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Wang Q. [Management Strategies of Pulmonary Ground Galss Nodule]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:160-162. [PMID: 29587931 PMCID: PMC5973040 DOI: 10.3779/j.issn.1009-3419.2018.03.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
肺部磨玻璃结节(ground glass nodule, GGN)是一种影像学表现,可能是肺部恶性肿瘤或良性病变。目前对于肺部磨玻璃结节的诊疗仍存在争议。2017年Fleischner协会和美国国立综合癌症网络(National Comprehensive Cancer Network, NCCN)都更新了GGN诊疗的指南,与之前的版本相比,手术或活检的指征更严,随访的间隔时间更长。临床工作中,GGN的大小、实性成分大小、动态随访变化和CT值都是判断手术介入时机的因素。GGN的诊疗中还存在一些误区:抗生素的使用、正电子发射型计算机断层显像(positron emission tomographycomputed tomography, PET-CT)检查、贴近胸膜的纯GGN和进入GGN的血管都是值得注意的问题。总之,GGN是一种发展缓慢的病灶,可以安全地进行随访。
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Affiliation(s)
- Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Modified inflammation-based score as an independent malignant predictor in patients with pulmonary focal ground-glass opacity: a propensity score matching analysis. Sci Rep 2016; 6:19105. [PMID: 26752624 PMCID: PMC4707538 DOI: 10.1038/srep19105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 12/02/2015] [Indexed: 12/18/2022] Open
Abstract
Pulmonary focal Ground-glass Opacities (fGGOs) would frequently be identified after widely implementation of low-dose computed tomography (LDCT) screening. Because of the high false-positive rate of LDCT, antibiotics should be regarded as advocates in clinical management for detected fGGOs. Retrospectively review consecutive patients with fGGOs between August 2006 and August 2012. Then, relative Glasgow prognostic score (GPS) were constructed in three different systems, traditional GPS system (tGPS), modified GPS system 1 (m1GPS), and modified GPS system 2 (m2GPS). Moreover, propensity score matching (PSM) was employed in balancing baseline covariates. After PSM, patients were matched and included in benign and malignant groups as 1:1 ratio. All reported parameters were balanced in both groups and no statistical differences could be detected. Finally, m1GPS exhibited remarkable different distribution between benign and malignant fGGOs. In detail, m1GPS 1 was more frequently observed in benign fGGOs nodules, while m1GPS 2 in malignant fGGOs nodules. Modified inflammation-based score was identified as an independent predictor of malignancies in patients with pulmonary fGGOs. Patients with m1GPS 1 were more likely to be benign fGGOs, while victims with m1GPS 2 more likely to be malignant.
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Callister MEJ, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, Franks K, Gleeson F, Graham R, Malhotra P, Prokop M, Rodger K, Subesinghe M, Waller D, Woolhouse I. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax 2015; 70 Suppl 2:ii1-ii54. [PMID: 26082159 DOI: 10.1136/thoraxjnl-2015-207168] [Citation(s) in RCA: 534] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - D R Baldwin
- Nottingham University Hospitals, Nottingham, UK
| | - A R Akram
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S Barnard
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle, UK
| | - P Cane
- Department of Histopathology, St Thomas' Hospital, London, UK
| | - J Draffan
- University Hospital of North Tees, Stockton on Tees, UK
| | - K Franks
- Clinical Oncology, St James's Institute of Oncology, Leeds, UK
| | - F Gleeson
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - P Malhotra
- St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - M Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - K Rodger
- Respiratory Medicine, St James's University Hospital, Leeds, UK
| | - M Subesinghe
- Department of Radiology, Churchill Hospital, Oxford, UK
| | - D Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - I Woolhouse
- Department of Respiratory Medicine, University Hospitals of Birmingham, Birmingham, UK
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Fussner LA, Midthun DE. Characteristics and management strategies for the incidental pulmonary nodule. Lung Cancer Manag 2014. [DOI: 10.2217/lmt.14.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY: Pulmonary nodules are frequent, unanticipated findings on imaging studies obtained for other purposes across all areas of medical practice. As nodule detection raises concern for malignancy, evaluation and follow-up of an incidental nodule is imperative. Clinicians are charged with counseling patients and directing further evaluation amid uncertainty and anxiety. The goals of follow-up and management are to identify malignant lesions at an early stage, while avoiding unnecessary procedures and potential harm to patients with benign nodules. In this review, we aim to outline the clinical and radiographic characteristics that can aid in likelihood stratification, to identify gaps in our current knowledge, and to present a logical approach to nodule management, based on the available evidence.
