Clinical significance of a solitary ground-glass opacity (GGO) lesion of the lung detected by chest CT

doi:10.1016/j.lungcan.2006.09.009

Lung Cancer

Volume 55, Issue 1, January 2007, Pages 67-73

https://doi.org/10.1016/j.lungcan.2006.09.009 Get rights and content

Summary

Ground-glass opacity (GGO) attracts attention because of the possibility of early lung cancer. However, some lesions are reduced in size or disappear at follow-up. This study was designed to explore the natural history of solitary GGO, to determine the prevalence of malignancy and to identify factors predictive of benignity or malignancy. Solitary and focal GGO lesions [pGGO (p = pure) and mGGO (m = mixed) based on the presence of a solid component] of less than 3 cm were included. Lesions of less than 1 cm were followed up by chest HRCT 3 months later and lesions over 1 cm were investigated by percutaneous needle biopsy (PCNB). One hundred and eighty-six patients (69 pGGO and 117 mGGO) were enrolled. Of the 69 pGGO lesions, 7 were diagnosed as pre-malignant or malignant lesions, 3 as benign lesions and 26 pGGO lesions (37.6%) were reduced or disappeared (transient lesions) at follow-up chest HRCT. The other 33 lesions showed no significant change during follow-up. Thus, the probability of malignancy in pGGO was 7/36 (19.4%). On the other hand, of the 117 mGGO lesions, 26 were found to be malignant, 3 were diagnosed as benign and 57 lesions (48.7%) were reduced or had disappeared at follow-up chest HRCT. The other 31 lesions showed no change during follow-up, and thus the probability of malignancy in mGGO was 26/86 (30.2%). A female sex and a spiculated mGGO border were found to be related with malignancy. However, a high blood eosinophil count was strongly associated with regressing or transient mGGO, suggesting that pulmonary infiltrate with eosinophilia (PIE) might have been responsible. We recommend short-term follow-up by chest HRCT be conducted for mGGO lesions in the presence of high eosinophilia—regardless of lesion size.

Introduction

Recent advances in CT screening have lead to increased focal ground-glass opacity (GGO) detection in the peripheral lung [1], [2]. GGO is a finding on high-resolution CT (HRCT) lung images, and has also been described as haziness with increased lung attenuation and preserved bronchial and vascular margins [3], [4]. These characteristics may be caused by partial filling of air spaces, interstitial thickening, partial collapse of alveoli, normal expiration or increased capillary blood volume [3]. It is known that GGO is a nonspecific finding, and the appearance of a focal area of GGO in thin-section CT images can indicate a variety of disorders, such as, inflammatory disease, pulmonary fibrosis, alveolar hemorrhage or a neoplasm [3], [5]. Recently, several studies on GGO have been published because of the possibility that it represents early lung cancer. Jang et al. reported that focal areas of GGO may indicate early stage bronchioloalveolar carcinoma (BACC)[6], and Kuriyama et al. also found that the presence of a GGO area on a HRCT image is useful for differentiating a small localized BACC from a small adenocarcinoma [7]. It has also been reported that the percentage of GGO area within a solitary nodule is related to prognosis [8], [9], [10], [11].

Current reports on GGO deal with patients that have already been diagnosed as having BACC or atypical adenomatous hyperplasia (AAH). However, the disappearance or regression of a GGO lesion during clinical follow-up is not infrequent, and this encouraged us to investigate the clinical significance of GGO detected by chest CT including HRCT.

This study was designed to further our understanding of the natural history of solitary GGO and to identify predictors of benign or malignant lesions by prospective study.

Section snippets

Patient eligibility

One hundred and eighty-six patients with a solitary GGO of maximum diameter <3 cm on chest CT including HRCT at Seoul National University Bundang Hospital and Seoul National University Hospital between January 2004 and December 2005 were enrolled. The majority of patients were identified by low dose CT screening for lung cancer. Patients with a pure solid nodule (including no GGO within the nodule) or multiple GGOs were excluded. Sixty-four patients still being evaluated by follow-up were

Demographic findings of patients with GGO

One hundred and eighty-six patients with GGO were included from January 2004 to December 2005, and all patients received a follow-up evaluation or definitive treatment after first evaluation. These 186 study subjects comprised 134 men and 52 women. Mean age, mean GGO size and mean follow-up duration were 54 years, 12.7 mm and 8.6 months (1–24 months), respectively (Table 1).

