Faber Dan Levy, Agbarya Abed, Lee Andrew, Tsenter Yael, Schneer Sonia, Robitsky Gelis Yulia, Galili Ronen
Department of Cardiothoracic Surgery, Lady Davis Carmel Medical Center, 7 Michal St., Haifa 3436212, Israel.
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel.
Diagnostics (Basel). 2024 Dec 20;14(24):2874. doi: 10.3390/diagnostics14242874.
A ground glass nodule (GGN) is a radiologically descriptive term for a lung parenchymal area with increased attenuation and preserved bronchial and vascular structures. GGNs are further divided into pure versus subsolid lesions. The differential diagnosis for GGNs is wide and contains a malignant possibility for a lung adenocarcinoma precursor or tumor. Clinical and pathological staging of GGNs is based on the lesions' solid component and falls into a specific classification including T0 for TIS, T1mi for minimally invasive adenocarcinoma (MIA) and T1abc for lepidic predominant adenocarcinoma (LPA) according to the eighth edition of the TNM classification of lung cancer. Correlation between solid parts seen on a CT scan and the tumor pathological invasive component is not absolute.
This retrospective study collected the data of 68 GGNs that were operated upon in Carmel Medical Center. A comparison between preoperative clinical staging and post-surgery pathological staging was conducted.
Over a third of the lesions, twenty-four (35.3%), were upstaged while only four (5.9%) lesions were downstaged. Another third of the lesions, twenty-three (33.8%), kept their stage. In three (4.4%) cases, premalignant lesion atypical adenomatous hyperplasia (AAH) was diagnosed. Ten (14.7%) cases were diagnosed as non-malignant on final pathology. These findings show an overall low agreement between the clinical and pathological stages of GGNs.
The relatively high percentage of upstaging tumors detected in this study and the overall safe and short surgical procedure advocate for surgical resection even in the presence of a significant number of non-malignant lesions that retrospectively do not mandate intervention at all.
磨玻璃结节（GGN）是一个放射学术语，用于描述肺实质区域，该区域密度增加但支气管和血管结构保留。GGN进一步分为纯磨玻璃结节与部分实性结节。GGN的鉴别诊断范围广泛，包括肺腺癌前驱病变或肿瘤的恶性可能性。GGN的临床和病理分期基于病变的实性成分，根据第八版肺癌TNM分类，分为TIS的T0期、微浸润腺癌（MIA）的T1mi期和贴壁为主型腺癌（LPA）的T1abc期。CT扫描所见实性部分与肿瘤病理浸润成分之间的相关性并非绝对。
这项回顾性研究收集了卡梅尔医疗中心68例接受手术治疗的GGN数据。对术前临床分期与术后病理分期进行了比较。
超过三分之一的病变（24个，35.3%）分期上调，而只有4个（5.9%）病变分期下调。另有三分之一的病变（23个，33.8%）分期不变。3例（4.4%）诊断为癌前病变非典型腺瘤样增生（AAH）。10例（14.7%）最终病理诊断为非恶性。这些结果表明GGN的临床和病理分期总体一致性较低。
本研究中检测到的分期上调肿瘤比例相对较高，且手术总体安全、操作时间短，这表明即使存在大量回顾性分析认为无需干预的非恶性病变，也主张进行手术切除。
