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So Hyeon Bak, MD; Ho Yun Lee, MD
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FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

CORRESPONDENCE TO: Ho Yun Lee, MD, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea


Copyright 2016, . All Rights Reserved.


Chest. 2016;149(6):1587-1588. doi:10.1016/j.chest.2016.04.005
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We would like to thank to Drs Tamura and Satoh for their interest regarding our study on quantitative CT analysis of pure ground-glass opacity nodules to predict further CT change. We are grateful for their questions, for which our responses are listed as follows.

We included three histological types of adenocarcinoma in situ, minimally invasive adenocarcinoma, and invasive adenocarcinoma. Thus, ground-glass opacity nodules of interest to us were classified into three pathological types upon examination of the resected tumor, which is based on the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society international multidisciplinary classification system.

In our study, tumors were divided into three subregions of former bronchioloalveolar carcinoma (BAC) component, non-BAC component, and central fibrosis component. Regarding their question about the definition of solid component, the solid component region (non-BAC region) was defined as the areas of the tumor; the tumor (1) contains an invasive component; (2) invades lymphatics, blood vessels, or pleura; or (3) contains tumor necrosis., In addition, the former BAC region was defined as the area of lepidic growth without invasion of stroma, blood vessels, or pleural.

The concept of an adenocarcinoma sequence of the lung is that atypical adenomatous hyperplasia would progress to lepidic growth without central collapse or fibrotic regions and then to lepidic growth with central fibrotic foci. The central fibrosis is defined as the areas of fibroblastic focus in which a moderate or abundant amount of collagen or hyalinized tissue is clearly noted. Regarding the central fibrosis, fibrous areas were not located always exactly in the epicenter of the tumor; however, there was no case in which the fibrous area was located the periphery of the tumor at all. Central fibrosis is a term used in the customary pathology. As previously reported, the position of central fibrosis was analyzed with sections that included the largest cut of tumor tissue.

References

Bak S.H. .Lee H.Y. .Kim J.H. .et al Quantitative CT scanning analysis of pure ground-glass opacity nodules predicts further CT scanning change. Chest. 2016;149:180-191 [PubMed]journal. [CrossRef] [PubMed]
 
Lee H.Y. .Choi Y.L. .Lee K.S. .et al Pure ground-glass opacity neoplastic lung nodules: histopathology, imaging, and management. AJR Am J Roentgenol. 2014;202:W224-W233 [PubMed]journal. [CrossRef] [PubMed]
 
Lee H.Y. .Han J. .Lee K.S. .et al Lung adenocarcinoma as a solitary pulmonary nodule: prognostic determinants of CT, PET, and histopathologic findings. Lung Cancer (Amsterdam, Netherlands). 2009;66:379-385 [PubMed]journal. [CrossRef] [PubMed]
 
Suzuki K. .Yokose T. .Yoshida J. .et al Prognostic significance of the size of central fibrosis in peripheral adenocarcinoma of the lung. Ann Thorac Surg. 2000;69:893-897 [PubMed]journal. [CrossRef] [PubMed]
 
Lee H.Y. .Jeong J.Y. .Lee K.S. .et al Solitary pulmonary nodular lung adenocarcinoma: correlation of histopathologic scoring and patient survival with imaging biomarkers. Radiology. 2012;264:884-893 [PubMed]journal. [CrossRef] [PubMed]
 

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References

Bak S.H. .Lee H.Y. .Kim J.H. .et al Quantitative CT scanning analysis of pure ground-glass opacity nodules predicts further CT scanning change. Chest. 2016;149:180-191 [PubMed]journal. [CrossRef] [PubMed]
 
Lee H.Y. .Choi Y.L. .Lee K.S. .et al Pure ground-glass opacity neoplastic lung nodules: histopathology, imaging, and management. AJR Am J Roentgenol. 2014;202:W224-W233 [PubMed]journal. [CrossRef] [PubMed]
 
Lee H.Y. .Han J. .Lee K.S. .et al Lung adenocarcinoma as a solitary pulmonary nodule: prognostic determinants of CT, PET, and histopathologic findings. Lung Cancer (Amsterdam, Netherlands). 2009;66:379-385 [PubMed]journal. [CrossRef] [PubMed]
 
Suzuki K. .Yokose T. .Yoshida J. .et al Prognostic significance of the size of central fibrosis in peripheral adenocarcinoma of the lung. Ann Thorac Surg. 2000;69:893-897 [PubMed]journal. [CrossRef] [PubMed]
 
Lee H.Y. .Jeong J.Y. .Lee K.S. .et al Solitary pulmonary nodular lung adenocarcinoma: correlation of histopathologic scoring and patient survival with imaging biomarkers. Radiology. 2012;264:884-893 [PubMed]journal. [CrossRef] [PubMed]
 
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