Slow-growing Tumors Research Articles

Head-to-Head Comparison of SSTR Antagonist [68Ga]Ga-DATA5m-LM4 with SSTR Agonist [68Ga]Ga-DOTANOC PET/CT in Patients with Well Differentiated Gastroenteropancreatic Neuroendocrine Tumors: A Prospective Imaging Study.

Neuroendocrine tumors (NETs) are slow-growing tumors that express high levels of somatostatin receptors (SSTRs). Recent studies have shown the superiority of radiolabeled SSTR antagonists in theranostics compared to agonists. In this prospective study, we compared the diagnostic efficacy between [68Ga]Ga-DOTANOC and [68Ga]Ga-DATA5m-LM4 in the detection of primary and metastatic lesions in patients with well differentiated gastroenteropancreatic (GEP) NETs. Histologically proven GEP-NET patients underwent [68Ga]Ga-DOTANOC & [68Ga]Ga-DATA5m-LM4 PET/CT scans, which were analyzed. The qualitative analysis involved the visual judgment of radiotracer uptake validated by the morphological findings using CT, which was considered as the reference standard. Quantitative comparisons were presented as the standardized uptake value (SUV) corrected for lean body mass: SULpeak, SULavg, and tumor-to-background ratios (TBR). In total, 490 lesions were confirmed via diagnostic CT. The lesion-based sensitivity of [68Ga]Ga-DATA5m-LM4 PET/CT was 94.28% (462/490) and 83.46% (409/490) for [68Ga]Ga-DOTANOC PET/CT (p < 0.0001). [68Ga]Ga-DATA5m-LM4 had statistical significance over [68Ga]Ga-DOTANOC in liver metastases [100% vs. 89.4%; p < 0.0001 (292 vs. 253 {283 lesions on CT})] and bone metastases [100% vs. 82.9%; p = 0.005 (45 vs. 34 {41 lesions on CT})]. Statistical significance was also noted for the TBR SULpeak of the primary and liver lesions. [68Ga]Ga-DATA5m-LM4 showed better sensitivity and a higher target-to-background ratio than [68Ga]Ga-DOTANOC PET/CT. [68Ga]Ga-DATA5m-LM4 PET/CT can be used to quantify the extent of skeletal and liver metastases for better planning of SSTR agonist- or antagonist-based therapy.

CASE REPORT : OLFACTORY GROOVE MENINGIOMA

Abstract&#x0D; Background: Olfactory Groove Meningiomas (OGM) are a rare cause of olfactory dysfunction. OGMs are benign, slow-growing tumors that cause non-specific symptoms, such as headaches, olfactory impairment, and psychiatric symptoms, such as depression, personality changes, decreased cognitive function, visual problems, or seizures.&#x0D; Aim: In this case report we would like to discuss about a rare case of olfactory groove meningioma with non-spesific symptoms presented in 47-year old female patient&#x0D; Case report: A 47-year old female with progressive blurred vision in the right eye for 3 months. Negative light perception in the right eye and fundus of the right eye indicated papillary atrophy. The direct and indirect light reflexes were negative in the right eye. We found Strong homogenous contrast enhancement extraaxial lesion accompanied by multiple dural tails in the left frontal convexity UK approximately 3.2 x 2.8 x 3.1 cm, Tuberculum sellae approximately 2.7 x 2.9 x 3 cm. Cranial decompression, frontal bone reconstruction, and tumor removal were performed. It was found that there was microcystic growth of tumor tissue, consisting of proliferation of meningoethelial cells, round to oval nuclei, smooth chromatin, visible intranuclear inclusions&#x0D; Discussion: OGM is a rare, benign tumor. Female patients were more likely to develop OGM than male patients. The ciliary ganglion of cranial nerve III may be affected by compression of the tumor, resulting in the absence of direct and indirect pupillary reflexes in the affected eyes.&#x0D; Conclusion: OGM is a slow-growing tumor that does not show significant symptoms at an early stage, making early detection difficult.&#x0D; Keyword: Olfactory Groove Meningioma, Blurred Vision, Meningioma&#x0D;

Association of MDM2 Overexpression in Ameloblastomas with MDM2 Amplification and BRAFV600E Expression.

