Lee Geun Dong, Park Chul Hwan, Park Heae Surng, Byun Min Kwang, Lee Ik Jae, Kim Tae Hoon, Lee Sungsoo
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Thorac Cardiovasc Surg. 2019 Jun;67(4):321-328. doi: 10.1055/s-0037-1612615. Epub 2018 Jan 22.
We aimed to identify clinicopathologic characteristics and risk of invasiveness of lung adenocarcinoma in surgically resected pure ground-glass opacity lung nodules (GGNs) smaller than 2 cm.
Among 755 operations for lung cancer or tumors suspicious for lung cancer performed from 2012 to 2016, we retrospectively analyzed 44 surgically resected pure GGNs smaller than 2 cm in diameter on computed tomography (CT).
The study group was composed of 36 patients including 11 men and 25 women with a median age of 59.5 years (range, 34-77). Median follow-up duration of pure GGNs was 6 months (range, 0-63). Median maximum diameter of pure GGNs was 8.5 mm (range, 4-19). Pure GGNs were resected by wedge resection, segmentectomy, or lobectomy in 27 (61.4%), 10 (22.7%), and 7 (15.9%) cases, respectively. Pathologic diagnosis was atypical adenomatous hyperplasia, adenocarcinoma in situ, minimally invasive adenocarcinoma (MIA), or invasive adenocarcinoma (IA) in 1 (2.3%), 18 (40.9%), 15 (34.1%), and 10 (22.7%) cases, respectively. The optimal cutoff value for CT-maximal diameter to predict MIA or IA was 9.1 mm. In multivariate analyses, maximal CT-maximal diameter of GGNs ≥10 mm (odds ratio, 24.050; 95% confidence interval, 2.6-221.908; = 0.005) emerged as significant independent predictor for either MIA or IA. Estimated risks of MIA or IA were 37.2, 59.3, 78.2, and 89.8% at maximal GGN diameters of 5, 10, 15, and 20 mm, respectively.
Pure GGNs were highly associated with lung adenocarcinoma in surgically resected cases, while estimated risk of GGNs invasiveness gradually increased as maximal diameter increased.
我们旨在确定手术切除的直径小于2 cm的纯磨玻璃密度肺结节（GGN）中肺腺癌的临床病理特征及侵袭风险。
在2012年至2016年进行的755例肺癌或疑似肺癌手术中，我们回顾性分析了计算机断层扫描（CT）上直径小于2 cm的44例手术切除的纯GGN。
研究组由36例患者组成，包括11例男性和25例女性，中位年龄为59.5岁（范围34 - 77岁）。纯GGN的中位随访时间为6个月（范围0 - 63个月）。纯GGN的中位最大直径为8.5 mm（范围4 - 19 mm）。分别有27例（61.4%）、10例（22.7%）和7例（15.9%）纯GGN通过楔形切除术、肺段切除术或肺叶切除术切除。病理诊断分别为非典型腺瘤样增生1例（2.3%）、原位腺癌18例（40.9%）、微浸润腺癌（MIA）15例（34.1%）和浸润性腺癌（IA）10例（22.7%）。预测MIA或IA的CT最大直径的最佳截断值为9.1 mm。在多变量分析中，GGN的最大CT最大直径≥10 mm（比值比，24.050；95%置信区间，2.6 - 221.908；P = 0.005）是MIA或IA的显著独立预测因素。在GGN最大直径为5、10、15和20 mm时，MIA或IA的估计风险分别为37.2%、59.3%、78.2%和89.8%。
在手术切除的病例中，纯GGN与肺腺癌高度相关，而GGN的侵袭风险估计随着最大直径的增加而逐渐增加。
