Objective:To evaluate the relationship between the clinical and imaging features of ground glass opacity(GGO)localized using a preoperative Hook-wire guidewire and postoperative pathology.Method:Preoperative Hook-wire...Objective:To evaluate the relationship between the clinical and imaging features of ground glass opacity(GGO)localized using a preoperative Hook-wire guidewire and postoperative pathology.Method:Preoperative Hook-wire guidewire localization was performed in 83 patients with GGO less than 2 cm,and their clinical data,imaging data,and postoperative pathology findings were retrospectively analyzed.The images were classified as pure GGO(pGGO) or mixed GGO(mGGO).The relationship between clinical and imaging features and postoperative pathology was analyzed.Result:The 83 cases were colocalized,and the success rate of the guidewire positioning was 100%.Complications included pneumothorax(19.2% [16/83]) and the incidence of minor bleeding(30.2 [25/83]).Forty-seven patients had mGGO and 36 had pGGO.Among the 47 cases of mGGO,18(38.3%) were invasive adenocarcinoma(IAC),18(38.3%) were microinvasive adenocarcinoma(MIA),8(17.0%) were adenocarcinoma in situ(AIS),2(4.3%) were atypical adenomatous hyperplasia(AAH),and 1(2.1%) was benign.Among the 36 cases of pGGO,6(16.7%) were IAC,13(36.1%) were MIA,8(22.2%) were AIS,2(5.6%) were AAH,and 7(19.4%) cases were benign lesions.A significantly higher proportion of patients with IAC had mGGO than pGGO(21.7% vs.7.2%,respectively;p=0.004).Among patients with mGGO,a higher proportion of them had a nodule diameter of ≥1 cm than those with a diameter of <1 cm(25.5% vs.12.8%,respectively;p=0.003).There was no significant difference in age,location distribution,or pathological type.Conclusion: Preoperative CT-guided Hook-wire guidewire positioning was safe with minor complications.A significantly higher proportion of patients with IAC had mGGO than pGGO.Patients with mGGO and a nodule diameter ≥1 cm require active treatment.展开更多
BACKGROUND The clinical role of ground glass opacity(GGO)on computed tomography(CT)in stage I pulmonary adenocarcinoma patients currently remains unclear.AIM To explore the prognostic value of GGO on CT in lung adenoc...BACKGROUND The clinical role of ground glass opacity(GGO)on computed tomography(CT)in stage I pulmonary adenocarcinoma patients currently remains unclear.AIM To explore the prognostic value of GGO on CT in lung adenocarcinoma patients who were pathologically diagnosed with tumor-node-metastasis stage I.METHODS A comprehensive and systematic search was conducted through the PubMed,EMBASE and Web of Science databases up to April 3,2021.The hazard ratio(HR)and corresponding 95%confidence interval(CI)were combined to assess the association between the presence of GGO and prognosis,representing overall survival and disease-free survival.Subgroup analysis based on the ratio of GGO was also conducted.STATA 12.0 software was used for statistical analysis.RESULTS A total of 12 studies involving 4467 patients were included.The pooled results indicated that the GGO predicted favorable overall survival(HR=0.44,95%CI:0.34-0.59,P<0.001)and disease-free survival(HR=0.35,95%CI:0.18-0.70,P=0.003).Subgroup analysis based on the ratio of GGO further demonstrated that the proportion of GGO was a good prognostic indicator in pathological stage I pulmonary adenocarcinoma patients,and patients with a higher ratio of GGO showed better prognosis than patients with a lower GGO ratio did.CONCLUSION This meta-analysis manifested that the presence of GGO on CT predicted favorable prognosis in tumor-node-metastasis stage I lung adenocarcinoma.Patients with a higher GGO ratio were more likely to have a better prognosis than patients with a lower GGO ratio.展开更多
