Personalized treatment strategy for ground-glass opacity-featured lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FU Fangqiu ^1,2 , MA Xiangyi ^1,2 ,  ZHANG Yang ^1,2 ,  CHEN Haiquan ^1,2

1. Department of Thoracic Surgery, Cancer Center, Fudan University, Shanghai, 200032, P.R.China;
2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, P.R.China;

Corresponding author：

ZHANG Yang, Email: fduzhangyang1987@hotmail.com; CHEN Haiquan, Email: hqchen1@yahoo.com

Keywords：

Ground-glass opacity; pathology; prognosis; surgical resection; screening

DOI：

10.7507/1007-4848.202109009

Video：

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Along with the popularity of low-dose computed tomography lung cancer screening, an increasing number of lung ground-glass opacity (GGO) lesions are detected. The pathology of GGO could be benign, but persistent GGO indicates early-stage lung cancer. Distinct from traditional lung cancer, GGO-featured lung cancer is more common in the young, nonsmokers and females. GGO-featured lung cancer represents an indolent type of malignancy with a long time to intervene. However, there is still no consensus on the screening, pathology, surgical procedure, and postoperative surveillance of GGO-featured lung cancer. Therefore, we proposed a personalized treatment strategy for GGO-featured lung cancer. The screening for GGO-featured lung cancer should be conducted at young age and low frequency. Adenocarcinoma in situ, minimally invasive adenocarcinoma, lepidic, and non-lepidic growth patterns could present as GGO. The following issues should be taken into consideration while determining the treatment of GGO-featured lung cancer: avoiding treating benign disease as malignancies, avoiding treating early-stage disease as advanced-stage disease, avoiding treating indolent malignancy as aggressive malignancy, and choosing appropriate timing to receive surgery without affecting life tracks and career developments. Bronchoscope and bone scan are not necessary for preoperative examinations of GGO-featured lung adenocarcinoma. For selected patients, sublobar resection without mediastinal lymph node dissection might be sufficient. Intraoperative frozen section is an effective method to guide resection strategy. Given the excellent survival of GGO-featured lung cancer, a less intensive postoperative surveillance strategy may be sufficient.

Citation： FU Fangqiu, MA Xiangyi, ZHANG Yang, CHEN Haiquan. Personalized treatment strategy for ground-glass opacity-featured lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(1): 1-10. doi: 10.7507/1007-4848.202109009 Copy

