Preoperative flexible bronchoscopy in patients with persistent ground-glass nodule.

Byung Woo Jhun,Joungho Han,Hojoong Kim,Sang-Won Um,Man Pyo Chung,Jhingook Kim,Gee Young Suh,O Jung Kwon,Kyung Soo Lee,Luis Seijo

doi:10.1371/journal.pone.0121250

Byung Woo Jhun, Joungho Han + Show 8 more

Open Access

https://doi.org/10.1371/journal.pone.0121250

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Journal: PloS one	Publication Date: Mar 24, 2015
Citations: 8	License type: CC BY 4.0

Affiliation: Samsung Medical Center, Sungkyunkwan University

Abstract

There are no accurate data on the diagnostic value of preoperative flexible bronchoscopy (FB) for persistent ground-glass nodule (GGN) of the lung. We evaluated the value of preoperative FB in patients with suspected GGN-type lung cancer. We retrospectively searched a database for subjects who had ‘ground-glass opacity’, ‘non-solid nodule’, ‘part-solid nodule’, or ‘sub-solid nodule’ on chest computed tomography reports between February 2004 and March 2012. Patients who had infiltrative ground-glass opacity lesions, mediastinal lymphadenopathy, or pleural effusion, focal ground-glass opacity lesions >3 cm, and were lost to follow-up were excluded. We assessed the diagnostic value of preoperative FB in patients with persistent GGNs who underwent surgical resection. In total, 296 GGNs were evaluated by FB in 264 patients with persistent GGNs who underwent preoperative FB and surgical resection. The median size of the GGNs was 18 mm; 135 (46%) were pure GGN and 161 (54%) were part-solid GGN. No visible tumor or unsuspected endobronchial metastasis was identified by preoperative FB. Only 3 (1%, 3/208) GGNs were identified preoperatively as malignant by bronchial washing cytology; all were part-solid GGNs. No other etiology was identified by FB. Of the GGNs, 271 (91%) were subsequently confirmed as malignant and 25 (9%) were confirmed as benign at surgical resection. Consequently, the overall diagnostic sensitivity and negative predictive value of preoperative FB on a per-nodule basis was 1% (3/271) and 8% (25/293), respectively. The preoperative FB did not change the surgical strategy. Preoperative FB did not add much to the evaluation of persistent GGNs of the lung. Routine preoperative FB may have limited value in surgical candidates with small persistent pure GGNs.

Highlights

Pulmonary nodules are a common, worrying clinical problem because they often indicate early-stage lung cancer [1, 2]
264 patients with persistent ground-glass nodule (GGN) who underwent preoperative flexible bronchoscopy (FB) and surgical resection were included in the study (Fig. 1)
No visible tumor or unsuspected endobronchial metastasis was identified by preoperative FB in patients with persistent GGNs

Summary

Introduction

Pulmonary nodules are a common, worrying clinical problem because they often indicate early-stage lung cancer [1, 2]. Recent guidelines for the management of pulmonary nodules have recommended strategies that include observation with serial radiographs, bronchoscopic or transthoracic needle biopsies, and surgical resection [4]. Persistent ground-glass nodules (GGNs) can indicate focal fibrosis, premalignant lesions, or subtypes of adenocarcinoma [6,7,8], and an early confirmatory diagnosis without surgery is difficult [9]. A bronchoscopic biopsy is usually impossible for GGN-type lung adenocarcinoma because endobronchial metastasis is uncommon and most lesions arise in peripheral areas [12,13,14]. Non-diagnostic transthoracic needle biopsy results cannot rule out the possibility of a malignancy [4]. Surgical resection with diagnostic and curative intent is usually performed for persistent GGNs that suggest malignancy

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Conclusion