“Early” peripheral lung cancer: prognostic significance of ground glass opacity on thin-section computed tomographic scan

doi:10.1016/S0003-4975(02)03895-X

The Annals of Thoracic Surgery

Volume 74, Issue 5, November 2002, Pages 1635-1639

https://doi.org/10.1016/S0003-4975(02)03895-X Get rights and content

Abstract

Background

The number of peripherally located lung cancers with an excellent prognosis has been increasing, possibly due to the introduction of computed tomography for lung cancer screening in Japan. The concept of peripherally located “early lung cancer” remains controversial.

Methods

A retrospective study was conducted on 1,540 lung cancers resected at our institute between May 1992 and December 2000. The sizes of solid attenuation and ground glass opacity were evaluated radiologically and the relationships between radiologic findings and clinicopathologic features were investigated to define peripheral early lung cancer.

Results

Sixty-nine (4.4%) lung cancers showed a large ground glass opacity component on thin-section computed tomographic scan. The maximum tumor dimension ranged from 6 to 41 mm, and all tumors were clinical stage I. Forty-seven patients were diagnosed as having bronchioloalveolar carcinoma pathologically. None of the tumors showed lymph node involvement or lymphatic invasion. Only two showed vascular invasion, but all were pathologic stage I disease. Most of the lung cancers that showed pure ground glass opacity were bronchioloalveolar carcinoma.

Conclusions

Peripheral lung nodules with a large ground glass opacity component on thin-section computed tomographic scan, which do not disappear during follow-up, tend to be bronchioloalveolar carcinomas or minimally invasive adenocarcinomas of the lung. These findings warrant a feasibility study of limited surgical resection for such lung tumors.

Section snippets

Material and methods

Between May 1992 and December 2000, 1,540 patients underwent lung resection for lung carcinoma at the National Cancer Center Hospital, Tokyo, Japan. Among them, 69 patients (4.4%) with peripheral lung cancer that showed a large ground glass opacity (GGO) component on thin-section CT were selected to be investigated retrospectively. The CT scan was performed using a TCT 900S or X-Vigor (Toshiba, Tokyo, Japan), and 10-mm-thick contiguous collimation was used to evaluate the entire lung. All

Clinical features

Thirty-one of the patients (45%) were men and 38 (55%) were women (Table 1) . Their ages ranged from 46 to 77 years, with a median of 63 years. Lung cancer was more frequently located on the right side than the left side. An abnormal carcinoembryonic antigen level was observed in 2 patients (3%). All of the tumors were clinical stage I; 64 T1 N0 M0 and 5 T2 N0 M0.

Radiologic findings

Radiologically, the maximum tumor dimension ranged from 6 to 41 mm. All 69 patients had tumors that showed GGO on thin-section CT.

Comment

The concept of “early” lung cancer is well known for centrally located squamous cell carcinoma of the lung, but has not yet been widely accepted for peripherally located lung cancer, although some investigators have reported that bronchioloalveolar carcinoma without fibrotic scarring could be considered early adenocarcinoma of the lung, so-called in-situ peripheral lung carcinoma 12, 17, 18, 19, 20, 21. However, their criteria were based on postoperative pathologic findings, which means that

Acknowledgements

The work was supported in part by a Grant-in-Aid for Cancer Research from the Ministry of Health and Welfare, Tokyo, Japan.

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Non–small cell lung cancers with a ground-glass opacity component have better prognosis than those with solid nodules of equivalent consolidation size. However, the impact of small ground-glass opacity components on prognosis is unknown. Therefore, we aimed to evaluate the significance of a small ground-glass opacity component in solid-dominant clinical stage IA non–small cell lung cancers.
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Original article: general thoracic“Early” peripheral lung cancer: prognostic significance of ground glass opacity on thin-section computed tomographic scan

Abstract

Background

Methods

Results

Conclusions

Section snippets

Material and methods

Clinical features

Radiologic findings

Comment

Acknowledgements

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Radiol Clin North Am

Lung Cancer

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Hum Pathol

Ann Thorac Surg

Conventional clinicopathologic prognostic factors in surgically resected nonsmall cell lung carcinomaa comparison of prognostic factors for each pathologic TNM stage based on multivariate analyses

Cancer

Peripheral lung cancerscreening and detection with low-dose spiral CT versus radiography

Radiology

Original article: general thoracic
“Early” peripheral lung cancer: prognostic significance of ground glass opacity on thin-section computed tomographic scan