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Correspondence |

The Value of CT Scan-Guided Biopsy in Evaluation of Ground-Glass OpacityCT Scan-Guided Biopsy in Ground-Glass Opacity FREE TO VIEW

Qinghuan Liu, MD; Wenjie Liang, MD
Author and Funding Information

From the Department of Emergent Surgery (Dr Liu), Linyi People’s Hospital; and Department of Radiology (Dr Liang), The First Affiliated Hospital, Zhejiang University School of Medicine.

Correspondence to: Wenjie Liang, MD, Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou City, Zhejiang Province, China 310003; e-mail: baduen.c@163.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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Chest. 2013;143(2):577. doi:10.1378/chest.12-1950
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To the Editor:

We read with interest the article by Dr Chang and colleagues1 in CHEST (January 2013) about the management of ground-glass opacities (GGOs). Their data indicate that the strategy of long-term follow-up and selective surgery was appropriate. However, we do not entirely agree with their ideas. We offer a third choice of CT scan-guided biopsy to solve the long-standing issue.

Previous studies have shown that a solid component of GGOs is a remarkable characteristic of malignancy.2,3 However, it is difficult to identify GGOs without a solid component. We congratulate the authors for the diagnosis of 11 cases of malignant GGOs, but was there other malignant neoplasm in the remaining follow-ups? Other investigators have reported that the malignancy rate of GGOs without a solid component is 18%.3 It should be noted that the rate of malignant GGOs in the study by Chang et al1 was only 10% (11 of 122).

In the evaluation of GGOs, benign lesions usually resolved partially or completely by CT scan recheck 3 months later.4 In our practice, when the nature of GGOs, especially those with a relatively large size, is still uncertain at 3 months, CT scan-guided biopsy is recommended to patients. In our experience, the success rate of biopsy is relatively high when the diameter of a GGO is >7 mm. Our biopsy cases all produced pathologic results, which were consistent with the subsequent results of surgical specimens. All these cases were adenocarcinoma or bronchioloalveolar carcinoma. In a study by Kim et al,5 CT scan-guided biopsy was also reported as effective in giving value to the nature of GGO, with a sensitivity of 93% and an accuracy of 91%. Therefore, we recommend that after a short-term follow-up, CT scan-guided biopsy be given as a choice for the evaluation of GGO with a relatively large diameter.

Chang B, Hwang JH, Choi Y-H, et al Natural history of pure ground-glass opacity lung nodules detected by low-dose CT scan. Chest. 2013;143(1):172-178
 
Nakata M, Saeki H, Takata I, et al Focal ground-glass opacity detected by low-dose helical CT. Chest. 2002;121(5):1464-1467. [CrossRef] [PubMed]
 
Henschke CI, Yankelevitz DF, Mirtcheva R, McGuinness G, McCauley D, Miettinen OS; ELCAP Group CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol. 2002;178(5):1053-1057. [PubMed]
 
Li F, Sone S, Abe H, Macmahon H, Doi K Malignant versus benign nodules at CT screening for lung cancer: comparison of thin-section CT findings. Radiology. 2004;233(3):793-798. [CrossRef] [PubMed]
 
Kim TJ, Lee JH, Lee CT, et al Diagnostic accuracy of CT-guided core biopsy of ground-glass opacity pulmonary lesions. AJR Am J Roentgenol. 2008;190(1):234-239. [CrossRef] [PubMed]
 

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References

Chang B, Hwang JH, Choi Y-H, et al Natural history of pure ground-glass opacity lung nodules detected by low-dose CT scan. Chest. 2013;143(1):172-178
 
Nakata M, Saeki H, Takata I, et al Focal ground-glass opacity detected by low-dose helical CT. Chest. 2002;121(5):1464-1467. [CrossRef] [PubMed]
 
Henschke CI, Yankelevitz DF, Mirtcheva R, McGuinness G, McCauley D, Miettinen OS; ELCAP Group CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol. 2002;178(5):1053-1057. [PubMed]
 
Li F, Sone S, Abe H, Macmahon H, Doi K Malignant versus benign nodules at CT screening for lung cancer: comparison of thin-section CT findings. Radiology. 2004;233(3):793-798. [CrossRef] [PubMed]
 
Kim TJ, Lee JH, Lee CT, et al Diagnostic accuracy of CT-guided core biopsy of ground-glass opacity pulmonary lesions. AJR Am J Roentgenol. 2008;190(1):234-239. [CrossRef] [PubMed]
 
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