Objective:Pulmonary ground glass opacity(GGO)nodules represent a significant dilemma in oncology since its diagnosis in clinical practice has increased because of growing application of low dose computed tomography an...Objective:Pulmonary ground glass opacity(GGO)nodules represent a significant dilemma in oncology since its diagnosis in clinical practice has increased because of growing application of low dose computed tomography and screening program.The aim of this study is to analyze the clinical and pathological features,the overall survival(OS)and disease-free interval(DFI)in surgically resected solitary ground glass nodules in order to assess the surgical treatment of choice.Methods:We retrospectively analyzed 49 patients(M/F=25/24)with a mean age of 67.7(range,40-81)years who underwent lung resection for solitary GGO nodules among 570 reviewed CT of patients who were treated for lung neoplasms between 2010 and 2016.The cohort included 22 pure GGO nodules and 27 part solid GGOs(also called mixed GGOs).Results:Median maximum diameter of GGOs,defined as the largest axial diameter of the lesion on the lung-window setting,was 17(range,5-30)mm.GGO nodules were removed by wedge resection,segmentectomy,or lobectomy in 17(35%),9(18%),and 23(47%)cases,respectively.Pathologic diagnosis was atypical adenomatous hyperplasia(AAH),adenocarcinoma in situ(AIS),minimally invasive adenocarcinoma(MIA),invasive adenocarcinoma(IA)or multifocal adenocarcinoma(MAC)in 4(8.2%),9(18.4%),11(22.4%),22(44.9%)and 3(6.1%)cases,respectively.With a median follow up of 47 months the OS and DFI of the entire cohort was 46.3 and 43 months,respectively.The histotype(P=0.008),the dimension of GGO(P=0.014)and the PET-SUV max(P=0.001)were independent prognostic factors of worse survival.Sex,age,previous lung surgery,type of surgical resection and the mediastinal lymph-node evaluation did not impact on OS and DFI.Analyzing the 22 pure GGO nodules,we found a 3-year OS and DFI of 98%and 100%respectively,significantly different from 80%and 75%respectively of part-solid GGOs(log-rank P=0.043 and P=0.011).Conclusion:Our data suggest an indolent behaviour of tumour presenting as solitary GGO nodules,especially in case of pure GGOs.In our series wedge resections guarantee the same results in terms of OS and DFI when compared to lobectomies.Sublobar resections without mediastinal lymph-nodes evaluation represent the treatment of choice for pure-GGO.More studies are needed to assess its role for part-solid GGO nodules.展开更多
Background:To explore the effect of scattered or eccentric shaped types of ground glass opacity(GGO)on outcomes of patients with solid-dominant peripheral lung adenocarcinoma.Methods:We evaluated patients with solid-d...Background:To explore the effect of scattered or eccentric shaped types of ground glass opacity(GGO)on outcomes of patients with solid-dominant peripheral lung adenocarcinoma.Methods:We evaluated patients with solid-dominant peripheral lung adenocarcinoma,who underwent radical surgery at Zhongshan Hospital,Fudan University,between January 2013 and December 2015.Morphologically heterogeneous solid-dominant lung adenocarcinoma in imaging findings was based on the last preoperative computed tomography(CT)scans.Endpoints were recurrence-free survival(RFS)and overall survival(OS).Kaplan-Meier analysis and the log-rank test were used to estimate survival differences.Impact factors were assessed by univariable logistic regression analysis.Results:We retrospectively collected data from 200 patients,including 170 patients with central island-shaped CT imaging,18 patients with scattered shaped CT imaging,and 12 patients with eccentric shaped CT imaging.Eleven patients experienced recurrence or metastases.Kaplan-Meier survival curves showed significant survival differences between the central island-shaped type and scattered shaped or eccentric shaped type for OS(c-stage IA:5-year OS:100%vs.92.1%;HR=0.019,p=0.0025;p-stage IA:100%vs.95.2%;HR=0.146,p=0.1139)and RFS(c-stage IA:5-year RFS:100%vs.59.7%;HR=0.001,p<0.0001;p-stage IA:100%vs.64.5%;HR<0.001,p<0.0001).Univariable logistic regression analysis showed that scattered and eccentric shaped types were related to poor outcomes(p<0.012,odds ratio=18.8)。Conclusions:Relative spatial position of GGO and solid components may affect patient outcomes.Patients with scattered or eccentric shaped GGO may have a poor prognosis.展开更多