Ameloblastoma is a rare tumor but represents the most common odontogenic neoplasm. It is localized in the jaws and, although it is a benign, slow-growing tumor, it has an aggressive local behavior and high recurrence rate. Therefore, alternative treatment options or complementary to surgery have been evaluated, with the most promising one among them being a targeted therapy with the v-Raf murine sarcoma viral oncogene homologue B (BRAF), as in ameloblastoma the activating mutation V600E in BRAF is common. Studies in other tumors have shown that the synchronous inhibition of BRAF and human murine double minute 2 homologue (MDM2 or HDM2) protein is more effective than BRAF monotherapy, particularly in the presence of wild type p53 (WTp53). To investigate the MDM2 protein expression and gene amplification in ameloblastoma, in association with BRAFV600E and p53 expression. Forty-four cases of ameloblastoma fixed in 10% buffered formalin and embedded in paraffin were examined for MDM2 overexpression and BRAFV600E and p53 expression by immunohistochemistry, and for MDM2 ploidy with fluorescence in situ hybridization. Sixteen of forty-four (36.36%) cases of ameloblastoma showed MDM2 overexpression. Seven of sixteen MDM2-positive ameloblastomas (43.75%) were BRAFV600E positive and fifteen of sixteen MDM2-positive ameloblastomas (93.75%) were p53 negative. All MDM2 overexpressing tumors did not show copy number alterations for MDM2. Overexpression of MDM2 in ameloblastomas is not associated with MDM2 amplification, but most probably with MAPK activation and WTp53 expression. Further verification of those findings could form the basis for the use of MDM2 expression as a marker of MAPK activation in ameloblastomas and the trial of dual BRAF/MDM2 inhibition in the management of MDM2-overexpressing/BRAFV600E-positive/WTp53 ameloblastomas.

Incidence and survival characteristics of pediatric ganglioglioma from 2004 to 2018, with focus on infratentorial sites.

Ganglioglioma (GG) is a slow-growing glioneuronal neoplasm, most frequently seen in the supratentorial location in older children and associated with epilepsy syndromes. GG is rare in the infratentorial location, hence we embarked upon analyzing the National Cancer Institute's (NCI) Survival, Epidemiology, and End Results (SEER) database to better evaluate GG outcomes by location in comparison to the broader pediatric low-grade glioma (pLGG) population. Pediatric patients diagnosed with GG and pLGG from 2004 to 2018 were included in the study. Their demographic, clinical, and survival characteristics were analyzed using SEER*Stat. This study describes the largest cohort of pediatric GG, including 852 cases from year 2004 to 2018, with focus on infratentorial sites. Patients with brainstem GG or those with subtotally resected disease were identified as having higher risk of death. Our analysis highlights brainstem GG as a high-risk, poor-prognostic subgroup and elaborates on the incidence and survival characteristic of this lesser-known subgroup.

Salivary gland secretory carcinoma presenting as a cervical soft tissue mass: a case report

BackgroundSecretory carcinoma (SC) has been described as a distinct salivary gland tumor in the fourth edition of the World Health Organization (WHO) classification of head and neck tumors. SC is generally considered as a slow-growing low-grade malignant tumor, while several cases have been reported with high-grade features, and even metastases in the literature up until now. In this article, a soft tissue SC case is discussed with high-grade microscopic features and neural invasion. A review of the salivary gland SC cases with aggressive behavior is also debated.Case presentationA 65-year-old Caucasian man presented with a left neck mass for the past six months. The imaging studies demonstrated a very large cystic cervical mass (46 × 23 mm) with papillary projections in the anterolateral aspect of the left neck zone Vb. He underwent left radical neck dissection (level I-V) and was followed up for 12 months with the diagnosis of Secretory carcinoma.ConclusionAlthough SC generally has a good outcome, multiple recurrences and unusual metastases may occur, which should be considered by either the pathologists or clinicians.

