Abstract
Pulmonary nodules that manifest as ground-glass opacity are particularly challenging on account of their malignant potential and heterogeneous characteristics. The “ground-glass nodule-like” lung cancer is different from the conventional lung cancer. This review focuses on the radiologic and pathologic classifications of ground-glass nodules, along with the staging and clinical management of these lesions. In addition, we discuss the lung cancer high-risk population shift and follow-up of ground-glass nodules in the light of experience from screening trials. The standard of care surgical treatment of early lung cancer is still lobectomy with systematic lymph node dissection. However, a recent research has shown that some ground-glass nodules may be treated with sublobar resections or non-surgical treatment; these findings may expand the treatment options available in the future.
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Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.
National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409.
Todo G, Ito H, Nakano Y, Dodo Y, Maeda H, Murata K, et al. High resolution CT (HR-CT) for the evaluation of pulmonary peripheral disorders. Rinsho Hoshasen. 1982;27(12):1319–26.
Naidich DP, McCauley DI, Siegelman SS. Computed tomography of bronchial adenomas. J Comput Assist Tomogr. 1982;6(4):725–32.
Nakata H, Ishimaru H, Nakayama C, Yoshimatsu H. Computed tomography for preoperative evaluations of lung cancer. J Comput Tomogr. 1986;10(2):147–51.
Zerhouni EA, Stitik FP, Siegelman SS, Naidich DP, Sagel SS, Proto AV, et al. CT of the pulmonary nodule: a cooperative study. Radiology. 1986;160(2):319–27.
Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;246(3):697–722.
Noguchi M, Morikawa A, Kawasaki M, Matsuno Y, Yamada T, Hirohashi S, et al. Small adenocarcinoma of the lung. Histologic characteristics and prognosis. Cancer. 1995;75(12):2844–52.
Suzuki K, Kusumoto M, Watanabe S, Tsuchiya R, Asamura H. Radiologic classification of small adenocarcinoma of the lung: radiologic-pathologic correlation and its prognostic impact. Ann Thorac Surg. 2006;81(2):413–9.
Kakinuma R, Noguchi M, Ashizawa K, Kuriyama K, Maeshima AM, Koizumi N, et al. Natural history of pulmonary subsolid nodules: a prospective multicenter study. J Thorac Oncol. 2016;11(7):1012–28.
Travis WD, Asamura H, Bankier AA, Beasley MB, Detterbeck F, Flieder DB, et al. The IASLC lung cancer staging project: proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol. 2016;11(8):1204–23.
Suzuki S, Sakurai H, Yotsukura M, Masai K, Asakura K, Nakagawa K, et al. Clinical features of ground glass opacity-dominant lung cancer exceeding 3.0 cm in the whole tumor size. Ann Thorac Surg. 2018;105(5):1499–506.
Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, et al. International association for the study of lung cancer/American thoracic society/European respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol. 2011;6(2):244–85.
Travis WD, Brambilla E, Nicholson AG, Yatabe Y, Austin JHM, Beasley MB, et al. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol. 2015;10(9):1243–60.
Sawada S, Yamashita N, Sugimoto R, Ueno T, Yamashita M. Long-term outcomes of patients with ground-glass opacities detected using CT scanning. Chest. 2017;151(2):308–15.
Smith RA, Andrews KS, Brooks D, Fedewa SA, Manassaram-Baptiste D, Saslow D, et al. Cancer screening in the United States, 2019: a review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2019;69(3):184–210.
Zhang Y, Jheon S, Li H, Zhang H, Xie Y, Qian B, et al. Results of low-dose computed tomography as a regular health examination among Chinese hospital employees. J Thorac Cardiovasc Surg. 2019. https://doi.org/10.1016/j.jtcvs.2019.10.145.
Rampinelli C, De Marco P, Origgi D, Maisonneuve P, Casiraghi M, Veronesi G, et al. Exposure to low dose computed tomography for lung cancer screening and risk of cancer: secondary analysis of trial data and risk-benefit analysis. BMJ. 2017;356:j347.
Mazzone PJ, Silvestri GA, Patel S, Kanne JP, Kinsinger LS, Wiener RS, et al. Screening for lung cancer: CHEST guideline and expert panel report. Chest. 2018;153(4):954–85.
Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995;60(3):615–22 (discussion 622–623).
Sesti J, Donington JS. Sublobar resection: ongoing controversy for treatment for stage I non-small cell lung cancer. Thorac Surg Clin. 2016;26(3):251–9.
Altorki NK, Wang X, Wigle D, Gu L, Darling G, Ashrafi AS, et al. Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503). Lancet Respir Med. 2018;6(12):915–24.
Schneider BJ, Daly ME, Kennedy EB, Antonoff MB, Broderick S, Feldman J, et al. Stereotactic body radiotherapy for early-stage non-small-cell lung cancer: American Society of Clinical Oncology endorsement of the American Society for Radiation Oncology evidence-based guideline. J Clin Oncol. 2018;36(7):710–9.
Detterbeck FC. Achieving clarity about lung cancer and opacities. Chest. 2017;151(2):252–4.
Acknowledgements
Funding for this work was provided by the National Key R&D Program of China (2017YFC0907504), the Beijing Municipal Administration of Hospitals Special Fund for Digestive System Multidisciplinary Synergic Development (XXT18), and the Beijing Municipal Administration of Hospitals Youth Program (QML20171106).
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Chen, KN. The diagnosis and treatment of lung cancer presented as ground-glass nodule. Gen Thorac Cardiovasc Surg 68, 697–702 (2020). https://doi.org/10.1007/s11748-019-01267-4
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DOI: https://doi.org/10.1007/s11748-019-01267-4