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1. Scholten ET, de Jong PA, de Hoop B, et al. Towards a close computed tomography monitoring approach for screen detected subsolid pulmonary nodules? Eur Respir J, 2015, 45(3): 765-773.
2. Chong S, Lee KS, Chung MJ, et al. Lung cancer screening with low-dose helical CT in Korea: Experiences at the Samsung Medical Center. J Korean Med Sci, 2005, 20(3): 402-408.
3. Zhang Y, Jheon S, Li H, et al. Results of low-dose computed tomography as a regular health examination among Chinese hospital employees. J Thorac Cardiovasc Surg, 2020, 160(3): 824-831.
4. Lee SW, Leem CS, Kim TJ, et al. The long-term course of ground-glass opacities detected on thin-section computed tomography. Respir Med, 2013, 107(6): 904-910.
5. 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.
6. Koo CW, Miller WT, Kucharczuk JC. Focal ground-glass opacities in non-small cell lung carcinoma resection patients. Eur J Radiol, 2012, 81(1): 139-145.
7. Gamsu G, Klein JS. High resolution computed tomography of diffuse lung disease. Clin Radiol, 1989, 40(6): 554-556.
8. Remy-Jardin M, Remy J, Giraud F, et al. Computed tomography assessment of ground-glass opacity: Semiology and significance. J Thorac Imaging, 1993, 8(4): 249-264.
9. Jang HJ, Lee KS, Kwon OJ, et al. Bronchioloalveolar carcinoma: Focal area of ground-glass attenuation at thin-section CT as an early sign. Radiology, 1996, 199(2): 485-488.
10. Kuriyama K, Seto M, Kasugai T, et al. Ground-glass opacity on thin-section CT: Value in differentiating subtypes of adenocarcinoma of the lung. AJR Am J Roentgenol, 1999, 173(2): 465-469.
11. Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: Glossary of terms for thoracic imaging. Radiology, 2008, 246(3): 697-722.
12. Hattori A, Matsunaga T, Hayashi T, et al. Prognostic impact of the findings on thin-section computed tomography in patients with subcentimeter non-small cell lung cancer. J Thorac Oncol, 2017, 12(6): 954-962.
13. Hattori A, Matsunaga T, Takamochi K, et al. Neither maximum tumor size nor solid component size is prognostic in part-solid lung cancer: Impact of tumor size should be applied exclusively to solid lung cancer. Ann Thorac Surg, 2016, 102(2): 407-415.
14. Ye T, Deng L, Wang S, et al. Lung adenocarcinomas manifesting as radiological part-solid nodules define a special clinical subtype. J Thorac Oncol, 2019, 14(4): 617-627.
15. Fu F, Zhang Y, Wen Z, et al. Distinct prognostic factors in patients with stage Ⅰnon-small cell lung cancer with radiologic part-solid or solid lesions. J Thorac Oncol, 2019, 14(12): 2133-2142.
16. 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.
17. Lai J, Li Q, Fu F, et al. Subsolid lung adenocarcinomas: Radiological, clinical and pathological features and outcomes. Semin Thorac Cardiovasc Surg, 2021, S1043-0679(21): 00248-3.
18. Engeler CE, Tashjian JH, Trenkner SW, et al. Ground-glass opacity of the lung parenchyma: A guide to analysis with high-resolution CT. AJR Am J Roentgenol, 1993, 160(2): 249-251.
19. Aokage K, Miyoshi T, Ishii G, et al. Influence of ground glass opacity and the corresponding pathological findings on survival in patients with clinical stageⅠ non-small cell lung cancer. J Thorac Oncol, 2018, 13(4): 533-542.
20. Zhang Y, Fu F, Chen H. Management of ground-glass opacities in the lung cancer spectrum. Ann Thorac Surg, 2020, 110(6): 1796-1804.
21. Kitami A, Sano F, Hayashi S, et al. Correlation between histological invasiveness and the computed tomography value in pure ground-glass nodules. Surg Today, 2016, 46(5): 593-598.
22. Lee GD, Park CH, Park HS, et al. Lung adenocarcinoma invasiveness risk in pure ground-glass opacity lung nodules smaller than 2 cm. Thorac Cardiovasc Surg, 2019, 67(4): 321-328.
23. Heidinger BH, Anderson KR, Nemec U, et al. Lung adenocarcinoma manifesting as pure ground-glass nodules: Correlating CT size, volume, density, and roundness with histopathologic invasion and size. J Thorac Oncol, 2017, 12(8): 1288-1298.
24. She Y, Zhao L, Dai C, et al. Preoperative nomogram for identifying invasive pulmonary adenocarcinoma in patients with pure ground-glass nodule: A multi-institutional study. Oncotarget, 2017, 8(10): 17229-17238.
25. Fu F, Zhang Y, Wang S, et al. Computed tomography density is not associated with pathological tumor invasion for pure ground-glass nodules. J Thorac Cardiovasc Surg, 2021, 162(2): 451-459.
26. Henschke CI, Yankelevitz DF, Mirtcheva R, et al. CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol, 2002, 178(5): 1053-1057.
27. Kakinuma R, Muramatsu Y, Kusumoto M, et al. Solitary pure ground-glass nodules 5 mm or smaller: Frequency of growth. Radiology, 2015, 276(3): 873-882.
28. Lee HW, Jin KN, Lee JK, et al. Long-term follow-up of ground-glass nodules after 5 years of stability. J Thorac Oncol, 2019, 14(8): 1370-1377.
29. de Margerie-Mellon C, Ngo LH, Gill RR, et al. The growth rate of subsolid lung adenocarcinoma nodules at chest CT. Radiology, 2020, 297(1): 189-198.
30. 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.
31. Cho S, Yang H, Kim K, et al. Pathology and prognosis of persistent stable pure ground-glass opacity nodules after surgical resection. Ann Thorac Surg, 2013, 96(4): 1190-1195.
32. Ye T, Deng L, Xiang J, et al. Predictors of pathologic tumor invasion and prognosis for ground glass opacity featured lung adenocarcinoma. Ann Thorac Surg, 2018, 106(6): 1682-1690.
33. Ettinger DS, Wood DE, Aggarwal C, et al. NCCN guidelines insights: Non-small cell lung cancer, version 1.2020. J Natl Compr Canc Netw, 2019, 17(12): 1464-1472.
34. Zhang Y, Chen Z, Hu H, et al. Surgical strategies for pre- and minimally invasive lung adenocarcinoma 3.0: Lessons learned from the optimal timing of surgical intervention. Semin Thorac Cardiovasc Surg, 2021, S1043-0679(21): 00003-4.
35. Zhuge L, Huang Y, Wang S, et al. Preoperative brain MRI for clinical stage ⅠA lung cancer: Is routine scanning rational? J Cancer Res Clin Oncol, 2019, 145(2): 503-509.
36. Li H, Hu H, Wang R, et al. When should ⁹⁹mTC bone scintigraphy be performed in CT1N0 non-small cell lung cancer patients? Medicine (Baltimore), 2015, 94(51): e2309.
37. Zhang Y, Zhang Y, Chen S, et al. Is bronchoscopy necessary in the preoperative workup of a solitary pulmonary nodule? J Thorac Cardiovasc Surg, 2015, 150(1): 36-40.
38. Li H, Ye T, Li N, et al. Is 99m Tc bone scintigraphy necessary in the preoperative workup for patients with cT1N0 subsolid lung cancer? A prospective multicenter cohort study. Thorac Cancer, 2021, 12(4): 415-419.
39. Ye T, Chen Z, Ma D, et al. Is flexible bronchoscopy necessary in the preoperative workup of patients with peripheral cT1N0 subsolid lung cancer? A prospective multi-center cohort study. Transl Lung Cancer Res, 2021, 10(4): 1635-1641.
40. 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): 615-622.
41. Liu S, Wang R, Zhang Y, et al. Precise diagnosis of intraoperative frozen section is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinoma. J Clin Oncol, 2016, 34(4): 307-313.
42. Donington JS. An additional step toward personalization of surgical care for early-stage non-small-cell lung cancer. J Clin Oncol, 2016, 34(4): 295-296.
43. Zhang Y, Deng C, Fu F, et al. Excellent prognosis of patients with invasive lung adenocarcinomas during surgery misdiagnosed as atypical adenomatous hyperplasia, adenocarcinoma in situ, or minimally invasive adenocarcinoma by frozen section. Chest, 2021, 159(3): 1265-1272.
44. Asamura H, Hishida T, Suzuki K, et al. Radiographically determined noninvasive adenocarcinoma of the lung: Survival outcomes of Japan Clinical Oncology Group 0201. J Thorac Cardiovasc Surg, 2013, 146(1): 24-30.
45. Suzuki K, Watanabe S, Wakabayashi M, et al. A nonrandomized confirmatory phase Ⅲ study of sublobar surgical resection for peripheral ground glass opacity dominant lung cancer defined with thoracic thin-section computed tomography (JCOG0804/WJOG4507L). American Society of Clinical Oncology, 2017.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Personalized treatment strategy for ground-glass opacity-featured lung cancer

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