European guidelines for the surgical management of pure ground-glass opacities and part-solid nodules: Task Force of the European Association of Cardio-Thoracic Surgery and the European Society of Thoracic Surgeons

Abstract

Pulmonary nodules are often encountered by respiratory physicians, radiologists, and thoracic surgeons alike. The European Society of Thoracic Surgery (ESTS) and European Association of Cardiothoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in managing pulmonary nodules with the aim of producing the first joint comprehensive review of the scientific literature, with a specific focus on the management of pure ground glass opacities and part-solid nodules. The scope of the document has been defined by the EACTS and ESTS governing bodies and focuses on six areas of main interest agreed upon by the Task Force. These include: management of solitary and multiple pure ground glass nodules, solitary part-solid nodules, identifying the non-palpable lesion, the role of minimally invasive surgery and the decision making behind sub-lobar versus lobar resection. The literature revealed that with the increasing use of incidental CT scans and CT lung cancer screening programs, the detection of early-stage lung cancer is going to rise with a higher number of potential cancers presenting on the ground glass and part-solid nodule spectrum. Given that the gold standard for improved survival is surgical resection, there is an urgent need for comprehensive characterisation of these nodules and guidelines that are directed towards their surgical management. It is recommended that standard decision-making tools are used to determine the risk of malignancy and thus guide referral for surgical management and decisions for surgical resection are made in a multidisciplinary setting with equitable consideration given to radiological characteristics, the evolution of the lesion, presence of solid component, patient fitness and co-morbidities. Given the recent surge in robust level I data comparing sublobar and lobar resection with the release of JCOG0802 and CALGB140503 data, a global overview of an individual case must be adopted into clinical practice. This set of recommendations are based on the available literature; however, close collaboration in the design and conduct of randomized controlled trials is still of utmost importance to answer further questions in this rapidly evolving field.

Prognostic implication of consolidation-to-tumor ratio in early lung adenocarcinoma: a retrospective cross-sectional study

“…On the basis of a series of prospective studies concerning the prognostic value of CTR and its effect on decision-making of surgical approach ( 18 ), this study aimed to determine the threshold value of CTR for distinguishing between GGO-predominant GGNs and solid-predominant GGNs and elucidate the prognostic implications of the solid-predominant GGNs categorized by CTR on c-stage IA lung adenocarcinoma. The strong point of this study is that this investigation is the first to experimentally identify CTR values that differentiate between solid-predominant GGNs and GGO-predominant GGNs.…”

Sublobectomy and lymph node sampling are adequate for patients with invasive lung adenocarcinoma presenting as pure ground glass nodules

“…16,18 To identify these components, the lung window was set with a window width of 1500 HU and a window level of À400 HU, while the mediastinal window had a window width of 350 HU and a window level of 50 HU. 16,19 The imaging results were independently reviewed by a radiologist (Jianfa Zhang) and two thoracic surgeons (Guibin Qiao and Hansheng Wu).…”

ERS International Congress 2023: highlights from the Thoracic Oncology Assembly

“…They may be neoplastic or not. There is currently no consensus between different guidelines regarding management and follow-up [ 29 – 31 ]. GGOs include ground-glass nodules or non-solid nodules, which are pure ground-glass lesions with a consolidation tumour ratio (CTR) of zero, and part-solid nodules (PSNs), in which we find a solid component (CTR>0) [ 32 ].…”