This study examined the value of volume rendering （VR） interpretation in assessing the growth of pulmonary nodular ground-glass opacity （nGGO）. A total of 47 nGGOs （average size, 9.5 mm; range, 5.7-20.6 mm） were...This study examined the value of volume rendering （VR） interpretation in assessing the growth of pulmonary nodular ground-glass opacity （nGGO）. A total of 47 nGGOs （average size, 9.5 mm; range, 5.7-20.6 mm） were observed by CT scanning at different time under identical parameter settings. The growth of nGGO was analyzed by three radiologists by comparing the thin slice （TS） CT images of initial and repeat scans with side-by-side cine mode. One week later synchronized VR images of the two scans were compared by side-by-side cine mode to evaluate the nGGO growth. The nodule growth was rated on a 5-degree scale： notable growth, slight growth, dubious growth, stagnant growth, shrinkage. Growth standard was defined as： Density increase 〉 30 HU and （or） diameter increase （by 20% in nodules 〉_10 mm, 30% in nodules of 5-9 mm）. Receiver operating characteristic （ROC） was performed. The results showed that 32 nGGOs met the growth criteria （29 nGGOs showed an increase in density; 1 nGGO showed an increase in diameter; 2 nGGOs showed an increase in both diameter and density）. Area under ROC curve revealed that the performance with VR interpretation was better than that with TS interpretation （P〈0.01, P〈0.05 and P〈0.05 for observers A, B and C respectively）. Consistency between different observers was excellent with both VR interpretation （κ=0.89 for observers A＆C A＆B, B＆C） and TS interpretation （κ=0.71 for A＆B, κ=0.68 for A＆C, κ=0.74 for B＆C）, but time spending was less with VR interpretation than with TS interpretation （P〈0.0001, P〈0.0001 and P〈0.05 for observers A, B and C, respectively）. It was concluded that VR is a useful technique for evaluating the growth of nGGO.展开更多
文摘Objective:To evaluate the relationship between the clinical and imaging features of ground glass opacity(GGO)localized using a preoperative Hook-wire guidewire and postoperative pathology.Method:Preoperative Hook-wire guidewire localization was performed in 83 patients with GGO less than 2 cm,and their clinical data,imaging data,and postoperative pathology findings were retrospectively analyzed.The images were classified as pure GGO(pGGO) or mixed GGO(mGGO).The relationship between clinical and imaging features and postoperative pathology was analyzed.Result:The 83 cases were colocalized,and the success rate of the guidewire positioning was 100%.Complications included pneumothorax(19.2% [16/83]) and the incidence of minor bleeding(30.2 [25/83]).Forty-seven patients had mGGO and 36 had pGGO.Among the 47 cases of mGGO,18(38.3%) were invasive adenocarcinoma(IAC),18(38.3%) were microinvasive adenocarcinoma(MIA),8(17.0%) were adenocarcinoma in situ(AIS),2(4.3%) were atypical adenomatous hyperplasia(AAH),and 1(2.1%) was benign.Among the 36 cases of pGGO,6(16.7%) were IAC,13(36.1%) were MIA,8(22.2%) were AIS,2(5.6%) were AAH,and 7(19.4%) cases were benign lesions.A significantly higher proportion of patients with IAC had mGGO than pGGO(21.7% vs.7.2%,respectively;p=0.004).Among patients with mGGO,a higher proportion of them had a nodule diameter of ≥1 cm than those with a diameter of <1 cm(25.5% vs.12.8%,respectively;p=0.003).There was no significant difference in age,location distribution,or pathological type.Conclusion: Preoperative CT-guided Hook-wire guidewire positioning was safe with minor complications.A significantly higher proportion of patients with IAC had mGGO than pGGO.Patients with mGGO and a nodule diameter ≥1 cm require active treatment.
