The impact of chemotherapy on persistent ground-glass nodules in patients with lung adenocarcinoma

Lu, Wenwen; Cham, Matthew D.; Qi, Linlin; Wang, Jianwei; Tang, Wei; Li, Xiaolu; Zhang, Jie

doi:10.21037/jtd.2017.10.50

Cited by 15 publications

(11 citation statements)

References 35 publications

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“…Any disagreement was settled by the third radiologist who had 15 years of experience. The image features included the following: (a) lesion diameter: for part-solid nodules, the CT sections chosen for measurements were those that displayed the largest portion of the overall nodule and the solid component; (b) lesion area; (c) diameter of the solid component; (d) area of the solid component 26 ; (e) shape: regular (round or oval) or irregular 27 ; (f) attenuation value; (g) presence of vacuoles (single or multiple cystic cavity with diameters <5 mm) 28 ; (h) presence of an air bronchogram; (i) lesion margin: smooth, lobulate, or spiculate; (j) lesion border; and (k) lesion location were interpreted. Clinical data of the enrolled patients were collected from the electronic data system.…”

Section: Ct Examination and Imaging Analysismentioning

confidence: 99%

A radiomics model for determining the invasiveness of solitary pulmonary nodules that manifest as part-solid nodules

et al. 2019

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to predict the histological subtypes of lung invasive adenocarcinomas (IAs) and minimally invasive adenocarcinomas (MIAs) that manifest as partsolid ground-glass nodules (GGNs). MATERIALS AND METHODS: This retrospective study enrolled 119 patients with histopathologically confirmed part-solid GGNs assigned to the training (n¼83) or testing cohorts (n¼36). Radiomic features were extracted based on the unenhanced computed tomography (CT) images. R software was applied to process the qualitative and quantitative data. The CT features model, radiomic signature model, and combined prediction model were constructed and compared. RESULTS: A total of 396 radiomic features were extracted from the preoperative CT images, four features including MaxIntensity, RMS, ZonePercentage, and Long-RunEmphasis_angle0_offset7 were indicated to be the best discriminators to establish the radiomic signature model. The performance of the model was satisfactory in both the training and testing set with areas under the curve (AUCs) of 0.854 (95% confidence interval [CI]: 0.774 to 0.934) and 0.813 (95% CI: 0.670 to 0.955), respectively. The CT morphology of the lesion shape and diameter of the solid component were confirmed to be a significant feature for building the CT features model, which had an AUC of 0.755 (95% CI: 0.648 to 0.843). A nomogram that integrated lesion shape and radiomic signature was constructed, which contributed an AUC of 0.888 (95% CI: 0.82 to 0.955). CONCLUSIONS: The radiomic signature could provide an important reference for differentiating IAs from MIAs, and could be significantly enhanced by the addition of CT morphology. The nomogram may be highly informative for making clinical decisions.

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Section: Ct Examination and Imaging Analysismentioning

confidence: 99%

A radiomics model for determining the invasiveness of solitary pulmonary nodules that manifest as part-solid nodules

et al. 2019

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“…A previous study investigated the effect of platinum-based chemotherapy on SSNs [ 24 ]. Ninety-one persistent SSNs in 51 adenocarcinoma patients received either cisplatin or carboplatin-based chemotherapy and 94.5% of the ground-glass opacity nodules (GGNs) remained unchanged in size, while 5.5% of the GGNs increased in size.…”

Section: Discussionmentioning

confidence: 99%

The Impact of EGFR Tyrosine Kinase Inhibitor on the Natural Course of Concurrent Subsolid Nodules in Patients with Non–Small Cell Lung Cancer

