Ground-glass Opacity Lung Research Articles

Diagnostic ability of percutaneous core biopsy immediately after microwave ablation for lung ground-glass opacity.

The objective of this study is to determine the diagnostic ability of percutaneous core biopsy immediately after microwave ablation (MWA) for lung ground-glass opacity (GGO). Seventy-four patients with 74 lung GGOs were enrolled and treated with MWA. A percutaneous core needle biopsy was performed pre- and immediately post-MWA. All biopsy specimens were histologically examined by hematoxylin and eosin staining and immunostaining. Histologically, atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (AC) were identified as positive, while chronic inflammation or normal lung tissue was identified as negative. The outcomes of pre-MWA histological diagnosis were AAH (n = 4), AIS (n = 16), MIA (n = 14), AC (n = 29), chronic inflammation (n = 2), and lung tissue (n = 9) with an 85.1% (63/74) positive diagnosis rate. The outcomes of the immediately post-MWA histological diagnosis were AAH (n = 5), AIS (n = 10), MIA (n = 11), AC (n = 29), chronic inflammation (n = 1), and lung tissue (n = 18) with a 74.3% (55/74) positive diagnosis rate. There was no significant difference in the positive diagnosis rate between the pre- and immediately post-MWA groups (P = 0.10). The outcomes of the combined diagnosis of pre- and immediately post-MWA were AAH (n = 4), AIS (n = 16), MIA (n = 16), AC (n = 31), chronic inflammation (n = 2), and lung tissue (n = 5) with a positive diagnosis rate of 90.5% (67/74), which was higher than that by pre-MWA biopsy (P < 0.05). The main complications were pneumothorax (n = 45, 60.8%), hemoptysis (n = 24, 32.4%), pleural effusion (n = 39, 52.7%), and pulmonary infection (n = 10, 13.5%). Immediately post-MWA core biopsy has promising efficacy for histological diagnosis of lung GGOs.

Computed tomography-guided percutaneous cryoablation for lung ground-glass opacity: A pilot study.

Ground-glass opacity (GGO) is a nonspecific imaging parameter for early-stage pulmonary cancer. In these cases, a definite diagnosis and prompt surgery usually yield satisfactory outcomes. This study aimed to assess the safety and feasibility of cryoablation treatment for lung GGO. We reviewed the clinical data of 14 patients (19 lung tumors) with lung GGO and evaluated the adverse events, lung function, and treatment efficacy after cryoablation. Statistical analyses were performed using the Statistical Package for the Social Sciences software (version 13.0; SPSS Inc., Chicago, IL, USA). None of the patients exhibited serious complications, and lung function recovered to >95% after 1 month. During a follow-up, computed tomography scan at 24 months, the GGO appeared to have been successfully ablated in all patients. Cryoablation may serve as a safe and feasible option for the treatment of GGO.

Preoperative 3-dimensional computed tomography lung simulation before video-assisted thoracoscopic anatomic segmentectomy for ground glass opacity in lung

Three-dimensional (3D) simulation of pulmonary vessels and the space between the lesion and adjacent tissues may improve the safety and accuracy of video-assisted thoracoscopic surgery (VATS) for lung. The aim of this study was to evaluate the effect of 3D simulation on the outcome of VATS segmentectomy for ground glass opacity (GGO) in lung. We retrospectively analyzed 68 cases of small (≤2 cm) GGO, which were diagnosed as cT1aN0M0 lung cancer, from May 1, 2016 to February 28, 2017 in our institute. All the patients underwent VATS segmentectomy. The patients were divided into "3D" group, 3D preoperative reconstruction simulation in 36 patients and "non-3D" group, 32 patients with only computed tomography (CT). Operation plans were firstly made by CT in all patients, then by 3D simulation only in 3D group. The clinical outcomes, including operation time, blood loss, resection margin distance, length of postoperative stay and postoperative complications were compared between the two groups. There were 21 male and 47 female analyzed, aging from 34 to 72 years (median 57). In 3D group, pathological result showed 8 cases of adenocarcinoma, 23 cases of microinvasive adenocarcinoma (MIA), 5 cases of adenocarcinoma in situ (AIS). In non-3D group, 18 cases of MIA, 9 cases of adenocarcinoma and 5 cases of AIS were diagnosed pathologically. The blood loss, postoperative hospital stay and the incidence of the postoperative complications were similar in both of the groups. There was no 30-day postoperative mortality in either group. The median operation time for the 3D group (111 minute) was shorter than non-3D group (139 minute) (P=0.03). Seven cases (19%) in 3D group changed the original operation plan according to the simulation result with the consideration of adequate resection margin distance. All cases in 3D group had adequate resection margin distance. Four cases (13%) in non-3D group got inadequate resection margin distance, and more lung tissues than the original plan were then resected in these patients (P=0.04). 3D preoperative simulation may be more precise in operation plan than CT scan and can significantly shorten the operation time in VATS segmentectomy for GGO in lung.

