The multiple nodules of ground-glass attenuation (GGA nodules) are occasionally detected on helical CT scans in the staging of lung cancer. They include synchronous lung cancer, metastasis, preinvasive lesion (atypical adenomatous hyperplasia [AAH]), and benign condition. The likelihood of a surgical cure and the operation methods for primary non-small cell lung cancer (NSCLC) are strongly dependent upon the local extent of the cancer. Should multiple GGA nodules coexisting with a potentially operable lung cancer be promptly diagnosed by invasive procedures? Our purpose is to answer this question.
We reviewed initial and sequential CT scans of 34 patients with potentially operable lung cancer and multiple coexisting GGA nodules. The range of the follow-up period was one to eight years. Pathological diagnosis was made according to 1999 WHO Classifications. The relationships between pathological diagnosis and HRCT features of coexisting GGA nodules were evaluated. The relationships between HRCT features of primary lung cancer and pathological diagnosis of coexisting GGA nodules were also evaluated.
GGA nodules showed a higher level of opacity and more well-defined margins in malignant lesions (70 and 100%) than in preinvasive lesions or benign condition (16.6% and 25%). Most GGA nodules with a low level of opacity or ill-defined margins showed very slow growth, even if they were primary lung cancers. When the coexisting GGA nodules were diagnosed to be a metastasis, all primary lesions showed soft-tissue density. When primary lesions showed GGA nodule, coexisting GGA nodules were diagnosed to be a primary lung cancer or a benign nodule.
In managing multiple GGA nodules coexisting with a lung cancer, it is very important to evaluate the features of a primary lesion, and the margins and a level of opacity of GGA nodules on HRCT.
We consider that our result is an indicator in managing patients with small pulmonary nodules detected by only CT.
H. Awaya, None.