 27526096 PMCID: PMC4985140 DOI: 10.1371/journal.pone.0160910] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/27/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The detection rate of synchronous multiple lung adenocarcinomas (SMLA), which display multiple ground glass opacity nodules in the peripheral lung, is increasing due to advances in high resolution computed tomography. The backgrounds of multicentric development of adenocarcinoma are unknown. In this study, we quantitated estrogen concentration in the peripheral lungs of postmenopausal female patients with SMLA. METHODS The tissue concentration of estrogens (estrone [E1] and estdadiol [E2]) in the noncancerous peripheral lung were measured with liquid chromatography/electrospray tandem mass spectrometry in postmenopausal female patients with lung adenocarcinoma. The expression levels of CYP19A1 in the normal lung were also quantitated with real-time PCR. Thirty patients with SMLA and 79 cases of control patients with single lung adenocarcinoma were analyzed. RESULTS The concentrations of E1 and E2 in the noncancerous tissue were significantly higher in SMLA cases than control cases (P = 0.004 and P = 0.02, respectively). The minor allele (A) of single nucleotide polymorphism rs3764221 were significantly associated with higher concentration of E1 and E2 (P = 0.002 and P = 0.01, respectively) and higher CYP19A1 mRNA expression (P = 0.03). CONCLUSION The tissue estrogen concentration of peripheral lung was significantly higher in SMLA than control cases. The high concentration of estrogen may be one of the causes of multicentric development of peripheral lung adenocarcinomas.
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Affiliation(s)
- Koei Ikeda
- Departments of Thoracic Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
- * E-mail:
| | - Kenji Shiraishi
- Departments of Thoracic Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Ayaka Yoshida
- Departments of Thoracic Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Yusuke Shinchi
- Departments of Thoracic Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Mune Sanada
- Departments of Thoracic Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Yamato Motooka
- Departments of Thoracic Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Kosuke Fujino
- Departments of Thoracic Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Takeshi Mori
- Departments of Thoracic Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Makoto Suzuki
- Departments of Thoracic Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
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Yoo RE, Goo JM, Hwang EJ, Yoon SH, Lee CH, Park CM, Ahn S. Retrospective assessment of interobserver agreement and accuracy in classifications and measurements in subsolid nodules with solid components less than 8mm: which window setting is better? Eur Radiol 2016; 27:1369-1376. [DOI: 10.1007/s00330-016-4495-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 06/22/2016] [Accepted: 06/27/2016] [Indexed: 12/19/2022]
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Persistent Pure Ground-Glass Nodules Larger Than 5 mm: Differentiation of Invasive Pulmonary Adenocarcinomas From Preinvasive Lesions or Minimally Invasive Adenocarcinomas Using Texture Analysis. Invest Radiol 2016; 50:798-804. [PMID: 26146871 DOI: 10.1097/rli.0000000000000186] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the differentiating potentials of computed tomography texture analysis for invasive pulmonary adenocarcinomas (IPAs) from their preinvasive lesions or minimally invasive adenocarcinomas (MIAs) manifesting as persistent pure ground-glass nodules (PGGNs) larger than 5 mm. MATERIALS AND METHODS This institutional review board-approved retrospective study included 63 patients (23 men and 40 women) with 66 PGGNs larger than 5 mm on unenhanced computed tomography from 2005 to 2013. All PGGNs were pathologically confirmed and categorized into 2 groups [IPAs (n = 11) vs preinvasive lesions (n = 41)/MIAs (n = 14)]. Each PGGN was segmented manually, and their texture features were quantitatively extracted. To identify significant differentiating factors of IPAs from preinvasive lesions/MIAs, multivariate logistic regression and C-statistic analyses were performed. RESULTS Between IPAs and preinvasive lesions/MIAs, nodule size, volume, mass, entropy, effective diameter, and surface area were significantly different (P < 0.05), and homogeneity and gray level co-occurrence matrix inverse difference moment showed marginal significance (P < 0.10). Subsequent multivariate analysis revealed larger nodule mass [adjusted odds ratio (OR), 11.92], higher entropy (adjusted OR, 35.12), and lower homogeneity (adjusted OR, 0.278 × 10) as independent differentiating factors of IPAs. Subgroup analysis showed that larger nodule mass, higher entropy, and lower homogeneity were also significant differentiating variables of IPAs in nodules of diameter 10 mm or larger. A multiple logistic regression model using these features showed excellent [area under the curve (AUC), 0.962] and significantly higher differentiating performance compared to nodule size (AUC, 0.712) or mass (AUC, 0.788) alone. CONCLUSION Computed tomography texture features such as higher entropy and lower homogeneity were significant differentiating factors of IPAs presenting as PGGNs larger than 5 mm and have potentials to enhance the differentiating performance.