Intravascular NK/T-cell lymphoma, Epstein\u2013Barr virus positive with multiorgan involvement: a clinical dilemma

BackgroundIntravascular lymphoma is a rare type of non-Hodgkin lymphoma mostly of B-cell lineage. A few cases of intravascular lymphoma have been found to be of NK/T-cell origin, mainly affecting the skin and central nervous system.Case presentationA 54-year-old Caucasian man sought care because of a 2 weeks history of jaundice and intermittent fever, not responsive to antibiotics and antipyretics. Laboratory tests showed low blood oxygen concentration and pancytopenia. Serum microbiological tests were negative. Computerized tomography (CT) scan revealed hepatosplenomegaly and diffuse ground-glass opacities in both lungs without interlobular septal thickening. Despite oxygen therapy, the clinical conditions rapidly deteriorated leading to death 3 days after admission. Autopsy revealed a multiorgan involvement by an Epstein-Barr virus positive NK/T-cell lymphoma, strikingly growing within the blood vessel lumina, in absence of skin lesions.ConclusionsThe current case highlights the pathological features of this rare entity, the protean clinical presentation of which is often misleading, resulting in delayed diagnosis and treatment.

Computed tomography and pathology evaluation of lung ground-glass opacity.

The aim of this study was to investigate the pathogenesis of lung ground-glass opacity (GGO) and the diagnostic value of computed tomography scan for lung GGO. Computed tomography (CT) images of 106 lung GGO cases were analyzed retrospectively, and the type, location, size, structure, boundaries and surrounding lung fields were evaluated. There were 12 cases of GGO with a diameter <1.0 cm, 36 cases with diameter of 1.0-1.5 cm, 25 cases with diameter of 1.6-2.0 cm, 19 cases with diameter of 2.0-2.5 cm and 14 cases with diameter of 2.5-3.0 cm. There were 20 lesions with a round shape and 68 lesions with an oval shape. There were 56 lesions with spinous processes, 18 lesions with air bronchograms and 37 lesions with surrounding pleural indentation. The diagnosis and differential diagnosis of GGO would be improved with combined CT scan and pathology results.

Purpura fulminans with Lemierre\u2019s syndrome caused by Gemella bergeri and Eikenella corrodens: a case report

BackgroundGemella bergeri is one of the nine species of the genus Gemella and is relatively difficult to identify. We herein describe the first case of septic shock due to a Gemella bergeri coinfection with Eikenella corrodens.Case presentationA 44-year-old Asian man with a medical history of IgG4-related ophthalmic disease who was prescribed corticosteroids (prednisolone) presented to our hospital with dyspnea. On arrival, he was in shock, and a purpuric eruption was noted on both legs. Contrast enhanced computed tomography showed fluid retention at the right maxillary sinus, left lung ground glass opacity, and bilateral lung irregular opacities without cavitation. Owing to suspected septic shock, fluid resuscitation and a high dose of vasopressors were started. In addition, meropenem, clindamycin, and vancomycin were administered. Repeat computed tomography confirmed left internal jugular and vertebral vein thrombosis. Following this, the patient was diagnosed with Lemierre’s syndrome. Furthermore, he went into shock again on day 6 of hospitalization. Additional soft tissue infections were suspected; therefore, bilateral below the knee amputations were performed for source control. Cultures of the exudates from skin lesions and histopathological samples did not identify any pathogens, and histopathological findings showed arterial thrombosis; therefore it was concluded that the second time shock was associated with purpura fulminans. Following this, his general status improved. He was transferred to another hospital for rehabilitation. The blood culture isolates were identified as Gemella bergeri and Eikenella corrodens. Gemella bergeri was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry and confirmed by 16S rRNA gene sequencing later. The primary focus of the infection was thought to be in the right maxillary sinus, because the resolution of the fluid retention was confirmed by repeat computed tomography.ConclusionsGemella bergeri can be the causative pathogen of septic shock. If this pathogen cannot be identified manually or through commercial phenotypic methods, 16S rRNA gene sequencing should be considered.