TCVM Treatment of Oral Peripheral Odontogenic Fibromas in a Dog

A 6-year-old poodle was presented with a one-year history of multiple gingival masses causing visible swelling of the face. Complete surgical resection of the masses was not possible due to the large number of gingival masses involving incisors, canines, premolars, and molars of the maxilla and mandible. Histopathology yielded a diagnosis of peripheral odontogenic fibromas (formerly known as fibromatous or ossifying epulis). These are benign, slow-growing tumors located on the gingiva that originate from the periodontal ligament. Although this tumor type does not readily metastasize, it can be locally extensive, damaging normal oral architecture and can recur following incomplete excision. Due to the extensive number of masses in the oral cavity of the present case, conventional medicine (i.e. surgery) was considered unlikely to be curative. The dog was presented for traditional Chinese veterinary medicine (TCVM) treatment to augment surgery and attempt to slow recurrence of the large number of oral tumors. Two TCVM modalities (moxibustion, Chinese herbal medicine) were selected for adjunct treatment. The Zhong-wan acupuncture point (CV-12) was treated daily with moxibustion for 6 months along with the administration of a tumor-suppressing Chinese herbal medicine, Ai Zhong Ping (San Huang Shuang Ding tablets) for 30 days. At the 6-month clinic recheck, there was no evidence of recurrence, however, at the 1-year follow-up oral examination, there was a single gingival mass (6 mm) between the first (201) and second maxillary incisors (202). The owner did not pursue further treatment, as the dog was doing well.

Subependymal giant cell astrocytoma as presentation of tuberous sclerosis: a case report

BackgroundA case of tuberous sclerosis patient on long-term follow-up is reported here.Case presentationA 22-year-old female patient with epilepsy was diagnosed with tuberous sclerosis at the age of 12 years. At that time, a small subependymal giant cell astrocytoma has been detected along with the other signs of the disease. But the patient was not symptomatic of the intracranial lesion at that time. So, she was kept under follow-up with treatment for the epilepsy. Within 10 years, the lesion gradually enlarged and caused symptoms and the tumour had to be resected at the age of 22 years of age.ConclusionsSubependymal giant cell astrocytoma is very slow-growing low-grade tumour. If small and asymptomatic at the time of the initial diagnosis, resection is not advised. The patient should be kept under close follow-up.

Epidermoid cyst of central nervous system: A case series and review of literature

IntroductionEpidermoid cysts, originating from ectodermal cell remnants during embryogenesis, are rare, slow-growing tumours commonly found in the cerebellopontine angle, fourth ventricle, and sellar/parasellar regions. This retrospective study explores clinicopathological features, demographics, and radiological details of fifteen central nervous system epidermoid cyst cases over three years. Materials and methodsHistologically confirmed cases undergoing surgical excision from July 2020 to July 2023 were retrospectively evaluated. Patient age, clinical presentations, radiological features, and histopathological findings were analyzed using descriptive statistics and aligned with the PROCESS criteria. ResultsFifteen cases, spanning various age groups and clinical presentations, were included. There were four cases each in the posterior fossa and cerebellopontine angle, three in temporal region, two in intraspinal region, and one each in the retromastoid intra-diploic and third intra-ventricular region. Lesions exhibited diverse distribution, gross findings, and microscopic features. Radiological imaging exhibited well-defined hypo-attenuated masses on computed tomography and contributed to the preoperative diagnosis in eight cases. Despite challenges in complete excision due to adherence, 13 cases underwent successful resection. Chemical meningitis, a common postoperative complication, underscores the importance of meticulous surgery. ConclusionThis study highlights clinicopathological characteristics, challenges in surgical management, and postoperative complications of central nervous system epidermoid cysts. Comparative analysis with existing literature emphasizes the uniqueness of epidermoid cysts, differentiating them from craniopharyngiomas and dermoid cysts. Despite the retrospective design, valuable insights are provided, emphasizing the need for prospective studies. Effective management involves complete excision, ensuring long-term remission and emphasizing the distinctive nature of these intriguing intracranial lesions.