Comparisons of the pGGO and mGGO groups in terms of clinical, radiographic and histologic characteristics

Of the 186 patients with a solitary GGO lesion, 69 had pGGO and 117 mGGO. mGGOs were larger than pGGOs (pGGO: 10.0 ± 5.9 mm

Discussion

Recent advances in CT screening have led to an increase in the detection of focal GGO in the lung that is undetectable by simple chest X-ray [1], [2], [12], and created considerable interest in the relation between GGO and lung cancer. Kakiruma et al. analyzed the progressions of eight pGGO cases diagnosed as lung cancer, and classified these during follow-up into three types: those that increased in size (increasing type, n = 5), decreased in size with the appearance of a solid component

Conclusions

A female gender and a mGGO with a spiculated border were identified as risk factors of GGO lesion malignancy. A significant proportion of GGO lesions were transient or regressed after only 3 months of follow-up. It was found that a high blood eosinophil count, especially in mGGO patients, strongly suggests a benign nature. We recommend that short-term follow-up by chest HRCT rather than by invasive diagnostic workups be adopted for mGGO lesions in the presence of eosinophilia regardless of

Conflict of interest statement

All authors declare that we do not have any actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations within 3 years of beginning the work submitted that could inappropriately influence our work.

Acknowledgement

This study was supported by the second stage Brain Korea 21 Project.

References (23)

M. Kaneko et al.
Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography
Radiology
(1996)
C.I. Henschke et al.
Early Lung Cancer Action Project: overall design and findings from baseline screening
Lancet
(1999)
R. Nagajima et al.
Localized pure ground-glass opacity on high-resolution CT: histologic characteristics
J Comput Assist Tomogr
(2002)
J.H. Austin et al.
Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society
Radiology
(1996)
J. Collins et al.
Ground-glass opacity at CT: the ABCs
Am J Roentgenol
(1997)
H.J. Jang et al.
Bronchioloalveolar carcinoma: focal area of ground-glass attenuation at thin-section CT as an early sign
Radiology
(1996)
K. Kuriyama et al.
Ground-glass opacity on thin-section CT: value in differentiating subtypes of adenocarcinoma of the lung
Am J Roentgenol
(1999)
S. Takashima et al.
High-resolution CT features: prognostic significance in peripheral lung adenocarcinoma with bronchioloalveolar carcinoma components
Respiration
(2003)
K. Shimizu et al.
Surgically curable peripheral lung carcinoma: correlation of thin-section CT findings with histologic prognostic factors and survival
Chest
(2005)
E.A. Kim et al.
Quantification of ground-glass opacity on high-resolution CT of small peripheral adenocarcinoma of the lung: pathologic and prognostic implications
Am J Roentgenol
(2001)

K. Kodama et al.

Prognostic value of ground-glass opacity found in small lung adenocarcinoma on high-resolution CT scanning

Lung Cancer

(2001)

Cited by (130)