Advances of location technology in ground-glass opacity

Video-assisted thoracic surgery remains the conventional method in treating lung ground-glass opacity. However, ground-glass opacities, which are small in size and short of solid component, are still a difficulty for thoracic surgeons to operative treatments. Currently, types of location technology are used in ground-glass opacity operative treatments. This article reviews certain main methods used in ground-glass opacity location. The advantages and disadvantages of these methods are also summarized and concluded. Key words: Ground-glass opacity; Video-assisted thoracic surgery; Location technology

Hereditary Lung Cancer Risk: Recent Discoveries and Implications for Genetic Counseling and Testing

Most lung cancer risk is attributed to environmental factors such as cigarette smoke. Family history also impacts lung cancer risk and as smoking rates decrease, the importance of understanding hereditary risk factors will increase. The goal of this paper is to review recent literature on germline variants that affect lung cancer risk, particularly in non-smokers. Germline EGFR T790M mutations have been identified in several families with a high density of lung cancer. Individuals with EGFR T790M appear to be predisposed to multifocal lung cancer and ground glass opacities. Other variants in EGFR (V769M, R776H, V843I), HER2 (G660D), and YAP1 (R331W) have also been identified in families with striking lung cancer histories. Several case reports have identified germline mutations in oncogenes as candidate high-risk lung cancer alleles. There are likely other germline lung cancer risk variants that have yet to be described. There are currently limited clinical testing options for these variants and limited guidance for medical management of carriers. More research with larger cohorts is needed to better understand hereditary lung cancer risks.

A primary study of intraoperative ultrasound location of pulmonary ground-glass opacities in video-assisted thoracic surgery

Objective To evaluate the clinical significance of video-assisted thoracic surgery (VATS) in localization of pulmonary ground-glass opacities(GGOs) by intraoperative ultrasound (IU). Methods An intraoperative ultrasonographic procedure was prospectively performed on 14 patients harboring GGOs of no more than 3 cm in diameter to localize these lesions and achieve adequate margins. Patients were excluded with both asthma and chronic obstructive pulmonary disease from this study inasmuch as the intraoperative ultrasonographic procedure was more difficult to interpret when residual air is present in the lung. The sonographic characteristics of nodules were compared with those from CT and pathology. Results A total of 18 GGOs were successfully identified by intraoperative ultrasonography without any complications.In all instances 13 GGOs were localized in the lung of complet collapse, and high-quality echo images were obtained. Additionally, the IU showed that the nodule sizes were similar to those of CT and postoperative pathological specimens(P<0.05). There was significant difference in lung collapse degree, the maximum diameter of CT and the distance from the lesion to the pleura between echo types (P<0.05). The mean operation time was (4.2±2.7)min. Conclusions Intraoperative ultrasonography can both safely and effectively localize pulmonary GGO in a completely deflated lung. Hence, ultrasonography may assist surgeons to perform minimally invasive lung resections with clear surgical margins during the treatment of lung GGO. Key words: Ultrasonography; Thoracoscopes; Ground-glass opacity

Ground glass opacities management in the lung cancer screening era.

Pulmonary ground glass opacity (GGO) is becoming an important clinical dilemma in oncology as its diagnosis in clinical practice is increasing due to the introduction of low dose computed tomography (CT) scan and screening. The incidence of cancer in GGO has been reported as high as 63%. The purpose of this manuscript is to review best available evidence papers on management of GGO in lung cancer to address the following questions: (I) how to correlate CT findings with malignancy; (II) when and who operate? (III) how to perform intraoperative detection of intrapulmonary GGO? (IV) wedge, segmentectomy or lobectomy? Taking a cue from a clinical scenario, a review on PubMed was conducted. The words search included: "Lung ground glass opacity". The research was limited to human and adults. We considered all published articles from 1990 to April 2017, which reported on at least sufficient data, to be eligible. The literature search was limited to articles in English. A total of 1,211 articles have been found. Interestingly, while in 1991, only one paper was published on low-dose high-resolution CT, in 2016, 126 papers have been published. Most cited and recent papers have been chosen for discussion. Many recent papers have been published from Asian groups. It is clearly not possible to conclude from these data what is the best strategy for GGO in the lung cancer screening era. Certainly, when there is uncertainty, personal opinion and experience should not influence decision making, on the contrary decision should be taken by a multidisciplinary team.