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Oncological Characteristics of Radiological Invasive Adenocarcinoma with Additional Ground-Glass Nodules on Initial Thin-Section Computed Tomography: Comparison with Solitary Invasive Adenocarcinoma. J Thorac Oncol 2016; 11:729-736. [DOI: 10.1016/j.jtho.2016.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/05/2016] [Accepted: 01/12/2016] [Indexed: 11/21/2022]
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Hwang EJ, Park CM, Kim YT, Kim H, Goo JM. Microscopic Invasions, Prognoses, and Recurrence Patterns of Stage I Adenocarcinomas Manifesting as Part-Solid Ground-Glass Nodules: Comparison With Adenocarcinomas Appearing as Solid Nodules After Matching Their Solid Parts' Size. Medicine (Baltimore) 2016; 95:e3419. [PMID: 27082622 PMCID: PMC4839866 DOI: 10.1097/md.0000000000003419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The purpose of the present study was to compare the frequency of microscopic invasions, disease-free-survival (DFS), and the frequency and pattern of disease recurrence between stage I pulmonary adenocarcinomas appearing as solid nodules and those appearing as part-solid ground-glass nodules (GGNs) after matching their solid parts' size (D(solid)) and patients' age. Among 501 patients who underwent curative surgery for stage I pulmonary adenocarcinomas between 2003 and 2011, 172 patients (86 with solid nodules [M: F = 36: 50; mean age, 62.8 years] and 86 with part-solid GGNs [M:F = 30:56; mean age, 63.0 years]) matched for D(solid) and patients' age were included. DFS, frequency of microscopic invasions, recurrence, and recurrence pattern were compared between the two groups. No significant difference was observed in the frequency of microscopic invasions between the two groups (visceral pleural invasion, 30.23% vs. 29.07%, P = 0.867; lymphatic invasion, 5.81% vs. 3.49%, P = 0.720; vascular invasion, 1.16% vs. 0%, P = 1.000; solid nodules vs. part-slid GGNs, respectively) and DFS (estimated 5-year DFS, 83.6% vs. 81.9%, P = 0.744; solid nodules vs. part-slid GGNs, respectively). As for recurrence and recurrence pattern, there were no significant differences between the solid nodule group (14/86), and part-solid GGN group (12/86) (P = 0.670). Lung parenchymal nodules were the most frequent pattern of disease recurrence in both groups, followed by pleural seeding. In conclusion, after matching D(solid) and patients' age, there was no significant difference in the frequency of microscopic invasions, DFS, and the frequency and pattern of recurrence between stage I pulmonary adenocarcinomas appearing as solid nodules and part-solid GGNs.
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Affiliation(s)
- Eui Jin Hwang
- From the Department of Radiology (EJH, CMP, HK, JMG), Seoul National University College of Medicine; Institute of Radiation Medicine (EJH, CMP, HK, JMG), Seoul National University Medical Research Center; Deparment of Radiology (EJH), Armed Forces Seoul Hospital; Cancer Research Institute (CMP, HK, JMG), Seoul National University; and Department of Thoracic Surgery and Cardiovascular Surgery (YTK), Seoul National University College of Medicine, Seoul, Korea
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High Discrepancy of Driver Mutations in Patients with NSCLC and Synchronous Multiple Lung Ground-Glass Nodules. J Thorac Oncol 2016; 10:778-783. [PMID: 25629635 DOI: 10.1097/jto.0000000000000487] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The aim of this study was to investigate the discordance rates of eight known driver mutations among multiple matched intrapulmonary ground-glass nodules (GGNs) in non-small-cell lung cancer (NSCLC) patients. METHODS Tumors from 35 patients with multiple lesions resected, including confirmed NSCLC and at least one GGN, were analyzed for mutations in EGFR, KRAS, HER2, BRAF, and PIK3CA together with fusions in ALK, ROS1, and RET. RESULTS From 35 patients, a total of 72 lesions (60 were GGNs) were analyzed. These included nine adenocarcinoma in situ, nine minimal invasive adenocarcinoma, and 54 invasive adenocarcinoma. Among them, 33 tumor lesions (45.8 %) were found harboring EGFR mutations: 13 tumors with exon 19 deletion, 18 with L858R on exon 21, and two with both exon 19 del and L858R mutation. There were 5 tumors (6.9 %) harboring EML4-ALK fusion, four HER2 mutations (5.6%), three KRAS mutations (4.2%), one ROS1 fusion and one BRAF mutation. When we used the matched tumors to determine the intertumor discrepancy, only six out of 30 patients harbored identical mutations. The discordance rate of driver mutations was 80% (24 of 30) in those patients harboring at least one of the detected driver mutations. The median disease-free survival was 41.2 months (95% confidence interval: 35.8-52.6 months) and the median overall survival was "still not reached" in this cohort. CONCLUSIONS We found a high discrepancy of driver mutations among NSCLC patients with GGNs and a favorable prognosis after multiple lesions resection, which support surgical resection in this situation as a reasonable approach.