文摘BACKGROUND The clinical role of ground glass opacity(GGO)on computed tomography(CT)in stage I pulmonary adenocarcinoma patients currently remains unclear.AIM To explore the prognostic value of GGO on CT in lung adenocarcinoma patients who were pathologically diagnosed with tumor-node-metastasis stage I.METHODS A comprehensive and systematic search was conducted through the PubMed,EMBASE and Web of Science databases up to April 3,2021.The hazard ratio(HR)and corresponding 95%confidence interval(CI)were combined to assess the association between the presence of GGO and prognosis,representing overall survival and disease-free survival.Subgroup analysis based on the ratio of GGO was also conducted.STATA 12.0 software was used for statistical analysis.RESULTS A total of 12 studies involving 4467 patients were included.The pooled results indicated that the GGO predicted favorable overall survival(HR=0.44,95%CI:0.34-0.59,P<0.001)and disease-free survival(HR=0.35,95%CI:0.18-0.70,P=0.003).Subgroup analysis based on the ratio of GGO further demonstrated that the proportion of GGO was a good prognostic indicator in pathological stage I pulmonary adenocarcinoma patients,and patients with a higher ratio of GGO showed better prognosis than patients with a lower GGO ratio did.CONCLUSION This meta-analysis manifested that the presence of GGO on CT predicted favorable prognosis in tumor-node-metastasis stage I lung adenocarcinoma.Patients with a higher GGO ratio were more likely to have a better prognosis than patients with a lower GGO ratio.
文摘Objective:Pulmonary ground glass opacity(GGO)nodules represent a significant dilemma in oncology since its diagnosis in clinical practice has increased because of growing application of low dose computed tomography and screening program.The aim of this study is to analyze the clinical and pathological features,the overall survival(OS)and disease-free interval(DFI)in surgically resected solitary ground glass nodules in order to assess the surgical treatment of choice.Methods:We retrospectively analyzed 49 patients(M/F=25/24)with a mean age of 67.7(range,40-81)years who underwent lung resection for solitary GGO nodules among 570 reviewed CT of patients who were treated for lung neoplasms between 2010 and 2016.The cohort included 22 pure GGO nodules and 27 part solid GGOs(also called mixed GGOs).Results:Median maximum diameter of GGOs,defined as the largest axial diameter of the lesion on the lung-window setting,was 17(range,5-30)mm.GGO nodules were removed by wedge resection,segmentectomy,or lobectomy in 17(35%),9(18%),and 23(47%)cases,respectively.Pathologic diagnosis was atypical adenomatous hyperplasia(AAH),adenocarcinoma in situ(AIS),minimally invasive adenocarcinoma(MIA),invasive adenocarcinoma(IA)or multifocal adenocarcinoma(MAC)in 4(8.2%),9(18.4%),11(22.4%),22(44.9%)and 3(6.1%)cases,respectively.With a median follow up of 47 months the OS and DFI of the entire cohort was 46.3 and 43 months,respectively.The histotype(P=0.008),the dimension of GGO(P=0.014)and the PET-SUV max(P=0.001)were independent prognostic factors of worse survival.Sex,age,previous lung surgery,type of surgical resection and the mediastinal lymph-node evaluation did not impact on OS and DFI.Analyzing the 22 pure GGO nodules,we found a 3-year OS and DFI of 98%and 100%respectively,significantly different from 80%and 75%respectively of part-solid GGOs(log-rank P=0.043 and P=0.011).Conclusion:Our data suggest an indolent behaviour of tumour presenting as solitary GGO nodules,especially in case of pure GGOs.In our series wedge resections guarantee the same results in terms of OS and DFI when compared to lobectomies.Sublobar resections without mediastinal lymph-nodes evaluation represent the treatment of choice for pure-GGO.More studies are needed to assess its role for part-solid GGO nodules.