Lung Adenocarcinoma Invasiveness Risk in Pure Ground-Glass Opacity Lung Nodules Smaller than 2 cm.

We aimed to identify clinicopathologic characteristics and risk of invasiveness of lung adenocarcinoma in surgically resected pure ground-glass opacity lung nodules (GGNs) smaller than 2 cm. Among 755 operations for lung cancer or tumors suspicious for lung cancer performed from 2012 to 2016, we retrospectively analyzed 44 surgically resected pure GGNs smaller than 2 cm in diameter on computed tomography (CT). The study group was composed of 36 patients including 11 men and 25 women with a median age of 59.5 years (range, 34-77). Median follow-up duration of pure GGNs was 6 months (range, 0-63). Median maximum diameter of pure GGNs was 8.5 mm (range, 4-19). Pure GGNs were resected by wedge resection, segmentectomy, or lobectomy in 27 (61.4%), 10 (22.7%), and 7 (15.9%) cases, respectively. Pathologic diagnosis was atypical adenomatous hyperplasia, adenocarcinoma in situ, minimally invasive adenocarcinoma (MIA), or invasive adenocarcinoma (IA) in 1 (2.3%), 18 (40.9%), 15 (34.1%), and 10 (22.7%) cases, respectively. The optimal cutoff value for CT-maximal diameter to predict MIA or IA was 9.1 mm. In multivariate analyses, maximal CT-maximal diameter of GGNs ≥10 mm (odds ratio, 24.050; 95% confidence interval, 2.6-221.908; p = 0.005) emerged as significant independent predictor for either MIA or IA. Estimated risks of MIA or IA were 37.2, 59.3, 78.2, and 89.8% at maximal GGN diameters of 5, 10, 15, and 20 mm, respectively. Pure GGNs were highly associated with lung adenocarcinoma in surgically resected cases, while estimated risk of GGNs invasiveness gradually increased as maximal diameter increased.

Assessing the Blood Supply Status of the Focal Ground-Glass Opacity in Lungs Using Spectral Computed Tomography.

ObjectiveTo exploit material decomposition analysis in dual-energy spectral computed tomography (CT) to assess the blood supply status of the ground-glass opacity (GGO) in lungs.Materials and MethodsThis retrospective study included 48 patients with lung adenocarcinoma, who underwent a contrast-enhanced dual-energy spectral CT scan before treatment (53 GGOs in total). The iodine concentration (IC) and water content (WC) of the GGO, the contralateral and ipsilateral normal lung tissues were measured in the arterial phase (AP) and their differences were analyzed. IC, normalized IC (NIC), and WC values were compared between the pure ground-glass opacity (pGGO) and the mixed ground-glass opacity (mGGO), and between the group of preinvasive lesions and the minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IA) groups.ResultsThe values of pGGO (IC = 20.9 ± 6.2 mg/mL and WC = 345.1 ± 87.1 mg/mL) and mGGO (IC = 23.8 ± 8.3 mg/mL and WC = 606.8 ± 124.5 mg/mL) in the AP were significantly higher than those of the contralateral normal lung tissues (IC = 15.0 ± 4.9 mg/mL and WC = 156.4 ± 36.8 mg/mL; IC = 16.2 ± 5.7 mg/mL and WC = 169.4 ± 41.0 mg/mL) and ipsilateral normal lung tissues (IC = 15.1 ± 6.2 mg/mL and WC = 156.3 ± 38.8 mg/mL; IC = 15.9 ± 6.0 mg/mL and WC = 174.7 ± 39.2 mg/mL; all p < 0.001). After normalizing the data according to the values of the artery, pGGO (NIC = 0.1 and WC = 345.1 ± 87.1 mg/mL) and mGGO (NIC = 0.2 and WC = 606.8 ± 124.5 mg/mL) were statistically different (p = 0.049 and p < 0.001, respectively), but not for the IC value (p = 0.161). The WC values of the group with preinvasive lesions and MIA (345.4 ± 96.1 mg/mL) and IA (550.1 ± 158.2 mg/mL) were statistically different (p < 0.001).ConclusionUsing dual-energy spectral CT and material decomposition analysis, the IC in GGO can be quantitatively measured which can be an indicator of the blood supply status in the GGO.