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Affiliation(s)
- Lynn A Fussner
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - David E Midthun
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Lederlin M, Revel MP, Khalil A, Ferretti G, Milleron B, Laurent F. Management strategy of pulmonary nodule in 2013. Diagn Interv Imaging 2013; 94:1081-94. [PMID: 24034970 DOI: 10.1016/j.diii.2013.05.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M Lederlin
- Service d'imagerie médicale, Université Bordeaux Segalen, CHU Bordeaux Groupe Sud, avenue de Magellan, 33600 Pessac, France.
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Abstract
In this review, we focus on the radiologic, clinical, and pathologic aspects primarily of solitary subsolid pulmonary nodules. Particular emphasis will be placed on the pathologic classification and correlative computed tomography (CT) features of adenocarcinoma of the lung. The capabilities of fluorodeoxyglucose positron emission tomography-CT and histologic sampling techniques, including CT-guided biopsy, endoscopic-guided biopsy, and surgical resection, are discussed. Finally, recently proposed management guidelines by the Fleischner Society and the American College of Chest Physicians are reviewed.
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Affiliation(s)
- Roy A Raad
- Department of Radiology, NYU Langone Medical Center, 660 First Avenue, New York, NY 10016, USA.
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Tag Eldin MA, Ibraheem T. An interpreting physician is essential to avoid inaccurate diagnosis of PET-CT: A case report. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Seidelman JL, Myers JL, Quint LE. Incidental, subsolid pulmonary nodules at CT: etiology and management. Cancer Imaging 2013; 13:365-73. [PMID: 24061063 PMCID: PMC3800431 DOI: 10.1102/1470-7330.2013.9025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pulmonary nodules, both solid and subsolid, are common incidental findings on computed tomography (CT) studies. Subsolid nodules (SSNs) may be further classified as either pure ground-glass nodules or part-solid nodules. The differential diagnosis for an SSN is broad, including infection, organizing pneumonia, inflammation, hemorrhage, focal fibrosis, and neoplasm. Adenocarcinomas of the lung are currently the most common type of lung cancer, representing 30–35% of all primary lung tumors, and the subtype of bronchioloalveolar cell carcinoma (BAC) commonly presents as an SSN. In 2011, a new classification system for lung adenocarcinomas was proposed by the International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society. An important feature of the new system is the relinquishment of the term BAC in favor of more specific histologic subtypes. It has been reported that these subtypes are associated with characteristic CT findings. This article reviews the new classification system of lung adenocarcinomas, discusses and illustrates the associated CT findings, and outlines the current recommendations for further diagnosis, treatment, and follow-up of SSNs based on computed tomography findings.
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Dong M, Xu S, Wu Y, Liu Y, Chen G, Chen J. [Lung adenocarcinoma in situ which CT showed single pure ground-glass opacity: a case report and literature review]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2013; 16:438-40. [PMID: 23945249 PMCID: PMC6000668 DOI: 10.3779/j.issn.1009-3419.2013.08.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ming Dong
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300053, China
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[Research progress of treatment strategy for pulmonary nodule]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2013; 16:261-6. [PMID: 23676983 PMCID: PMC6000607 DOI: 10.3779/j.issn.1009-3419.2013.05.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Naidich DP, Bankier AA, MacMahon H, Schaefer-Prokop CM, Pistolesi M, Goo JM, Macchiarini P, Crapo JD, Herold CJ, Austin JH, Travis WD. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology 2012; 266:304-17. [PMID: 23070270 DOI: 10.1148/radiol.12120628] [Citation(s) in RCA: 693] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This report is to complement the original Fleischner Society recommendations for incidentally detected solid nodules by proposing a set of recommendations specifically aimed at subsolid nodules. The development of a standardized approach to the interpretation and management of subsolid nodules remains critically important given that peripheral adenocarcinomas represent the most common type of lung cancer, with evidence of increasing frequency. Following an initial consideration of appropriate terminology to describe subsolid nodules and a brief review of the new classification system for peripheral lung adenocarcinomas sponsored by the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS), six specific recommendations were made, three with regard to solitary subsolid nodules and three with regard to multiple subsolid nodules. Each recommendation is followed first by the rationales underlying the recommendation and then by specific pertinent remarks. Finally, issues for which future research is needed are discussed. The recommendations are the result of careful review of the literature now available regarding subsolid nodules. Given the complexity of these lesions, the current recommendations are more varied than the original Fleischner Society guidelines for solid nodules. It cannot be overemphasized that these guidelines must be interpreted in light of an individual's clinical history. Given the frequency with which subsolid nodules are encountered in daily clinical practice, and notwithstanding continuing controversy on many of these issues, it is anticipated that further refinements and modifications to these recommendations will be forthcoming as information continues to emerge from ongoing research.
