Clinical, pathological, and radiological characteristics of 328 solitary ground-glass opacity lung nodules on high-resolution computed tomography_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

QIU Zhixing ,  LI Weimin

Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LI Weimin, Email: weimi003@yahoo.com

Keywords：

Solitary ground-glass opacity nodule; Adenocarcinoma; Clinic; Pathology; Radiology

DOI：

10.7507/1671-6205.201804007

Video：

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Objective To analyze the clinical, pathological, and radiological characteristics of solitary ground-glass opacity nodules (SGGN) of the lungs on high-resolution computed tomography (HRCT).Methods A total of 328 resected SGGN were evaluated with HRCT from January 2008 to March 2018. The clinical, pathological, and radiological characteristics of these cases were analyzed.Results Three hundred and twenty-eight adenocarcinomas were observed. Patients with adenocarcinoma in non-smoking women (230, 70.1%) were more than men (98, 29.9%). All SGGN were at the stage IA or IB. Forty-eight patients (all were male) had smoking history, 19 patients with a history of cancer, and 60 patients had a family history of cancer, which including 32 patients with family lung cancer history. However, elevated blood tumor markers were rare in patients. The adenocarcinoma nodules included 10 (3.0%) atypical hyperplasia (AAH), 43 (13.1%) adenocarcinoma in situ (AIS), 71 (21.6%) minimally invasive adenocarcinoma (MIA), and 204 (62.2%) invasive adenocarcinoma (IPA). The positive expression rates of anaplastic lymphoma kinase (ALK-V), proto-oncogene tyrosine-protein kinase ROS (ROS-1) and programmed death ligand 1 (PDL-1) were 4.2% (6/143), 13.9% (20/144) and 17.8% (13/73), respectively. HRCT showed that there were 149 (45.4%) pure SGGN and 179 (54.6%) mixed SGGN, and the most common lesion was the superior lobe of right lung (138, 42.1%). The size, density, shape, and pleural tag of nodules were significant factors that differentiated IPA from AAH, AIS and MIA. All patients were followed up for an average of 3.32 months. All patients underwent surgical excision and no recurrence or metastasis of the tumor had occurred.Conclusions The size, density, shape, and pleural tag of SGGN on HRCT are found to be the determinant factors of IPA. Additionally, patients were all at the early clinical stage, and have high survival rate after surgical removal of the nodules. Moreover, the positive expression rate of ALK-V, ROS-1 and PDL-1 are very low in patients with SGGN.

Citation： QIU Zhixing, LI Weimin. Clinical, pathological, and radiological characteristics of 328 solitary ground-glass opacity lung nodules on high-resolution computed tomography. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(5): 470-476. doi: 10.7507/1671-6205.201804007 Copy

1.	Liu Q, Liang W. The value of CT scan-guided biopsy in evaluation of ground-glass opacity. Chest 2013, 143(2): 577.
2.	Yabuuchi H, Matsuo Y, Tsukamoto H, et al. Evaluation of the extent of ground-glass opacity on high-resolution CT in patients with interstitial pneumonia associated with systemic sclerosis: comparison between quantitative and qualitative analysis. Clin Radiol 2014, 69(7): 758-764.
3.	Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011, 365(5): 395-409.
4.	Church TR, Black WC, Aberle DR, et al. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med 2013, 368(21): 1980-1991.
5.	參考文獻.Qiu ZX, Cheng Y, Liu D, et al. Clinical, pathological, and rediological characteristics of solitary ground-glass opacity lung nodules on high-resolution computed tomography. Ther Clin Risk Manag, 2016, 12: 1445-1456.
6.	Stang A, Schuler M, Kowall B, et al. Lung Cancer screening using low dose CT scanning in Germany. Dtsch Arztebl Int, 2015, 112(38): 637-644.
7.	Wiener RS, Gould MK, Arenberg DA, et al. An Official American Thoracic Society/American College of Chest Physicians Policy Statement: implementation of low-dose computed tomography lung cancer screening programs in clinical practice. Am J Respir Crit Care Med, 2015, 192(7): 881-891.
8.	Bankier Macmahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: from the fleischner society 2017. Radiology, 2017, 284(1): 228-243.
9.	Patz EF Jr, Pinsky P, Gatsonis C, et al. Overdiagnosis in low–dose computed tomography screening for lung cancer. JAMA Intern Med, 2014, 174(2): 269-274.
10.	Cho J, Ko SJ, Kim SJ, et al. Surgical resection of nodular ground-glass opacities without percutaneous needle aspiration or biopsy. BMC Cancer. 2014, 14(18): 838.
11.	Lim HJ, Ahn S, Lee KS, et al. Persistent pure ground-glass opacity lung nodules 10 mm in diameter at CT scan: histopathologic comparisons and prognostic implications. Chest. 2013, 144(4): 1291-1299.
12.	Lee HJ, Goo JM, Lee CH, et al. Predictive CT findings of malignancy in ground-glass nodules on thin-section chest CT: the effects on radiologist performance. Eur Radiol. 2009, 19(3): 552-560.
13.	Kim HY, Shim YM, Lee KS, et al. Persistent pulmonary nodular ground-glass opacity at thin-section CT: histopathologic comparisons. Radiology. 2007, 245(1): 267-275.
14.	Heo EY, Lee KW, Jheon S, et al. Surgical resection of highly suspicious pulmonary nodules without a tissue diagnosis. Jpn J Clin Oncol. 2011, 41(8): 1017-1022.
15.	Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a state?ment from the Fleischner Society. Radiology. 2013;266(1):304–317.
16.	Tsushima Y, Tateishi U, Uno H, et al. Diagnostic performance of PET/CT in differentiation of malignant and benign non-solid solitary pulmonary nodules. Ann Nucl Med. 2008, 22(7): 571-577.