基金Shanghai Medical Innovation Research Project,Grant/Award Number:20Y11908200the institutional review board of Zhongshan Hospital,Fudan University(B2018-137R,July 27,2018).
文摘Background:To explore the effect of scattered or eccentric shaped types of ground glass opacity(GGO)on outcomes of patients with solid-dominant peripheral lung adenocarcinoma.Methods:We evaluated patients with solid-dominant peripheral lung adenocarcinoma,who underwent radical surgery at Zhongshan Hospital,Fudan University,between January 2013 and December 2015.Morphologically heterogeneous solid-dominant lung adenocarcinoma in imaging findings was based on the last preoperative computed tomography(CT)scans.Endpoints were recurrence-free survival(RFS)and overall survival(OS).Kaplan-Meier analysis and the log-rank test were used to estimate survival differences.Impact factors were assessed by univariable logistic regression analysis.Results:We retrospectively collected data from 200 patients,including 170 patients with central island-shaped CT imaging,18 patients with scattered shaped CT imaging,and 12 patients with eccentric shaped CT imaging.Eleven patients experienced recurrence or metastases.Kaplan-Meier survival curves showed significant survival differences between the central island-shaped type and scattered shaped or eccentric shaped type for OS(c-stage IA:5-year OS:100%vs.92.1%;HR=0.019,p=0.0025;p-stage IA:100%vs.95.2%;HR=0.146,p=0.1139)and RFS(c-stage IA:5-year RFS:100%vs.59.7%;HR=0.001,p<0.0001;p-stage IA:100%vs.64.5%;HR<0.001,p<0.0001).Univariable logistic regression analysis showed that scattered and eccentric shaped types were related to poor outcomes(p<0.012,odds ratio=18.8)。Conclusions:Relative spatial position of GGO and solid components may affect patient outcomes.Patients with scattered or eccentric shaped GGO may have a poor prognosis.
基金supported by a grant from the Science and Technology Program of Guangdong Province of China(No.2009B030801120)
文摘This study examined the value of volume rendering （VR） interpretation in assessing the growth of pulmonary nodular ground-glass opacity （nGGO）. A total of 47 nGGOs （average size, 9.5 mm; range, 5.7-20.6 mm） were observed by CT scanning at different time under identical parameter settings. The growth of nGGO was analyzed by three radiologists by comparing the thin slice （TS） CT images of initial and repeat scans with side-by-side cine mode. One week later synchronized VR images of the two scans were compared by side-by-side cine mode to evaluate the nGGO growth. The nodule growth was rated on a 5-degree scale： notable growth, slight growth, dubious growth, stagnant growth, shrinkage. Growth standard was defined as： Density increase 〉 30 HU and （or） diameter increase （by 20% in nodules 〉_10 mm, 30% in nodules of 5-9 mm）. Receiver operating characteristic （ROC） was performed. The results showed that 32 nGGOs met the growth criteria （29 nGGOs showed an increase in density; 1 nGGO showed an increase in diameter; 2 nGGOs showed an increase in both diameter and density）. Area under ROC curve revealed that the performance with VR interpretation was better than that with TS interpretation （P〈0.01, P〈0.05 and P〈0.05 for observers A, B and C respectively）. Consistency between different observers was excellent with both VR interpretation （κ=0.89 for observers A＆C A＆B, B＆C） and TS interpretation （κ=0.71 for A＆B, κ=0.68 for A＆C, κ=0.74 for B＆C）, but time spending was less with VR interpretation than with TS interpretation （P〈0.0001, P〈0.0001 and P〈0.05 for observers A, B and C, respectively）. It was concluded that VR is a useful technique for evaluating the growth of nGGO.
