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Experience With Surgical Intervention for Screening-Detected Lung Cancer* FREE TO VIEW

Masahiro Tsuboi, MD; Norihiko Ikeda, MD; Harubumi Kato, MD, FCCP
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*From Tokyo Medical University, Tokyo, Japan.

Correspondence to: Mashahiro Tsuboi, MD, Department of Thoracic Surgery, Tokyo Medical University, 6–7–1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan 160-0023

Chest. 2004;125(5_suppl):167S. doi:10.1378/chest.125.5_suppl.167S
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In Japan, a lung cancer screening program using high-resolution CT (HRCT) has been employed for approximately 10 years. In the past decade, the detection of peripheral tumors < 2 cm in size has increased significantly because of CT examinations. In order to clarify the efficacy of the surgical intervention for screening-detected lung cancer, the surgical experiences in Tokyo Medical University were retrospectively analyzed.

Seven hundred eighty-three patients with lung cancer were treated surgically in our hospital during the past 5 years. Among them were 150 patients with peripheral nodules < 2 cm in diameter; of these 150 patients, 135 nodules were adenocarcinoma. Lobectomies were performed in 93 patients, and limited resections including video-assisted thoracoscopic surgery were performed in 42 patients; 2.5% of the patients with tumors < 1 cm in diameter had already showed N2 disease. In the patients with nodules between 1 cm and 1.5 cm and between 1.5 cm and 2 cm, lymph node involvement was recognized in 8.1% and 12%, respectively. In 16 patients who showed 100% ground-glass attenuation (GGA) and 21 patients who had between 50% and 100% GGA, there was no lymph node metastasis. In the patients with no GGA findings, the presence of lymph node metastases was not related to the size of the tumor. Five-year survival rate in the tumors < 1 cm, between 1 cm and 1.5 cm, and between 1.5 cm and 2 cm were 100%, 86.5%, and 92.4%, respectively. In the patients expressing > 50% GGA, a 100% 5-year survival rate was obtained; the patients showing < 50% GGA had 91.1% 5-year survival rate. In terms of surgical procedures, the 5-year survival rate was 100% in limited operation and 91.5% in lobectomy.

The most important factor of “noninvasive cancer” in terms of HRCT image is not “tumor size” but the ratio of GGA findings within the HRCT image. Although there are still controversies regarding limited surgical resection for lung cancer, GGA findings on HRCT images may indicate the suitability of surgical partial resection by video-assisted thoracoscopic surgery. Lesions consisting entirely or between 50% and 100% of GGA could be indications for partial resection in cases with tumors < 2 cm in diameter. Preoperative definitive cytologic diagnosis of the GGA lesion is important. The establishment of definition for early stage lung cancer is necessary, and restriction of surgical intervention for cases earlier than stage IA might be desirable.

Abbreviations: GGA = ground-glass attenuation; HRCT = high-resolution CT




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