Analysis of a surgical series of patients with synchronous multiple ground-glass nodules_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GE Tengfei , XU Ning , ZHU Feng , TANG Lei , LIU Dan , WANG Lu , QIAN Peng , GUO Hua , HUA Congshu , CHEN Hai ,  MA Dongchun

Department of Thoracic Surgery, Anhui Chest Hospital, Hefei, 230022, P.R.China;

Corresponding author：

MA Dongchun, Email: madongchun126@126.com

Keywords：

Ground-glass opacity; synchronous multiple ground-glass nodules; surgical resection

DOI：

10.7507/1007-4848.202005088

Video：

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Objective To summarize the clinical experience of surgical resection of synchronous multiple ground-glass nodules (SMGN), and explore the individualized diagnosis and treatment strategy of SMGN.Methods Clinical data of 84 patients with SMGN who underwent thoracic surgery in Anhui Chest Hospital from July 2016 to August 2018 were analyzed retrospectively, including 18 males (21.4%) and 66 females (78.6%), aged 32-80 (55.6±10.3) years. The results of operation and the information of GGNs were analyzed.Results Except for 1 patient who was converted to thoracotomy due to extensive dense adhesion of thoracic, other patients underwent video-assisted thoracoscopic surgery successfully. All patients recuperated successfully after operation, without severe perioperative complications or death. Finally, 79 patients were diagnosed as malignant tumors (94.0%), and 5 patients of benign lesions (6.0%). A total of 240 GGNs were removed, among which there were 168 pGGNs, including 68 benign lesions (40.5%) and 100 malignant tumors (59.5%), and 72 mGGNs, including 2 benign nodules (2.8%) and 70 malignant tumors (97.2%). Nodules diameter (P<0.001), consolidation/maximum diameter of nodule ratio (P<0.001), vacuole sign (P<0.001), air bronchograms sign (P=0.001), spine-like process (P=0.001), pleural indentation sign (P<0.001), lobulation sign (P<0.001), and vascular convergence (P=0.002) were correlated with malignant tumor.Conclusion Analysis of the imaging features of GGNs by thin-section CT scan and three-dimensional reconstruction is of great value in predicting the benign and malignant nodules, which can guide the surgical decision-making and preoperative planning. Through reasonable preoperative planning and following certain principles, simultaneous surgical treatment for SMGN is safe and feasible.

Citation： GE Tengfei, XU Ning, ZHU Feng, TANG Lei, LIU Dan, WANG Lu, QIAN Peng, GUO Hua, HUA Congshu, CHEN Hai, MA Dongchun. Analysis of a surgical series of patients with synchronous multiple ground-glass nodules. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(7): 830-836. doi: 10.7507/1007-4848.202005088 Copy

