Abstract
BackgroundLung tumors showing ground-glass opacities on high-resolution computed tomography indicate the presence of inflammation, atypical adenomatous hyperplasia, or localized bronchioloalveolar carcinoma. We adopted a two-staged video-assisted thoracoscopic lobectomy strategy involving completion lobectomy for localized bronchioloalveolar carcinoma with an invasive component according to postoperative pathological examination by permanent section after partial resection.MethodsForty-one patients with undiagnosed small peripheral ground-glass opacity lesions underwent partial resection from 2001 to 2007 in Hokkaido University Hospital. Localized bronchioloalveolar carcinoma was classified according to the Noguchi classification for adenocarcinoma. Malignant lesions other than Noguchi types A and B were considered for completion lobectomy and systemic mediastinal lymphadenectomy. Perioperative data of completion video-assisted thoracoscopic lobectomies were compared with data of 67 upfront video-assisted thoracoscopic lobectomies for clinical stage IA adenocarcinoma performed during the same period.ResultsPostoperative pathological examination revealed 35 malignant and 6 non-malignant diseases. Histologically, all of the malignant diseases were adenocarcinomas of Noguchi type A (n = 7), B (n = 9), C (n = 18), and F (n = 1). Eleven of 19 patients (58%) with Noguchi type C or F underwent two-staged video-assisted thoracoscopic lobectomy. Three patients refused a second surgery. There was no cancer recurrence. The two-staged lobectomy group had a significantly longer operative time and more blood loss than the upfront lobectomy group. There was no surgical mortality or cancer recurrence.ConclusionsTwo-staged lobectomy for undiagnosed small peripheral ground-glass opacity lesions showed satisfactory oncological results. However, low compliance for and invasiveness of the second surgery are concerns associated with this strategy.
Highlights
Lung tumors showing ground-glass opacities on high-resolution computed tomography indicate the presence of inflammation, atypical adenomatous hyperplasia, or localized bronchioloalveolar carcinoma
Aoki et al reported that most Noguchi type A or B adenocarcinomas showed localized ground-glass opacities (GGO) on high-resolution computed tomography (HRCT), and that most Noguchi type C adenocarcinomas showed partial GGO mixed with localized solid attenuation [2]
Patients who were diagnosed with adenocarcinoma other than Noguchi type A or B or with cancers of other histologic types underwent two-staged lobectomy if the patient met the medical criteria for lobectomy and agreed to the second surgery
Summary
Lung tumors showing ground-glass opacities on high-resolution computed tomography indicate the presence of inflammation, atypical adenomatous hyperplasia, or localized bronchioloalveolar carcinoma. Noguchi type C adenocarcinoma, which is LBAC with foci of active fibroblastic proliferation, has the potential for lymph node metastasis and has a 5-year survival rate of 75%. Noguchi type was subsequently reported to be associated with radiological findings on high-resolution computed tomography (HRCT) imaging [2,3,4]. Most cases of bronchioloalveolar carcinoma (BAC), such as Noguchi types A, B, and C, have radiological findings of ground-glass opacities (GGO) on HRCT. Aoki et al reported that most Noguchi type A or B adenocarcinomas showed localized GGO on HRCT, and that most Noguchi type C adenocarcinomas showed partial GGO mixed with localized solid attenuation [2]. Tumors that comprise a larger GGO component on HRCT, especially tumors with pure GGO, are likely to be Noguchi type A or B adenocarcinoma
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