Safety and feasibility comparison between three different CT-guided localization techniques under systemic approach algorithm
2024, European Journal of Radiology
In the era of lung cancer screening, more and more sub-centimeter indeterminate lung lesions are being identified. It is difficult to approach these lesions and obtain tissue to confirm diagnosis. CT-guided navigation followed by surgical resection is the best way to overcome this difficulty. The aim of this study is to compare the safety and feasibility of wire and dye-tattoo CT-guided localization techniques.
From September 2019 to August 2021, 418 patients who presented with single lung lesion and received single CT-guided localization were included in this study. Procedure details, navigation results, and related complications were compared.
For patients who received wire localization, majority (98.3 %) had perihilar lesions. In addition, 68 (57.1 %) patients received tangential approach because of lesions were blocked by bony or vital structure, abutting major fissure, or previous approach failure. The characteristics of lesion location was quite different than dye-tattooing technique (p = 0.033). As regards persistence of the target lesion localization, the interval between localization and surgery using ICG tattooing was 829.0 ± 552.9 min; much longer than the other two navigation techniques (p < 0.0001). As regards safety, patients who received wire localization had a higher rate of pneumothorax (p = 0.042) and pulmonary hemorrhage (p < 0.001) than the dye-tattooing techniques.
CT-guided navigation techniques are safe and feasible. Wire localization is suitable for centrally located lesions but the wire needs to be fixed properly and symptomatic pneumothorax monitored for. Dye-tattooing is more suitable for peripheral lesions, while ICG localization persists longer than other techniques.
Subsolid Nodules: Significance and Current Understanding
2024, Clinics in Chest Medicine
Diagnosis and treatment of high-risk bilateral lung ground-glass opacity nodules
2024, Asian Journal of Surgery
In recent years, there has been a significant increase in the detection rate of Ground Glass Opacity (GGO) nodules through high-resolution computed tomography (HRCT). GGO is an imaging finding that encompasses various pathological types, some of which exhibit indolent growth, while others may represent early lung cancer or remain relatively stable, not significantly impacting the surgical treatment outcome. In clinical practice, patients often experience psychological anxiety when multiple pulmonary GGO nodules are present, and they may request simultaneous resection. However, there is currently no standardized criterion for determining when multiple GGO nodules should be resected. As personalized medicine continues to advance, the treatment approach for multiple pulmonary GGO nodules needs to prioritize accuracy. High-risk factors associated with multiple pulmonary GGO nodules may necessitate surgical intervention along with mediastinal lymph node dissection or sampling. This article provides a review of the characteristics, treatment methods, and clinical experiences related to multiple pulmonary GGO nodules, offering practical insights and guidance for healthcare professionals.
Lung Cancer Screening Considerations During Respiratory Infection Outbreaks, Epidemics or Pandemics: An International Association for the Study of Lung Cancer Early Detection and Screening Committee Report
2022, Journal of Thoracic Oncology
After the results of two large, randomized trials, the global implementation of lung cancer screening is of utmost importance. However, coronavirus disease 2019 infections occurring at heightened levels during the current global pandemic and also other respiratory infections can influence scan interpretation and screening safety and uptake. Several respiratory infections can lead to lesions that mimic malignant nodules and other imaging changes suggesting malignancy, leading to an increased level of follow-up procedures or even invasive diagnostic procedures. In periods of increased rates of respiratory infections from severe acute respiratory syndrome coronavirus 2 and others, there is also a risk of transmission of these infections to the health care providers, the screenees, and patients. This became evident with the severe acute respiratory syndrome coronavirus 2 pandemic that led to a temporary global stoppage of lung cancer and other cancer screening programs. Data on the optimal management of these situations are not available. The pandemic is still ongoing and further periods of increased respiratory infections will come, in which practical guidance would be helpful.
The aims of this report were: (1) to summarize the data available for possible false-positive results owing to respiratory infections; (2) to evaluate the safety concerns for screening during times of increased respiratory infections, especially during a regional outbreak or an epidemic or pandemic event; (3) to provide guidance on these situations; and (4) to stimulate research and discussions about these scenarios.
Adenocarcinoma spectrum lesions of the lung: Detection, pathology and treatment strategies
2021, Cancer Treatment Reviews
Citation Excerpt :
Many GGNs are due to inflammation, with others consistent with small patches of fibrosis, infection or haemorrhage [24]. Thirty seven per cent of GGNs will disappear on a 3 month surveillance CT scan [25] but 10% of GGNs will ultimately become invasive cancer [26]. Recent lung cancer screening trials have shed light on the frequency of GGNs in a Western population at high risk of lung cancer.
Adenocarcinoma has become the most prevalent lung cancer sub-type and its frequency is increasing. The earliest stages in the development of lung adenocarcinomas are visible using modern computed tomography (CT) as ground glass nodules. These pre-invasive nodules can progress over time to become invasive lung adenocarcinomas. Lesions in this developmental pathway are termed ‘adenocarcinoma spectrum’ lesions. With the introduction of lung cancer screening programs there has been an increase in the detection of these lesions raising questions about natural history, surveillance and treatment.
Here we review how the radiological appearance of an adenocarcinoma spectrum lesion relates to its underlying pathology and explore the natural history and factors driving lesion progression. We examine the molecular changes that occur at each stage of adenocarcinoma spectrum lesion development, including the effects of the driver mutations, EGFR and KRAS, that are key to invasive adenocarcinoma pathology. A better understanding of the development of pre-invasive disease will create treatment targets. Our understanding of how tumours interact with the immune system has led to the development of new therapeutic strategies. We review the role of the immune system in the development of adenocarcinoma spectrum lesions.
With a clear preinvasive phase there is an opportunity to treat early adenocarcinoma spectrum lesions before an invasive lung cancer develops. We review current management including surveillance, surgical resection and oncological therapy as well as exploring potential future treatment avenues.
Incidental Lung Nodules on Cross-sectional Imaging: Current Reporting and Management
2021, Radiologic Clinics of North America

View all citing articles on Scopus

View full text

Clinical significance of a solitary ground-glass opacity (GGO) lesion of the lung detected by chest CT

Summary

Introduction

Section snippets

Patient eligibility

Demographic findings of patients with GGO

Comparisons of the pGGO and mGGO groups in terms of clinical, radiographic and histologic characteristics

Discussion

Conclusions

Conflict of interest statement

Acknowledgement

Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography

Radiology

Early Lung Cancer Action Project: overall design and findings from baseline screening

Lancet

Localized pure ground-glass opacity on high-resolution CT: histologic characteristics

J Comput Assist Tomogr

Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society

Radiology

Ground-glass opacity at CT: the ABCs

Am J Roentgenol

Bronchioloalveolar carcinoma: focal area of ground-glass attenuation at thin-section CT as an early sign

Radiology

Ground-glass opacity on thin-section CT: value in differentiating subtypes of adenocarcinoma of the lung

Am J Roentgenol

High-resolution CT features: prognostic significance in peripheral lung adenocarcinoma with bronchioloalveolar carcinoma components

Respiration

Surgically curable peripheral lung carcinoma: correlation of thin-section CT findings with histologic prognostic factors and survival

Chest

Quantification of ground-glass opacity on high-resolution CT of small peripheral adenocarcinoma of the lung: pathologic and prognostic implications

Am J Roentgenol

Prognostic value of ground-glass opacity found in small lung adenocarcinoma on high-resolution CT scanning

Lung Cancer