Computed tomography-guided percutaneous microwave ablation for treatment of peripheral ground-glass opacity-Lung adenocarcinoma: A pilot study.

The purpose of the study is to retrospectively evaluate the safety and efficacy of microwave ablation (MWA) for the treatment of ground-glass opacity (GGO)-lung adenocarcinoma. From December 2013 to June 2017, a total of 51 patients (22 males and 29 females, mean age of 69.4 ± 10.1 years) were included in this study, with 51 lung adenocarcinoma lesions showing GGO (mean long-axis diameter of 18.7 ± 6.05 mm). They received a total of 52 sessions of percutaneous computed tomography-guided (CT-guided) MWA. First, lung adenocarcinoma with GGO was histologically defined by needle biopsy under the guidance of CT. Second, the efficacy of CT-guided MWA was analyzed, including the feasibility, safety, 3 years local progression-free survival (LPFS), 3 years disease-specific survival, and 3 years overall survival (OS). Final, complications after MWA were also summarized. The technical success rate was 100%, without MWA procedure-related death. At the median follow-up period (27.02, range: 7-45 months), the rates of 3 years LPFS, cancer-specific survival, and OS were 98%, 100%, and 96%, respectively. The complications after MWA included pneumothorax (48.1%, 25/52), hemoptysis (28.8%, 14/52), pleural effusion (23.1%, 12/52), and pulmonary infection (7.7%, 4/52). CT-guided percutaneous MWA was a feasible, safe, and effective therapeutic approach for treating GGO-lung adenocarcinoma.

Immune-related pneumonitis caused by programmed death-1 inhibitor Pembrolizumab: a case report and literature review

Objective: To investigate the risk factors, clinical manifestations, radiological features, diagnosis, treatment and prognosis of immune-related pneumonitis caused by programmed death-1(PD-1)/PD-L1 inhibitors. Methods: The clinical data of immune-related pneumonitis caused by PD-1 inhibitor Pembrolizumab in a patient with advanced esophageal carcinoma admitted to the 307(th) Hospital of Chinese People's Liberation Army was retrospectively analyzed and the related literatures were reviewed. We searched Medline database using the keywords"PD-1 inhibitor","PD-L1 inhibitor","Pembrolizumab","Nivolumab","Atezolizumab"combined with"Pneumonitis"by Mar 31, 2017. Results: The patient was a 60-year-old male presented with progression disease after surgery, local radiation and couples of chemotherapy for his esophageal carcinoma. Then pembrolizumab, a kind of PD-l inhibitors, was given intravenously every 3 weeks with the average dosage 3 mg per kg. After six cycles of pembrolizumab, the patient began to have fever, cough and dyspnea, which aggravated gradually. Chest CT showed diffuse ground glass opacity, exudation and consolidation in both lungs and little pleural effusion in the right side. Cellular interstitial pneumonitis was confirmed by pathological examination. The patient's symptoms were alleviated after enough steroids and chest CT showed pulmonary infiltration was also absorbed. But the pneumonitis reoccurred twice after stopping or tapering steroids quickly and could also be controlled by using steroids again. Now the patient was still given steroids treatment and the primary esophageal cancer remained stable. 14 articles were retrieved and 88 cases of immune-related pneumonitis caused by PD-1/PD-L1 inhibitors were reported. Among these 89 cases with immune-related pneumonitis, both male and female could attack and the median age was 67 years old. Most cases were grade 1 or 2. The common clinical manifestations were dyspnea, cough, fever and other immune-related damages. And about 20% patients had no symptoms. Ground glass opacities, reticular opacities, consolidation and centrilobular nodules were the common radiological features. The commonest histologic pattern of pneumonitis associated with anti-PD-1/PD-L1 therapy on lung biopsy was organizing pneumonia. Adequate steroid and tapering slowly is the standard treatment. Immunosuppressive agents could be added in some serious cases. The prognosis was relatively good. Most patients were alleviated but few patients died of progression disease or infections during treatment. Conclusions: Immune-related pneumonitis associated with PD-l/PD-L1 inhibitor should be aware of; early detection, early treatment, and the prognosis could be better.

Solitary pulmonary capillary hemangioma presents as ground glass opacity on computed tomography indicating adenocarcinoma in situ/atypical adenomatous hyperplasia: A case report.

