Differential diagnosis and management of focal ground-glass opacities

Abstract

Focal pulmonary ground-glass opacities (GGOs) can be associated with bronchioloalveolar carcinoma. The present retrospective study aimed to test the validity of a multistep approach to discriminate malignant from benign localised (focal) GGOs, identifies useful diagnostic features on computed tomography (CT), and suggests appropriate management guidelines.A stepwise approach, including oral antibiotics, follow-up high-resolution CT (HRCT) 40-60 days later and CT-guided core biopsy, was used. All cases with localised GGOs detected since 2001 were reviewed. CT features were described according to a structured scheme. In total, 40 patients were evaluated. Of these, 11 patients were diagnosed with benign GGOs, 19 patients had lung cancer and 10 were undetermined.Nonpolygonal shape, apparent radial growth and clear-cut margins were associated with a malignant histology. The specificity of CT findings was low. Diagnostic accuracy increased after oral antibiotics, follow-up HRCT and percutaneous core biopsy. Overall, 18 patients underwent surgery for lung cancer.In conclusion, malignant ground-glass opacities have a fairly typical appearance, but some benign lesions closely mimic their malignant counterparts. The stepwise approach adopted in the present study increased the diagnostic specificity and reduced time to definitive diagnosis. Segmentectomy might be the ideal resection volume for such tumours.

Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?

“…162 In another small study of 40 individuals with subsolid nodules, the diagnostic yield of CT scan-guided core needle biopsy was 84% (16 of 19), but two of three individuals with nondiagnostic results were subsequently found to have cancer. 163 Hence, although TTNB appears to be less sensitive for subsolid than for solid nodules, it is still potentially useful, particularly for individuals who are at higher risk for surgical complications and those who wish to confi rm malignancy before undergoing surgical resection. Although nonsurgical biopsy specimens can confi rm the diagnosis of malignancy preoperatively in some cases, it should not be used to exclude malignancy in view of its imperfect sensitivity and limited negative predictive value.…”

Differential diagnosis and management of focal pulmonary ground-glass opacities

“…One of the major conclusions in the study by INFANTE et al [1] was that the stepwise approach increased the diagnostic specificity and reduced time to definitive diagnosis. They recommended response to antibiotic trial as the first management step.…”

“…Because this is a central part of their conclusion, clarification of the question may be helpful. INFANTE et al [1] assumed that lesions with regression after antibiotics treatment were benign GGOs. However, a decrease in size with the appearance of solid components during follow-up has been reported in bronchioloalveolar carcinoma (BAC) and adenocarcinoma with mixed subtype [2].…”

“…In a recent article printed in the European Respiratory Journal, INFANTE et al [1] validated a stepwise approach including oral antibiotics, follow-up computed tomography and computed tomography-guided biopsy for the differential diagnosis and management of focal pulmonary ground-glass opacities (GGOs). Although a retrospective study, their work provides critical information on discrimination and management of focal GGOs.…”

Adenocarcinoma in pure ground glass nodules: histological evidence of invasion and open debate on optimal management

“…The reports from lung cancer screening trials showed that conservative management of pGGN provides optimal balance between risk and benefits. In asymptomatic subjects at high risk of lung cancer, pGGN did not progress to advanced stage lung cancer in several years after first documentation on CT (29)(30)(31)(32). Therefore, long-term active surveillance by low-dose CT (LDCT) is encouraged until the evidence of nodule progression.…”