Differentiating pre- and minimally invasive from invasive adenocarcinoma using CT-features in persistent pulmonary part-solid nodules in Caucasian patients

Cohen, Julien G.; Reymond, Eric D.; Léderlin, Mathieu; Medici, Maud; Lantuéjoul, Sylvie; Laurent, François; Arbib, François; Jankowski, A.; Moreau–Gaudry, Alexandre; Ferretti, G.

doi:10.1016/j.ejrad.2014.12.031

Cited by 81 publications

(50 citation statements)

References 31 publications

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“…AIS and MIA, in which a lepidic pattern is a major component, show a very good prognosis (22). Since a lepidic pattern is known to be non-invasive and often appears as GGO on CT, a patient with a GGO nodule on imaging is likely to be diagnosed with AIS or MIA (4,23). Although the standard surgical treatment of early lung cancer is major pulmonary resection with MLND, a lesser surgical procedure such as limited resection may be sufficient for GGO since there is a good possibility that it is AIS or MIA.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of mediastinal lymph node evaluation in a patient with ground glass opacity tumor

et al. 2016

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Background: The prognosis of non-small cell lung cancer (NSCLC) presenting as a ground glass opacity (GGO) nodule is better than other types of lung cancer. The purpose of this study was to evaluate the necessity of mediastinal lymph node evaluation (MLE) in clinical N0 GGO-predominant NSCLC. Methods:We conducted a retrospective chart review of 358 patients treated for clinical N0 NSCLC that was found by curative resection to be 3 cm or smaller in size. We analyzed clinicopathological findings and survival among three groups with either GGO-predominant or solid-predominant tumor: no mediastinal lymph node evaluation (NoMLE) group, mediastinal lymph node sampling (MLS) group, and mediastinal lymph node dissection (MLND) group.Results: Except for sex, there were no differences in clinicopathological characteristics among the three groups with GGO-predominant tumor or solid-predominant tumor. There was no difference in the 5-year recurrence-free survival (RFS) rate among three groups in the GGO-predominant patients (100%, 92.9%, 93.8%, respectively; P=0.889). However, in the solid-predominant tumor group, the 5-year recurrence free survival of the NoMLE group was lower than in the MLND group (48.6% vs. 73.1%, P=0.007). MLE was not a significant risk factor for recurrence in GGO-predominant tumor [hazard ratio (HR) =1.021; P=0.987].GGO-predominant tumor [odds ratio (OR) =0.063; P=0.008] was identified as the sole parameter that significantly impacted nodal upstaging.Conclusions: MLE is not an essential procedure for clinical N0 NSCLC presenting as a 3 cm or smaller GGO-predominant nodule.

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Section: Discussionmentioning

confidence: 99%

The effectiveness of mediastinal lymph node evaluation in a patient with ground glass opacity tumor

et al. 2016

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“…Although part-solid nodules have a high likelihood of malignancy, nodules with a solid component smaller than 6 mm typically represent either adenocarcinoma in situ or minimally invasive adenocarcinoma rather than invasive adenocarcinoma (42,43). Additionally, part-solid nodules may be due to transient infections and may resolve after short-term follow-up (Fig 12) (44).…”

Section: Special Report: Guidelines For Management Of Incidental Pulmmentioning

confidence: 99%

“…In this setting, sooner follow-up may be warranted, as many of these lesions will either resolve or show no change, thereby reassuring the patient (Fig 11) (3,36,41,42). Again, we would emphasize that these guidelines are not intended to preclude either shorter or longer term follow-up in individual subjects, when deemed clinically appropriate (43).…”

Section: Special Report: Guidelines For Management Of Incidental Pulmmentioning

confidence: 99%

“…Abundant evidence enables us to confirm that the larger the solid component, the greater the risk of invasiveness and metastases. A solid component larger than 5 mm correlates with a substantial likelihood of local invasion (7,43,(45)(46)(47)(48)(49)(50)(51)(52)(53)(54), and this is a threshold criterion in the newly revised T factor staging for adenocarcinoma (Fig 13) (55-57). However, a large solid component can also be seen in transient part-solid nodules (44,58).…”