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Detterbeck FC, Marom EM, Arenberg DA, Franklin WA, Nicholson AG, Travis WD, Girard N, Mazzone PJ, Donington JS, Tanoue LT, Rusch VW, Asamura H, Rami-Porta R. The IASLC Lung Cancer Staging Project: Background Data and Proposals for the Application of TNM Staging Rules to Lung Cancer Presenting as Multiple Nodules with Ground Glass or Lepidic Features or a Pneumonic Type of Involvement in the Forthcoming Eighth Edition of the TNM Classification. J Thorac Oncol 2016; 11:666-680. [PMID: 26940527 DOI: 10.1016/j.jtho.2015.12.113] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/01/2015] [Accepted: 12/23/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Application of tumor, node, and metastasis (TNM) classification is difficult in patients with lung cancer presenting as multiple ground glass nodules or with diffuse pneumonic-type involvement. Clarification of how to do this is needed for the forthcoming eighth edition of TNM classification. METHODS A subcommittee of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee conducted a systematic literature review to build an evidence base regarding such tumors. An iterative process that included an extended workgroup was used to develop proposals for TNM classification. RESULTS Patients with multiple tumors with a prominent ground glass component on imaging or lepidic component on microscopy are being seen with increasing frequency. These tumors are associated with good survival after resection and a decreased propensity for nodal and extrathoracic metastases. Diffuse pneumonic-type involvement in the lung is associated with a worse prognosis, but also with a decreased propensity for nodal and distant metastases. CONCLUSION For multifocal ground glass/lepidic tumors, we propose that the T category be determined by the highest T lesion, with either the number of tumors or m in parentheses to denote the multifocal nature, and that a single N and M category be used for all the lesions collectively-for example, T1a(3)N0M0 or T1b(m)N0M0. For diffuse pneumonic-type lung cancer we propose that the T category be designated by size (or T3) if in one lobe, as T4 if involving an ipsilateral different lobe, or as M1a if contralateral and that a single N and M category be used for all pulmonary areas of involvement.
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Affiliation(s)
| | - Edith M Marom
- Department of Diagnostic Imaging, Tel-Aviv University, Ramat Gan, Israel
| | - Douglas A Arenberg
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, United Kingdom
| | - William D Travis
- Department of Pathology, Sloan-Kettering Cancer Center, New York, New York
| | - Nicolas Girard
- Respiratory Medicine Service, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Peter J Mazzone
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Lynn T Tanoue
- Department of Internal Medicine, Yale University, New Haven, Connecticut
| | - Valerie W Rusch
- Thoracic Surgery Service, Sloan-Kettering Cancer Center, New York, New York
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University, School of Medicine, Tokyo, Japan
| | - Ramón Rami-Porta
- Thoracic Surgery Service, Hospital Universitari Mutua Terrassa; Centros de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
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Cho H, Lee HY. Is preoperative positron emission tomography–computed tomography a useful diagnostic or staging tool for pure ground glass opacity nodular adenocardinomas? J Thorac Cardiovasc Surg 2016; 151:280-1. [DOI: 10.1016/j.jtcvs.2015.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 12/25/2022]
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Abstract
Ground-glass opacity nodules (GGNs) in the lung attract clinical attention owing to their increasing incidence, unique natural course, and association with lung adenocarcinoma. A long and indolent course of a GGN makes it difficult to manage. Current extensive clinical, radiological, pathological, and genetic studies on GGNs have shed light on their pathogenesis and allowed development of a reliable strategy of management. The present editorial provides answers to clinical questions related to GGNs, such as the natural course, follow-up, prediction of growth, and resection techniques. Finally, I discuss the etiology of GGNs, which has not been fully elucidated so far.
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Affiliation(s)
- Choon-Taek Lee
- 1 Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea ; 2 Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Persistent pulmonary subsolid nodules with solid portions of 5 mm or smaller: Their natural course and predictors of interval growth. Eur Radiol 2015; 26:1529-37. [PMID: 26385803 DOI: 10.1007/s00330-015-4017-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/05/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the natural course of persistent pulmonary subsolid nodules (SSNs) with solid portions ≤5 mm and the clinico-radiological features that influence interval growth over follow-ups. METHODS From 2005 to 2013, the natural courses of 213 persistent SSNs in 213 patients were evaluated. To identify significant predictors of interval growth, Kaplan-Meier analysis and Cox proportional hazard regression analysis were performed. RESULTS Among the 213 nodules, 136 were pure ground-glass nodules (GGNs; growth, 18; stable, 118) and 77 were part-solid GGNs with solid portions ≤5 mm (growth, 24; stable, 53). For all SSNs, lung cancer history (p = 0.001), part-solid GGNs (p < 0.001), and nodule diameter (p < 0.001) were significant predictors for interval growth. On subgroup analysis, nodule diameter was an independent predictor for the interval growth of both pure GGNs (p < 0.001), and part-solid GGNs (p = 0.037). For part-solid GGNs, lung cancer history (p = 0.002) was another significant predictor of the interval growth. Interval growth of pure GGNs ≥10 mm and part-solid GGNs ≥8 mm were significantly more frequent than in pure GGNs <10 mm (p < 0.001) and part-solid GGNs <8 mm (p = 0.003), respectively. CONCLUSION The natural course of SSNs with solid portions ≤5 mm differed significantly according to their nodule type and nodule diameters, with which their management can be subdivided. KEY POINTS • Pure GGNs ≥10 mm have significantly more frequent interval growth than those <10 mm. • Part-solid GGNs ≥8 mm have significantly more frequent interval growth than those <8 mm. • Management of SSNs with solid portions ≤5 mm can be subdivided by diameter.