Solitary pulmonary capillary hemangioma (SPCH) is a rare type of benign lung tumor, which must be distinguished from early lung cancer and precancerous lesions of the lung that manifest in a similar way upon imaging. The current study describes a case of SPCH and a review of the literature is performed. The patient was a 40-year-old Chinese woman who was referred to the Liaoning Cancer Hospital and Institute (Shenyang, China) in October, 2015 with a cough without obvious inducement. Computed tomography (CT) demonstrated pure ground glass opacity (GGO) in the right upper lung. Following systemic anti-inflammatory therapy over 6 months, the lesion did not exhibit any change on CT and was suspected to be an adenocarcinoma in situ (AIS) or atypical adenomatous hyperplasia (AAH). Video-assisted thoracic surgery wedge resection was subsequently performed. Frozen section diagnosis revealed a benign tumor without atypical epithelial cells. Subsequent to surgery, paraffin sections demonstrated that the tumor contained narrow alveolar cavities, thickened alveolar septa and a clear boundary separating it from healthy lung tissue. Furthermore, the proliferation lumens in the alveolar septa were lined with a single layer of flat cells. Immunohistochemical staining revealed that the flat cells were positive for cluster of differentiation CD31 and CD34, and negative for thyroid transcription factor-1 and cytokeratin. The proliferation of capillary vessels lead to the thickened alveolar septa and the tumor was diagnosed as SPCH. When imaging examination demonstrates a GGO in lung, SPCH must be considered in the differential diagnosis of AIS/AAH. As the prognosis of these lesions is entirely different, a pathological examination must be conducted to ensure a correct diagnosis.

Abnormal air bronchogram within pure ground glass opacity lung adenocarcinoma: value for predicting histopathologic subtypes

Objective To analyze the value of abnormal air bronchogram for predicting the invasiveness of lung adenocarcinoma with pure ground-glass nodule (pGGN). Methods From April 2014 to February 2016, 157 patients with 165 pGGN lung adenocarcinomas confirmed by surgical pathology were selected. There were 30 pre-invasive lesions (AAH+AIS), 39 minimally invasive adenocarcinoma (MIA), and 96 invasive adenocarcinoma (IAC). CT characteristics including lesion size, density, abnormal air bronchogram were recorded. All lesions were divided into two groups: normal group (no air bronchogram or normal air bronchogram) and abnormal air bronchogram group. Chi-square test was used to analyze the difference of pathological subtypes between the two groups. Mann-Whitney rank test was used to analyze the size difference of pGGN between the two groups. Two-independent samples t-test was used to analyze the lesion density difference of pGGN between the two groups. Results Of the 165 lesions, 85 were found to have air bronchogram, there were 12 lesions in 30 pre-invasive lesions (AAH+AIS), 17 in 39 MIAs, 56 in 96 IACs. Abnormal air bronchogram were demonstrated in 61 lesions which was 1 in 30 pre-invasive lesions (IACs+AIS), 13 in 39 MIAs and 47 in 96 IACs, significant differences were found between two groups (χ2=25.943, P<0.01). The mean size of the IACs were (10.8±4.2) mm for normal group, (17.0±6.7) mm for abnormal air bronchogram group, the mean density were (-519±118) HU and (-518±124) HU, respectively. There was a significant difference in lesion diameter between two groups (Z=-6.197, P<0.01), but not in density (t=-0.042, P=0.966). Conclusions Abnormal air bronchogram can be used to predict the invasiveness of pGGN lung adenocarcinoma, and is correlated with lesion size, but not with density. Key words: Lung neoplasms; Pure ground glass nodule; Pathology; Tomography, X-ray computed

134P - Applicable CT-guided percutaneous radiofrequency ablation (RFA) in the treatment of unresectable Lung Ground Glass Opacity (GGO)