Section: Risk Factors For Malignancy: General Considerations Nodule Smentioning

confidence: 99%

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Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

et al. 2017

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The Fleischner Society Guidelines for management of solid nodules were published in 2005, and separate guidelines for subsolid nodules were issued in 2013. Since then, new information has become available; therefore, the guidelines have been revised to reflect current thinking on nodule management. The revised guidelines incorporate several substantive changes that reflect current thinking on the management of small nodules. The minimum threshold size for routine follow-up has been increased, and recommended follow-up intervals are now given as a range rather than as a precise time period to give radiologists, clinicians, and patients greater discretion to accommodate individual risk factors and preferences. The guidelines for solid and subsolid nodules have been combined in one simplified table, and specific recommendations have been included for multiple nodules. These guidelines represent the consensus of the Fleischner Society, and as such, they incorporate the opinions of a multidisciplinary international group of thoracic radiologists, pulmonologists, surgeons, pathologists, and other specialists. Changes from the previous guidelines issued by the Fleischner Society are based on new data and accumulated experience. Table. These are followed by graded ratings of each recommendation using the American College of Chest Physicians recommendations for evidence grading in clinical guidelines (9). Additional explanations are provided regarding the rationale for each recommendation, which is based on the consensus of a multidisciplinary team and a systematic review of the literature, further details of which are included in Appendix E1 [online]. The minimum threshold size for recommending follow-up is based on an estimated cancer risk in a nodule on the order of 1% or greater. This criterion is necessarily arbitrary, and we recognize that a higher threshold may be considered appropriate in some environments and that this threshold will ultimately depend on social and economic factors. Several general considerations regarding technical aspects of using these recommendations are also presented. Finally, in Appendix E1 (online), additional information regarding methods and risk factors is given. detected at CT in adult patients who are at least 35 years old. Separate guidelines have been issued for lung cancer screening, such as those from the American College of Radiology (ACR), and we support the use of those guidelines when interpreting the results of CT screening (8). Specific recommendations are provided for patients with multiple solid and subsolid nodules, and several other commonly encountered clinical situations are addressed.These guidelines are not intended for use in patients with known primary cancers who are at risk for metastases, nor are they intended for use in immunocompromised patients who are at risk for infection; in these patients, treatment should be based on the specific clinical situation. Also, because lung cancer is rare in children and adults younger than 35 years, these guidelines are no...

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“…However, recent studies have proven that those nodules often correspond to invasive adenocarcinomas, representing for example 39% of the nodules in a Korean series of 46 pGGNs (5) and 40% in a Chinese series of 94 pGGNs (6). This makes pGGNs a very different entity in comparison to part-solid nodules, which show by contrast good radio-pathological correlations between solid component on CT and invasive foci on pathology for nodules corresponding to adenocarcinomas (7,8), putting aside a few false positive of solid component on CT such as alveolar collapses, fibrotic scars or mucinous components (9,10). This significant overlap in imaging features of in situ/minimally invasive and invasive adenocarcinomas manifesting as pGGNs on CT, as shown in Figure 1, can be explained by several reasons.…”

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confidence: 92%

Pure ground-glass nodules: are they really indolent?

Cohen¹,

Ferretti²

2017

J. Thorac. Dis.

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Differentiating pre- and minimally invasive from invasive adenocarcinoma using CT-features in persistent pulmonary part-solid nodules in Caucasian patients

Cited by 81 publications

References 31 publications

The effectiveness of mediastinal lymph node evaluation in a patient with ground glass opacity tumor

The effectiveness of mediastinal lymph node evaluation in a patient with ground glass opacity tumor

Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

Pure ground-glass nodules: are they really indolent?

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