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Background To evaluate the long‐term outcomes after surgical resection for stage I lung adenocarcinoma based on the percentage of lepidic component (LC) and invasive tumor size (IS). Methods The clinicopathological characteristics of 1049 patients with stage I lung adenocarcinoma who underwent surgery between 2006 and 2016 were retrospectively reviewed. Tumors were categorized into groups: A (LC ≥ 50%) and B (LC < 50%). Groups A0 and A1 consisted of minimally invasive adenocarcinomas (MIA) and other lepidic‐predominant invasive adenocarcinomas, respectively. Group B was categorized into B1 (IS ≤ 1 cm), B2 (1 < IS≤2 cm), and B3 (2 < IS≤3 cm) by invasive tumor size and divided into subgroups (B1[lep+]/[lep−], B2[lep+]/[lep−], and B3[lep+]/[lep−]) according to the presence[lep+] or absence[lep−] of LCs. Cumulative incidence of recurrence (CIR) and cancer‐specific survival (CSS) were examined. Results LC decreased with increasing IS. Only 24 (8.5%) tumors in group A had an IS >1 cm. 10‐year CIR and CSS were 15.2% and 86.0%. LC and IS were found to be independent predictors of CSS. Patients in group A had 1.4% 10‐year CIR and 100% 10‐year CSS. In group B, a significantly higher CIR and worse CSS were observed as IS increased (p < 0.001), but LC was not a predictor for CSS (p = 0.593). No significant differences in CIR or CSS were found in presence of LC or not when LC < 50% (B1[lep+]/[lep−], B2[lep+]/[lep−], and B3[lep+]/[lep−]: p = 0.36/0.48, p = 0.82/0.94, and p = 0.90/0.37, respectively). Conclusions LC≥50% tumors demonstrated excellent prognosis regardless of IS. The outcomes of LC < 50% tumors were well predicted by IS, corresponding to the T‐staging system. The predictive value of LC for prognosis became insignificant.

The wide application of computed tomography (CT) and lung cancer screening has increased the incidence of ground-glass opacities (GGOs). For those malignant potential of pulmonary lesions, several guidelines are conducted for radiologists or clinicians while encountering newly formed or persisted GGOs on CT scan. Active surveillance scanning instead of upfront surgical resection was mostly suggested as an initial decision of choice for small pulmonary lesions, except developing solid components or new growth. Standard surgical treatment has been lobectomy in the past decades for early-stage lung cancer, the feasibility of limited pulmonary resection based on radiologic features had investigated also recently. Several pivotal trials have been conducted using consolidation-to-tumor ratio, advocating the hypothesized advantages of preserving pulmonary function with equivalent oncologic outcome to lobectomy. After initial surgery for a main tumor, observation alone without further therapy is suggested for those residual GGOs which are not resected. Even though there might be no inferiority in postoperative survival outcomes, the evaluation made by experienced multidisciplinary team during follow-up is necessary. This paper is a review of the recent managements and guidelines for GGOs.