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8.	Kuriyama K, Tateishi R, Doi O, et al. CT-pathologic correlation in small peripheral lung cancers. Am J Roentgenol, 1987, 149(6): 1139-1143.
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13.	Xiang W, Xing Y, Jiang S, et al. Morphological factors differentiating between early lung adenocarcinomas appearing as pure ground-glass nodules measuring ≤10 mm on thin-section computed tomography. Cancer Imaging, 2014, 14(1): 33.
14.	Lee SM, Goo JM, Lee KH, et al. CT findings of minimally invasive adenocarcinoma (MIA) of the lung and comparison of solid portion measurement methods at CT in 52 patients. Eur Radiol, 2015, 25(8): 2318-2325.
15.	Tanvetyanon T, Finley DJ, Fabian T, et al. Prognostic factors for survival after complete resections of synchronous lung cancers in multiple lobes: Pooled analysis based on individual patient data. Ann Oncol, 2013, 24(4): 889-894.
16.	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.
17.	屈日荣, 张洋, 别磊, 等. 同期手术切除肺多发磨玻璃影的临床分析. 中国胸心血管外科临床杂志, 2020, 27(1): 39-44.
18.	姜格宁, 陈昶, 朱余明, 等. 上海市肺科医院磨玻璃结节早期肺腺癌的诊疗共识(第一版). 中国肺癌杂志, 2018, 21(3): 147-159.
19.	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.
20.	Sihoe AD, Van Schil P. Non-small cell lung cancer: When to offer sublobar resection. Lung Cancer, 2014, 86(2): 115-120.
21.	Haruki T, Aokage K, Miyoshi T, et al. Mediastinal nodal involvement in patients with clinical stage Ⅰ non-small-cell lung cancer: possibility of rational lymph node dissection. J Thorac Oncol, 2015, 10(6): 930-936.
22.	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. Austin JH, Muller NL, Friedman PJ, et al. Glossary of terms for CT of the lungs: Recommendation of the Nomenclature Committee of the Fleischner Society. Radiology, 1996, 200(2): 327-331.
2. Hansell DM, Bankier AA, Macmabon H, et al. Fleischner Society: Glossary of terms for thoracic imaging. Radiology, 2008, 246(3): 697-722.
3. Kim HY, Shim YM, Lee KS, et al. Persistent pulmonary nodular ground-glass opacity at thin-section CT: Histopathologic comparisons. Radiology, 2007, 245(1): 267-245.
4. Hiramatsu M, Inagaki T, Inagaki T, et al. Pulmonary ground-glass opacity (GGO) lesions-large size and a history of lung cancer are risk factors for growth. J Thorac Oncol, 2008, 3(11): 1245-1250.
5. Kobayashi Y, Mitsudomi T. Management of ground-glass opacities: Should all pulmonary lesions with ground-glass opacity be surgically resected? Transl Lung Cancer Res, 2013, 2(5): 354-363.
6. Noguchi M, Shimosato Y. The development and progression of adenocarcinoma of the lung. Cancer Treat Res, 1995, 72(72): 131.
7. 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.
8. Kuriyama K, Tateishi R, Doi O, et al. CT-pathologic correlation in small peripheral lung cancers. Am J Roentgenol, 1987, 149(6): 1139-1143.
9. Kakinuma R, Noguchi M, Ashizawa K, et al. Natural history of pulmonary subsolid nodules: A prospective multicenter study. J Thorac Oncol, 2016, 11(7): 1012-1028.
10. 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.
11. Dai C, Ren Y, Xie H, et al. Clinical and radiological features of synchronous pure ground-glass nodules observed along with operable non-small cell lung cancer. J Surg Oncol, 2016, 113(7): 738-744.
12. Xing Y, Li Z, Jiang S, et al. Analysis of pre-invasive lung adenocarcinoma lesions on thin-section computerized tomography. Clin Respir J, 2015, 9(3): 289-296.
13. Xiang W, Xing Y, Jiang S, et al. Morphological factors differentiating between early lung adenocarcinomas appearing as pure ground-glass nodules measuring ≤10 mm on thin-section computed tomography. Cancer Imaging, 2014, 14(1): 33.
14. Lee SM, Goo JM, Lee KH, et al. CT findings of minimally invasive adenocarcinoma (MIA) of the lung and comparison of solid portion measurement methods at CT in 52 patients. Eur Radiol, 2015, 25(8): 2318-2325.
15. Tanvetyanon T, Finley DJ, Fabian T, et al. Prognostic factors for survival after complete resections of synchronous lung cancers in multiple lobes: Pooled analysis based on individual patient data. Ann Oncol, 2013, 24(4): 889-894.
16. 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.
17. 屈日荣, 张洋, 别磊, 等. 同期手术切除肺多发磨玻璃影的临床分析. 中国胸心血管外科临床杂志, 2020, 27(1): 39-44.
18. 姜格宁, 陈昶, 朱余明, 等. 上海市肺科医院磨玻璃结节早期肺腺癌的诊疗共识(第一版). 中国肺癌杂志, 2018, 21(3): 147-159.
19. 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.
20. Sihoe AD, Van Schil P. Non-small cell lung cancer: When to offer sublobar resection. Lung Cancer, 2014, 86(2): 115-120.
21. Haruki T, Aokage K, Miyoshi T, et al. Mediastinal nodal involvement in patients with clinical stage Ⅰ non-small-cell lung cancer: possibility of rational lymph node dissection. J Thorac Oncol, 2015, 10(6): 930-936.
22. 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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