et al. 2022

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Purpose The role of epidermal growth factor receptor–tyrosine kinase inhibitors (EGFR-TKIs) in the management of persistent subsolid nodules (SSNs) is unclear. This study aimed to investigate the impact of EGFR-TKIs on concurrent SSNs in patients with stage IV non–small cell lung cancer (NSCLC).Materials and Methods Patients who received an EGFR-TKI for at least 1 month for stage IV NSCLC and had concurrent SSN(s) that had existed for at least 3 months on chest computed tomography were included in this retrospective study. Size change of each nodule before and after EGFR-TKI therapies were evaluated using a cutoff value of 2 mm; increase (≥ 2 mm), decrease (≤ –2 mm), and no change (–2 mm < size change < +2 mm).Results A total of 77 SSNs, 51 pure ground-glass (66.2%) and 26 part-solid nodules (33.8%), were identified in 59 patients who received gefitinib (n=45) and erlotinib (n=14). Among 58 EGFR mutation analysis performed for primary lung cancer, 45 (77.6%) were EGFR mutant. The proportions of decrease group were 19.5% (15/77) on per-nodule basis and 25.4% (15/59) on per-patient basis. Four SSNs (5.2%) disappeared completely. On per-patient based multivariable analysis, EGFR exon 19 deletion positivity for primary lung cancer was associated with a decrease after initial EGFR-TKI therapy (adjusted odds ratio, 4.29; 95% confidence interval, 1.21 to 15.29; p=0.025).Conclusion Approximately 20% of the concurrent SSNs decreased after the initial EGFR-TKI therapy. EGFR exon 19 deletion positivity for primary lung cancer was significantly associated with the size change of concurrent SSNs.

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“…However, Zhang et al 22 retrospectively included patients who had GGO-featured lung cancer before undergoing chemotherapy for other concurrent malignancies; eventually, all the GGO lesions either remained unchanged or enlarged and no chemotherapy-induced histopathologic response (necrosis, fibrosis or inflammation) was observed in any of the resected GGO lesions. Similarly, Lu et al 23 evaluated the response of persistent GGOs in lung adenocarcinoma patients treated with platinum-based chemotherapy and concluded that GGOs were insensitive to the chemotherapy.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Management for Residual Ground-Glass Opacity Lesions After Resection of Main Tumor in Multifocal Lung Cancer: A Case Report and Literature Review

Cheng

Deng

Zhao

et al. 2021

CMAR

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There are increasing numbers of synchronous multiple primary lung cancer (SMPLC) patients in clinical practice, with most lesions presenting as ground-glass opacity (GGO). For SMPLC patients, surgical resection should be a prior option for all lesions suspected of being malignant, if medically and technically feasible. However, it is frequently a dilemma for the management of residual GGO lesions that were unresected simultaneously with the main tumor in SMPLC patients. We report a case of SMPLC, in which the patient underwent surgical resection of the major lesion with EGFR mutation and then received compelling EGFR-TKI treatment for one enlarging residual GGO lesion after 12 months since operation. Furthermore, a comprehensive literature review about the risk for the progress of GGOs unresected simultaneously with the main lesion and the management of these residual GGOs was also summarized. With the treatment of EGFR-TKI gefitinib for 3 months, the biggest residual GGO lesion (more than 10mm) achieved a complete response (CR), three lesions reduced in size, and the other three lesions remained stable in this case. Surgical resection for major lesion and EGFR-TKI treatment on unresected GGOs might bring favorable outcome for patients with EGFR-mutated multifocal lung cancer. This strategy is safe and effective, which could be a promising therapeutic approach for unresectable GGO lesions in EGFR-mutated SMPLC patients after primary surgery. Notably, folate receptor-positive circulating tumor cell (FR + -CTC) for therapeutic monitoring was more sensitive for GGO-featured lung adenocarcinoma than serum markers.

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The impact of chemotherapy on persistent ground-glass nodules in patients with lung adenocarcinoma

Cited by 15 publications

References 35 publications

A radiomics model for determining the invasiveness of solitary pulmonary nodules that manifest as part-solid nodules

A radiomics model for determining the invasiveness of solitary pulmonary nodules that manifest as part-solid nodules

The Impact of EGFR Tyrosine Kinase Inhibitor on the Natural Course of Concurrent Subsolid Nodules in Patients with Non–Small Cell Lung Cancer

Management for Residual Ground-Glass Opacity Lesions After Resection of Main Tumor in Multifocal Lung Cancer: A Case Report and Literature Review

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