1. Liu Q, Liang W. The value of CT scan-guided biopsy in evaluation of ground-glass opacity. Chest 2013, 143(2): 577.
2. Yabuuchi H, Matsuo Y, Tsukamoto H, et al. Evaluation of the extent of ground-glass opacity on high-resolution CT in patients with interstitial pneumonia associated with systemic sclerosis: comparison between quantitative and qualitative analysis. Clin Radiol 2014, 69(7): 758-764.
3. Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011, 365(5): 395-409.
4. Church TR, Black WC, Aberle DR, et al. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med 2013, 368(21): 1980-1991.
5. 參考文獻.Qiu ZX, Cheng Y, Liu D, et al. Clinical, pathological, and rediological characteristics of solitary ground-glass opacity lung nodules on high-resolution computed tomography. Ther Clin Risk Manag, 2016, 12: 1445-1456.
6. Stang A, Schuler M, Kowall B, et al. Lung Cancer screening using low dose CT scanning in Germany. Dtsch Arztebl Int, 2015, 112(38): 637-644.
7. Wiener RS, Gould MK, Arenberg DA, et al. An Official American Thoracic Society/American College of Chest Physicians Policy Statement: implementation of low-dose computed tomography lung cancer screening programs in clinical practice. Am J Respir Crit Care Med, 2015, 192(7): 881-891.
8. Bankier Macmahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: from the fleischner society 2017. Radiology, 2017, 284(1): 228-243.
9. Patz EF Jr, Pinsky P, Gatsonis C, et al. Overdiagnosis in low–dose computed tomography screening for lung cancer. JAMA Intern Med, 2014, 174(2): 269-274.
10. Cho J, Ko SJ, Kim SJ, et al. Surgical resection of nodular ground-glass opacities without percutaneous needle aspiration or biopsy. BMC Cancer. 2014, 14(18): 838.
11. Lim HJ, Ahn S, Lee KS, et al. Persistent pure ground-glass opacity lung nodules 10 mm in diameter at CT scan: histopathologic comparisons and prognostic implications. Chest. 2013, 144(4): 1291-1299.
12. Lee HJ, Goo JM, Lee CH, et al. Predictive CT findings of malignancy in ground-glass nodules on thin-section chest CT: the effects on radiologist performance. Eur Radiol. 2009, 19(3): 552-560.
13. Kim HY, Shim YM, Lee KS, et al. Persistent pulmonary nodular ground-glass opacity at thin-section CT: histopathologic comparisons. Radiology. 2007, 245(1): 267-275.
14. Heo EY, Lee KW, Jheon S, et al. Surgical resection of highly suspicious pulmonary nodules without a tissue diagnosis. Jpn J Clin Oncol. 2011, 41(8): 1017-1022.
15. Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a state?ment from the Fleischner Society. Radiology. 2013;266(1):304–317.
16. Tsushima Y, Tateishi U, Uno H, et al. Diagnostic performance of PET/CT in differentiation of malignant and benign non-solid solitary pulmonary nodules. Ann Nucl Med. 2008, 22(7): 571-577.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical, pathological, and radiological characteristics of 328 solitary ground-glass opacity lung nodules on high-resolution computed tomography

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