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Cho H, Lee HY, Kim J, Kim HK, Choi JY, Um SW, Lee KS. Pure ground glass nodular adenocarcinomas: Are preoperative positron emission tomography/computed tomography and brain magnetic resonance imaging useful or necessary? J Thorac Cardiovasc Surg 2015; 150:514-20. [DOI: 10.1016/j.jtcvs.2015.06.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 03/10/2015] [Accepted: 03/25/2015] [Indexed: 12/25/2022]
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Callister MEJ, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, Franks K, Gleeson F, Graham R, Malhotra P, Prokop M, Rodger K, Subesinghe M, Waller D, Woolhouse I. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax 2015; 70 Suppl 2:ii1-ii54. [PMID: 26082159 DOI: 10.1136/thoraxjnl-2015-207168] [Citation(s) in RCA: 545] [Impact Index Per Article: 60.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - D R Baldwin
- Nottingham University Hospitals, Nottingham, UK
| | - A R Akram
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S Barnard
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle, UK
| | - P Cane
- Department of Histopathology, St Thomas' Hospital, London, UK
| | - J Draffan
- University Hospital of North Tees, Stockton on Tees, UK
| | - K Franks
- Clinical Oncology, St James's Institute of Oncology, Leeds, UK
| | - F Gleeson
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - P Malhotra
- St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - M Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - K Rodger
- Respiratory Medicine, St James's University Hospital, Leeds, UK
| | - M Subesinghe
- Department of Radiology, Churchill Hospital, Oxford, UK
| | - D Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - I Woolhouse
- Department of Respiratory Medicine, University Hospitals of Birmingham, Birmingham, UK
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Quantitative CT analysis of pulmonary ground-glass opacity nodules for distinguishing invasive adenocarcinoma from non-invasive or minimally invasive adenocarcinoma: the added value of using iodine mapping. Eur Radiol 2015; 26:43-54. [PMID: 25981222 DOI: 10.1007/s00330-015-3816-y] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/13/2015] [Accepted: 04/21/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine whether quantitative analysis of iodine-enhanced images generated from dual-energy CT (DECT) have added value in distinguishing invasive adenocarcinoma from non-invasive or minimally invasive adenocarcinoma (MIA) showing ground-glass nodule (GGN). METHODS Thirty-four patients with 39 GGNs were enrolled in this prospective study and underwent DECT followed by complete tumour resection. Various quantitative imaging parameters were assessed, including virtual non-contrast (VNC) imaging and iodine-enhanced imaging. RESULTS Of all 39 GGNs, four were adenocarcinoma in situ (AIS) (10 %), nine were MIA (23 %), and 26 were invasive adenocarcinoma (67 %). When assessing only VNC imaging, multivariate analysis revealed that mass, uniformity, and size-zone variability were independent predictors of invasive adenocarcinoma (odds ratio [OR] = 19.92, P = 0.02; OR = 0.70, P = 0.01; OR = 16.16, P = 0.04, respectively). After assessing iodine-enhanced imaging with VNC imaging, both mass on the VNC imaging and uniformity on the iodine-enhanced imaging were independent predictors of invasive adenocarcinoma (OR = 5.51, P = 0.04 and OR = 0.67, P < 0.01). The power of diagnosing invasive adenocarcinoma was improved after adding the iodine-enhanced imaging parameters versus VNC imaging alone, from 0.888 to 0.959, respectively (P = 0.029). CONCLUSION Quantitative analysis using iodine-enhanced imaging metrics versus VNC imaging metrics alone generated from DECT have added value in distinguishing invasive adenocarcinoma from AIS or MIA. KEY POINTS Quantitative analysis using DECT was used to distinguish invasive adenocarcinoma. Tumour mass and uniformity were independent predictors of invasive adenocarcinoma. Diagnostic performance was improved after adding iodine parameters to VNC parameters.
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