Background: Radiofrquency ablation (RFA) is a locoregional therapeutic for variable unresectable malignancies and currently used for lung cancer (either primary or metastatic). It is minimally invasive and accurate for percutaneous RFA under CT guidance. This study was to investigate the safety and efficacy of RFA in the treatment of unresectable lung Ground Glass Opacity (GGO). Methods: From June 2015 to June 2016 a total of 68 patients (29 males and 39 females with a median age of 46 y, range, 29-78 y) with 83 lesions (GGO) have been enrolled in this study. As approved by institutional review board, all patients were informed and signed the consent forms beforehand. All the preselected lesions were proven by needle biopsy under CT guidance percutaneously prior to the procedure. In total 60 malignancies were ultimately included and CT-guided percutaneous RFA was serially performed with pre-set power of 40-80w and ablation time of 12-25 min. Imaging follow-up served as evaluation method. Results: All of the procedures were performed to completion. There were 18 patients with pneumothorax postoperatively and of those 6 needed a closed thoracic drainage. 8 patients showed slight bleeding during the procedures. Follow-up CT scanning at 30-, 90-, and 180-day postoperatively have shown that 56 of 60 lesions turned consolidated and with volume diminished. 4 of 60 were without significant dimensional change at 30-day follow-up, 3 of the 4 with accentuation were detected on 90-day CT follow-up and needed a reoperation of RFA. Conclusions: CT-guided percutaneous RFA is safe and effective. It offers good control and is well-tolerated as a viable option for unresectable GGO. Legal entity responsible for the study: Chinese PLA General Hospital Funding: Chinese PLA General Hospital Disclosure: The author has declared no conflicts of interest.

P1.03-080 The SUVmax Ratio of Two Tumors on PET/CT May Differentiate Separate Primary Lung Cancers and Intrapulmonary Metastases

Differentiation between separate primary lung cancers and intrapulmonary metastases (IM) has significant therapeutic and prognostic implications in lung cancer patients with multiple pulmonary nodules. In this retrospective study, we investigated the diagnostic ability of ratio (MSR) and differences (MSD) of maximum standardized uptake values (SUVmax) between two tumors in discriminating separate primary lung cancers from metastases. We evaluated 5641 lung cancer patients between March 2009 and March 2016 at the Chinese People’s Liberation Army General Hospital. Patients underwent PET/CT and pathology confirmed as multiple lung cancers were included. Patients with ground glass opacity lung cancers or underwent preoperative radiotherapy or chemotherapy were excluded. All lung cancers tissues were reassessed and discriminated from separate primary lung cancer to metastases by two pathologists independently according to comprehensive histological assessment criteria, which was proposed by IASLC lung cancer staging project as pathologic definition to distinguish multiple primary lung cancers from metastatic in the forthcoming eighth edition TNM classification of lung cancer. The MSR and MSD were determined and compared in diagnosing separate primary lung cancers. Receiver-operating characteristic (ROC) curve analysis was performed to determine the area under the curve (AUC), sensitivity and specificity with an optimal cut-off value. Example of MSR and MSD deduction was given in Figure. 1. Totally 24 patients with 24 pairs-tumor (18 primary, 6 metastases) were included. The area under the curve of MSR (AUC, 0.843; 95% CI, 0.637-0.958; p=0.001) was significantly higher than MSD (AUC, 0.685; 95% CI, 0.465–0.857; p=0.240) with p value 0.022. The optimal cut-off value for MSR and MSD was 1.61 (83.33% sensitivity, 83.33% specificity) and 1.94 (83.33% sensitivity, 66.67% specificity). The MSR from PET/CT may helpful in differentiating separate primary lung cancers from intrapulmonary metastases and larger studies were needed to confirm this result.

P1.05-037 Histopathologic Results of Surgically Resected Pure Ground-Glass Opacity Lung Nodules

P1.05-037 Histopathologic Results of Surgically Resected Pure Ground-Glass Opacity Lung Nodules

Pulmonary intravascular large B-cell lymphoma successfully treated with rituximab, cyclophosphamide, vincristine, doxorubicin and prednisolone immunochemotherapy: Report of a patient surviving for over 1 year.

A 73-year-old man with a history of lethargy, fever and dyspnea was admitted to Tottori University Hospital. A computed tomography (CT) scan revealed splenomegaly and diffusely spreading ground-glass opacities (GGOs) in both lungs. A video-assisted thoracoscopic surgery (VATS)-guided lung biopsy revealed intravascular proliferation of large atypical lymphoid cells in the arteries, veins and alveolar walls. The patient was diagnosed with intravascular large B-cell lymphoma (IVLBCL); he received 6 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) immunochemotherapy and has remained in complete remission for >1 year. Although IVLBCL is a rare disease, it should be considered in the differential diagnosis of pulmonary diffuse lesions that present with GGOs on CT scans.