Overview and Strategic Management of Subsolid Pulmonary Nodules

Abstract

A new classification of lung adenocarcinoma has been proposed recently-the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Abundant information from recent lung cancer computed tomography (CT) screening programs has increased our understanding of the strong, although imperfect, correlation between histologic findings of lung adenocarcinoma and subsolid pulmonary nodules on CT, including both "pure" ground-glass nodules (GGNs) and "part-solid" GGNs. Moreover, serial CT imaging has demonstrated stepwise progression of these nodules in a subset of patients, characterized by increase in size and density of GGNs and development of a solid component. Given the higher incidence of malignancy and the considerably lower growth rate of subsolid nodules, dedicated standardized guidelines for management of these nodules have been proposed, including long-term (≥3 y) CT follow-up using a low-dose technique. Radiologists should be familiar with the new terminology of lung adenocarcinomas and strategic management of subsolid pulmonary nodules.

Diagnostic performance of percutaneous lung biopsy using automated biopsy needles under CT-fluoroscopic guidance for ground-glass opacity lesions

“…This classification would influence the next revision of the turnour, node, metastasis (TNM) staging classification. Studies have shown a close correlation between histological and CT findings [11,49,50]. On CT, AAH tends to present as a small pure GGO lesion that typically measures ,5 mm in diameter but can be as large as 1-2 cm.…”

“…MIA has an excellent prognosis with almost 100% disease-specific survival, similar to AIS. Invasive adenocarcinoma usually manifests as a solid nodule or part-solid GGO lesion, only rarely appearing as having pure GGO [49].…”

Pulmonary subsolid nodules: what radiologists need to know about the imaging features and management strategy

“…To date, imaging features have not been sufficiently described for MIAs; however, nonmucinous MIAs have been shown to appear as part-solid GGNs with a small solid component ≤5 mm (Fig. 3) or as pure GGNs (1,11). Mucinous MIAs are much less frequent and may present as predominantly solid nodules (1).…”

“…3) or as pure GGNs (1,11). Mucinous MIAs are much less frequent and may present as predominantly solid nodules (1).…”

“…During the past decade, the natural history, management strategy and long-term prognosis in the case of GGNs have attracted attention. Pure GGNs are defined as focal nodular areas of increased lung attenuation through which lung parenchymal structures, such as the pulmonary vessels or bronchial structures, can be observed (1). Part-solid GGNs are nodules that present with both ground-glass and solid components in which the underlying lung architecture cannot be visualized (1,2).…”