Department of Thoracic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.
J Thorac Oncol. 2010 Apr;5(4):546-50. doi: 10.1097/JTO.0b013e3181d0a480.
In our limited resection trial of pulmonary peripheral ground-glass opacity (GGO) lesions from 1998 to 2002, limited resection of Noguchi type A and B carcinomas seemed to have a positive outcome. However, recently three of the 24 patients, with mixed GGO lesions intraoperatively diagnosed as type B, developed a solid lesion at the cut-end scar.
Medical records and radiology and pathology findings of the three patients were reviewed. We also analyzed epidermal growth factor receptor gene mutations when possible.
Radiologically, these three second tumors were clearly cut-end scar area recurrences. However, other pathologic and mutation findings suggest metachronous primary cancers developed in Case 1, cut-end recurrence in Case 2, and needle biopsy implantation in Case 3. It is difficult to definitively conclude whether the second tumors were recurrences or metachronous primaries.
These second tumors have convinced us that our initial caution in concluding GGO lesions can be cured by limited resection was very appropriate. The recurrences definitely indicate that continuing follow-up attention for more than 5 years is needed after limited resection even for GGO bronchioloalveolar carcinomas.
在我们 1998 年至 2002 年进行的肺部周围磨玻璃密度（GGO）病变的局限性切除试验中，Noguchi 型 A 和 B 癌的局限性切除似乎有良好的结果。然而，最近在 24 名患者中有 3 名，术中诊断为 B 型的混合性 GGO 病变，在切端疤痕处出现实性病变。
回顾了这 3 名患者的病历和放射学及病理学发现。如果可能，我们还分析了表皮生长因子受体基因突变情况。
影像学上，这三个第二肿瘤均为明确的切端疤痕区复发。然而，其他的病理和突变发现提示，在病例 1 中为异时性原发性癌症，病例 2 为切端复发，病例 3 为针吸活检植入。难以明确结论这些第二肿瘤是复发还是异时性原发性。
这些第二肿瘤使我们确信，我们最初对局限性切除可以治愈 GGO 病变的谨慎态度是非常恰当的。这些复发肯定表明，即使是 GGO 细支气管肺泡癌，局限性切除后也需要 5 年以上的持续随访关注。