Rapid expansion of a left atrial myxoma caused by acute multiple internal hemorrhages: a case report and literature review.

Left atrial myxoma is the most common benign tumor, with the growth rate remaining unknown because specific symptoms do not present until the tumor grows to a certain size. Early surgical management is performed in most cases once it is detected by physicians. Despite cardiac myxomas commonly being perceived as slow-growing tumors, rapid enlargement of myxomas has been reported. A 64-year-old woman was referred to our hospital with a diagnosis of a left atrial tumor. The pointed tumor changed morphologically in a few hours, and her respiratory condition, which had been normal at admission, suddenly deteriorated. Emergent surgery was performed, and the diagnosis was myxoma with multiple intratumor massive hematomas. The patient recovered uneventfully and was discharged on postoperative day 12 without any complications. We report an extremely rare case of left atrial myxoma rapidly expanded due to acute multiple hemorrhages within itself. Massive internal hemorrhage alters the size, shape, and fragility of the tumor. We should recognize the potential risk of internal hemorrhage that may lead to acute deterioration of the so-called "slow-growing benign" tumors, such as myxomas.

Periosteal Lipoma Compressing Peripheral Nerves

Introduction: Lipoma is a common benign, slow-growing soft tissue neoplasm. Periosteal lipomas of the proximal radius causing posterior interosseus nerve (PIN) palsy are the rarest. &#x0D; Due to specific anatomical relationships, proximal antebrachial lipomas can easily compress PIN. We present a case report and report on the related literature.&#x0D; Material and Methods: A 55-year-old female was admitted complaining of a progressively growing lump in the anterior-lateral antebrachial region near the left elbow. The recent onset of weakness in finger extension was more evident during manual work. &#x0D; MRI showed a well-defined oval lesion in the dorsal aspect of the proximal radius bone with inter-muscular laying between m. supinator et extensor carpi radialis brevis of 7x5x3 cm in diameter. EMG study confirmed PIN compression syndrome.&#x0D; An en-block extirpation was performed through extensor muscles. PIN and its muscular branches were well preserved. Histological examination confirmed lipoma. The postoperative course was uneventful, and a good recovery was seen within 12 days. &#x0D; We revised three other similar cases operated for the same Clinical diagnosis by our team. &#x0D; Pertinent literature was reported. &#x0D; Discussion: Periosteal radius lipoma related to compression of PIN has rarely been reported in the literature. We say our operative series and the surgical technique. MRI and EMG are the standard diagnostic methods. The intermuscular approach is safe for total tumor removal in experienced hands.&#x0D; Conclusion: Periosteal lipoma compressing PIN is a rare clinical finding. Total removal may be obtained through an intermuscular approach. Intraoperative monitoring can assist in preserving tiny PIN branches

Pancreatic Serous Cystadenoma: A Continuing Diagnostic Challenge.

