Single-stage resection of multiple pulmonary ground-glass opacities: A clinical analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QU Rirong ¹ , ZHANG Yang ² , BIE Lei ¹ , PING Wei ¹ , CAI Yixin ¹ , HAO Zhipeng ¹ ,  FU Xiangning ¹

1. Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P.R.China;
2. Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P.R.China;

Corresponding author：

FU Xiangning, Email: fuxn2006@aliyun.com

Keywords：

Pulmonary ground-glass opacity; multiple nodules; single-stage surgery; surgery

DOI：

10.7507/1007-4848.201908003

Video：

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Objective To summarize our experience of surgical resection of multiple ground-glass opacity (GGO) in recent years.Methods Clinical data of patients who underwent one-stage resections of multiple GGO from November 2015 to May 2019 in our hospital were collected, including 13 males and 52 females at an average age of 56.0±9.4 years. The clinical effects and pathological types of GGO were evaluated.Results Time interval from first discovery to surgery was 8-1 447 (236.5±362.4) days. There were 48 patients with unilateral surgery and 17 patients with bilateral surgery during the same period. Except for 2 patients who underwent open thoracotomy due to total thoracic adhesions, other patients underwent video-assisted thoracoscopic surgery (VATS). The mean postoperative hospital stay was 12.2±4.3 days. No severe perioperative complication or death occurred. A total of 156 GGO lesions were resected, 80 lesions were pure GGO, including 58 (72.5%) malignant lesions and 22 (27.5%) benign lesions, with an average diameter of 7.7±3.3 mm and 5.5±2.6 mm, respectively. Another 76 lesions were mixed GGO, including 69 (90.8%) malignant lesions and 7 (9.2%) benign lesions, with an average diameter of 13.6±6.6 mm and 7.7±3.5 mm, respectively.Conclusion Patients with multiple GGO should be treated with anti-inflammatory therapy firstly. When conservative treatment is ineffective and no benign outcomes are observed, surgical treatment should be considered. And when lung function is sufficient for patients to underwent surgeries, the simultaneous unilateral or bilateral thoracoscopic resection is suggested, and the sublobar resection or lobectomy methods can be adopted flexibly according to the clinical features of the lesion and the rapid pathological results, which will not increase the risk of postoperative complications. Otherwise, surgical resection should be given priority for pure GGO lesions with a diameter > 7.7 mm and mixed GGO lesions.

Citation： QU Rirong, ZHANG Yang, BIE Lei, PING Wei, CAI Yixin, HAO Zhipeng, FU Xiangning. Single-stage resection of multiple pulmonary ground-glass opacities: A clinical analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(1): 39-44. doi: 10.7507/1007-4848.201908003 Copy

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2.	Chang B, Hwang JH, Choi YH, et al. Natural history of pure ground-glass opacity lung nodules detected by low-dose CT scan. Chest, 2013, 143(1): 172-178.
3.	Moon Y, Sung SW, Lee KY, et al. Pure ground-glass opacity on chest computed tomography: predictive factors for invasive adenocarcinoma. J Thorac Dis, 2016, 8(7): 1561-1570.
4.	Bak SH, Lee HY, Kim JH, et al. Quantitative CT scanning analysis of pure ground-glass opacity nodules predicts further CT scanning change. Chest, 2016, 149(1): 180-191.
5.	Park CM, Goo JM, Lee HJ, et al. Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up. Radiographics, 2007, 27(2): 391-408.
6.	Travis WD, Brambilla E, Noguchi M, et al. International association for the study of lung cancer/American Thoracic Society/European Respiratory Society international multidiscipli-nary classification of lung adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
7.	Lee HY, Choi YL, Lee KS, et al. Pure ground-glass opacity neoplastic lung nodules: histopathology, imaging, and management. AJR Am J Roentgenol, 2014, 202(3): W224-W233.
8.	National Lung Screening Trial Research Team, Church TR, Black WC, et al. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med, 2013, 368(21): 1980-1991.
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10.	Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology, 2013, 266(1): 304-317.
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13.	Kim HK, Choi YS, Kim K, et al. Management of ground-glass opacity lesions detected in patients with otherwise operable non-small cell lung cancer. J Thorac Oncol, 2009, 4(10): 1242-1246.
14.	刘明, 姜格宁. 孤立性肺结节的良恶性鉴别及处理策略. 中国胸心血管外科临床杂志, 2014, 21(1): 102-106.
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17.	Yao F, Yang H, Zhao H. Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules. J Thorac Dis, 2016, 8(3): 469-475.
18.	Miller DL, Rowland CM, Deschamps C, et al. Surgical treatment of non-small cell lung cancer 1 cm or less in diameter. Ann Thorac Surg, 2002, 73(5): 1545-1550.
19.	Lee HY, Lee KS. Ground-glass opacity nodules: histopathology, imaging evaluation, and clinical implications. J Thorac Imaging, 2011, 26(2): 106-118.
20.	Shimada Y, Saji H, Otani K, et al. Survival of a surgical series of lung cancer patients with synchronous multiple ground-glass opacities, and the management of their residual lesions. Lung Cancer, 2015, 88(2): 174-180.
21.	Nakata M, Sawada S, Yamashita M, et al. Surgical treatments for multiple primary adenocarcinoma of the lung. Ann Thorac Surg, 2004, 78(4): 1194-1199.
22.	Chen K, Chen W, Cai J, et al. Favorable prognosis and high discrepancy of genetic features in surgical patients with multiple primary lung cancers. J Thorac Cardiovasc Surg, 2018, 155(1): 371-379.
23.	Dai L, Yang HL, Yan WP, et al. The equivalent efficacy of multiple operations for multiple primary lung cancer and a single operation for single primary lung cancer. J Thorac Dis, 2016, 8(5): 855-861.
24.	Detterbeck FC, Marom EM, Arenberg DA, et al. 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(5): 666-680.
25.	蒋彬, 孙天宇, 邓波, 等. 孤立性肺结节良、恶性危险因素分析和外科诊治. 中国胸心血管外科临床杂志, 2016, 23(7): 702-705.
26.	鲍彤, 肖飞, 郭永庆, 等. 对孤立性肺结节恶性概率预测模型的验证、比较和改良. 中国胸心血管外科临床杂志, 2018, 25(6): 471-476.
27.	Ye B, Cheng M, Li W, et al. Predictive factors for lymph node metastasis in clinical stage IA lung adenocarcinoma. Ann Thorac Surg, 2014, 98(1): 217-223.

1. Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology, 2008, 246(3): 697-722.
2. Chang B, Hwang JH, Choi YH, et al. Natural history of pure ground-glass opacity lung nodules detected by low-dose CT scan. Chest, 2013, 143(1): 172-178.
3. Moon Y, Sung SW, Lee KY, et al. Pure ground-glass opacity on chest computed tomography: predictive factors for invasive adenocarcinoma. J Thorac Dis, 2016, 8(7): 1561-1570.
4. Bak SH, Lee HY, Kim JH, et al. Quantitative CT scanning analysis of pure ground-glass opacity nodules predicts further CT scanning change. Chest, 2016, 149(1): 180-191.
5. Park CM, Goo JM, Lee HJ, et al. Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up. Radiographics, 2007, 27(2): 391-408.
6. Travis WD, Brambilla E, Noguchi M, et al. International association for the study of lung cancer/American Thoracic Society/European Respiratory Society international multidiscipli-nary classification of lung adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
7. Lee HY, Choi YL, Lee KS, et al. Pure ground-glass opacity neoplastic lung nodules: histopathology, imaging, and management. AJR Am J Roentgenol, 2014, 202(3): W224-W233.
8. National Lung Screening Trial Research Team, Church TR, Black WC, et al. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med, 2013, 368(21): 1980-1991.
9. Wang J, Ma H, Ni CJ, et al. Clinical characteristics and prognosis of ground-glass opacity nodules in young patients. J Thorac Dis, 2019, 11(2): 557-563.
10. Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology, 2013, 266(1): 304-317.
11. Park JH, Lee KS, Kim JH, et al. Malignant pure pulmonary ground-glass opacity nodules: prognostic implications. Korean J Radiol, 2009, 10(1): 12-20.
12. Ikeda N, Maeda J, Yashima K, et al. A clinicopathological study of resected adenocarcinoma 2 cm or less in diameter. Ann Thorac Surg, 2004, 78(3): 1011-1016.
13. Kim HK, Choi YS, Kim K, et al. Management of ground-glass opacity lesions detected in patients with otherwise operable non-small cell lung cancer. J Thorac Oncol, 2009, 4(10): 1242-1246.
14. 刘明, 姜格宁. 孤立性肺结节的良恶性鉴别及处理策略. 中国胸心血管外科临床杂志, 2014, 21(1): 102-106.
15. Detterbeck FC, Homer RJ. Approach to the ground-glass nodule. Clin Chest Med, 2011, 32(4): 799-810.
16. Tsutsui S, Ashizawa K, Minami K, et al. Multiple focal pure ground-glass opacities on high-resolution CT images: Clinical significance in patients with lung cancer. AJR Am J Roentgenol, 2010, 195(2): W131-W138.
17. Yao F, Yang H, Zhao H. Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules. J Thorac Dis, 2016, 8(3): 469-475.
18. Miller DL, Rowland CM, Deschamps C, et al. Surgical treatment of non-small cell lung cancer 1 cm or less in diameter. Ann Thorac Surg, 2002, 73(5): 1545-1550.
19. Lee HY, Lee KS. Ground-glass opacity nodules: histopathology, imaging evaluation, and clinical implications. J Thorac Imaging, 2011, 26(2): 106-118.
20. Shimada Y, Saji H, Otani K, et al. Survival of a surgical series of lung cancer patients with synchronous multiple ground-glass opacities, and the management of their residual lesions. Lung Cancer, 2015, 88(2): 174-180.
21. Nakata M, Sawada S, Yamashita M, et al. Surgical treatments for multiple primary adenocarcinoma of the lung. Ann Thorac Surg, 2004, 78(4): 1194-1199.
22. Chen K, Chen W, Cai J, et al. Favorable prognosis and high discrepancy of genetic features in surgical patients with multiple primary lung cancers. J Thorac Cardiovasc Surg, 2018, 155(1): 371-379.
23. Dai L, Yang HL, Yan WP, et al. The equivalent efficacy of multiple operations for multiple primary lung cancer and a single operation for single primary lung cancer. J Thorac Dis, 2016, 8(5): 855-861.
24. Detterbeck FC, Marom EM, Arenberg DA, et al. 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(5): 666-680.
25. 蒋彬, 孙天宇, 邓波, 等. 孤立性肺结节良、恶性危险因素分析和外科诊治. 中国胸心血管外科临床杂志, 2016, 23(7): 702-705.
26. 鲍彤, 肖飞, 郭永庆, 等. 对孤立性肺结节恶性概率预测模型的验证、比较和改良. 中国胸心血管外科临床杂志, 2018, 25(6): 471-476.
27. Ye B, Cheng M, Li W, et al. Predictive factors for lymph node metastasis in clinical stage IA lung adenocarcinoma. Ann Thorac Surg, 2014, 98(1): 217-223.

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Single-stage resection of multiple pulmonary ground-glass opacities: A clinical analysis

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