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Affiliation(s)
- David P Naidich
- Department of Radiology, New York University Medical Center, 560 First Ave, New York, NY 10016, USA.
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Georgiadou SP, Sampsonas FL, Rice D, Granger JM, Swisher S, Kontoyiannis DP. Open-lung biopsy in patients with undiagnosed lung lesions referred at a tertiary cancer center is safe and reveals noncancerous, noninfectious entities as the most common diagnoses. Eur J Clin Microbiol Infect Dis 2012; 32:101-5. [PMID: 22895891 DOI: 10.1007/s10096-012-1720-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 07/29/2012] [Indexed: 11/27/2022]
Abstract
We evaluated the diagnostic yield of open-lung biopsies (OLBs) in a large tertiary cancer center to determine the role of infectious diseases as causes of undiagnosed pulmonary lesions. All consecutive adult patients with either single or multiple pulmonary nodules or masses who underwent a diagnostic OLB over a period of 10 years (1998-2007) were retrospectively identified. Their risk factors for malignancy and clinical and radiological characteristics were reviewed, and their postoperative complications were assessed. We evaluated 155 patients with a median age of 57 years (range, 19-83 years). We identified infectious etiologies in 29 patients (19 %). The most common diagnosis in this group was histoplasmosis (12 [41 %]), followed by nontuberculous mycobacterial infection (7 [24 %]) and aspergillosis (4 [14 %]). The majority of the 126 remaining patients had nonmalignant diagnoses, the most prevalent being nonspecific granuloma (26 %), whereas only 17 % had malignant diagnoses. We observed no significant differences among the patients with infectious, malignant, or both noninfectious and nonmalignant final diagnoses regarding their demographic, laboratory, and clinical characteristics. Six percent of the patients had at least one post-OLB complication, and the post-OLB mortality rate was 1 %. OLB is a safe diagnostic procedure which frequently identifies a wide variety of infectious and inflammatory diseases.
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Affiliation(s)
- S P Georgiadou
- Department of Infectious Diseases, Infection Control and Employee Health, Unit 1463, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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Thoracic operations for pulmonary nodules are frequently not futile in patients with benign disease. J Thorac Oncol 2012; 6:1720-5. [PMID: 21760552 DOI: 10.1097/jto.0b013e318226b48a] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Pulmonary nodules often require operative resection to obtain a diagnosis. However, 10 to 30% of operations result in a benign diagnosis. Our purpose was to determine whether negative thoracic operations are futile by describing the pathological diagnoses; determining new diagnoses and treatment changes initiated based on operative findings; and assessing morbidity, mortality, and cost of the procedure. METHODS At our academic medical center, 278 thoracic operations were performed for known or suspected cancer between January 1, 2005, and April 1, 2009. We collected and summarized data pertaining to preoperative patient and nodule characteristics, pathologic diagnosis, postoperative treatment changes resulting from surgical resection, perioperative morbidity and mortality, and hospital charges for patients with benign pathology. RESULTS Twenty-three percent (65/278) of patients who underwent surgical resection for a suspicious nodule had benign pathology. We report granulomatous disease in 57%, benign tumors in 15%, fibrosis in 12%, and autoimmune and vascular diseases in 9%. Definitive diagnosis or treatment changes occurred in 85% of cases. Surgical intervention led to a new diagnosis in 69%, treatment course changes in 68% of benign cases, medication changes in 38%, new consultation in 31%, definitive treatment in 9%, and underlying disease management in 34%. There was no intraoperative, in-hospital, or 30-day mortality. Postoperative in-hospital events occurred in seven patients. The mean total cost was $25,515 with a mean cost per day of $7618. CONCLUSIONS Patients with a benign diagnosis after surgical resection for a pulmonary nodule received a new diagnosis or had a treatment course change in 85% of the cases.
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