Objective: To understand the natural history of serous cystadenoma. To understand the diagnostic accuracy of serous cystadenoma and identify possible factors that lead to the correct diagnosis. Summary Background data: Serous cystadenoma (SCA) is a benign cystic pancreatic neoplasm of the pancreas, accounting for approximately 15% of resected pancreatic cysts. Current recommendations are to proceed with surgical resection in symptomatic patients or when there is uncertainty regarding diagnosis. The latter continues to be a challenge since intentional resection of a serous cystadenoma account for only a minority of resected of cases. Methods: Retrospective single-institution review of patients who on final pathology had a diagnosis of pancreatic serous cystadenoma and of patients who had this diagnosis and were managed non-operatively. Demographic data, cyst characteristics, and growth rate were collected for analysis. Results: A total of 250 patients were analyzed. Median age was 62 (range 22 – 89), 65% were female, and 34% had symptoms. Tumor size ranged from 0.6 to 20, with a median of 3.4 cm. The morphological appearance was microcystic in 58%, macrocystic in 16%, mixed-type in 23%, and solid in 3%. Pancreatic duct dilation and pancreatic atrophy were found in 22% and 14%, respectively. The average growth rate was 1.8 mm/year regardless of tumor size. Of the 172 patients who underwent surgery, serous cystadenoma was the preoperative diagnosis in only 33%. A correct diagnosis was independently associated with large tumors and cyst fluid CEA analysis. Pancreatic duct dilation was independently associated with an in-growing cyst and presence of calcification. Conclusion: SCA is a slow-growing pancreatic cystic neoplasm that is mostly asymptomatic but can lead to pancreatic duct dilation and atrophy in some patients. A surprisingly small number of correct preoperative diagnoses confirms that this entity continues to be a diagnostic challenge. A more thorough preoperative workup that includes EUS should improve the rate of mis-diagnosis.

Unusual Variant of Ameloblastoma with Calcifying Epithelial Odontogenic Tumor-like Areas in a Three-Year Old Child

The Calcifying Epithelial Odontogenic Tumor (CEOT) is a benign odontogenic tumor, comprising approximately 1% of all odontogenic tumors. It presents as a slow-growing tumor in posterior mandibular region. A three year-old female child from Multan, reported a swelling in right lower jaw progressively increasing in size eventually causing facial asymmetry. On intraoral examination, a protuberance was seen arising from posterior mandibular region and causing displacement of overlying teeth. The swelling was cystic on palpation and mildly tender. The patient underwent complete excision of lesion at a tertiary care center in her locality. The excision biopsy specimen was received at our lab which was intact and well preserved. A diagnosis of ameloblastoma with Calcifying epithelial odontogenic tumor-like areas was made. The patient was followed up after six months however no complaint of any recurrent swelling in the area of was recorded.

Surgical outcome of Acoustic Neuroma Surgery in a Malaysian Tertiary Hospital

INTRODUCTION: Acoustic neuroma (AN) or vestibular schwannoma, is a benign, slow-growing tumour that arises from the Schwann cell of the vestibular branch of the vestibulocochlear nerve. Treatment options are mainly conservative or surgical excision. The aim of this study is to describe the clinical characteristics of AN and the surgical outcomes in a Malaysian tertiary hospital. MATERIALS AND METHOD: Records of 73 patients who were diagnosed with AN from January 2008 until December 2019 were retrieved. All patients were analyzed for demographic data and clinical characteristics. In all 52 patients underwent AN surgery and had normal preoperative facial nerve function. A descriptive analysis was used for the surgical outcomes of each patient. RESULTS: The median age of patients was 51.5 (15.8 SD). Hearing levels pre-operatively were severe to profound in 74.0% of the patients, followed by moderate to severe in 15.1%, mild to moderate in 6.8%, and mild hearing loss in 2.7%. Retrosigmoid (48.1%) was the most common surgical approach used, followed by translabyrinthine (44.2%) and middle cranial fossa (MCF) (7.7%). The translabyrinthine approach is associated with the least incidence of facial nerve paresis postoperatively (21.2%) when compared to the retrosigmoid and middle cranial fossa approaches (40.4%). However, there was no significant association between surgical approaches and facial nerve outcome (p=0.07). CONCLUSION: AN surgery is a safe procedure, regardless of the surgical approach used. There was a significant relationship between tumour size and facial nerve outcome.

Giant intrapulmonary solitary fibrous tumor.

Solitary fibrous tumor (SFT) is a soft tissue tumor of mesenchymal origin involving, most commonly, the pleura. Intrapulmonary SFT is a slow-growing tumor that rarely reaches giant forms. SFTs are asymptomatic and often randomly discovered by routine chest X-rays. The diagnosis requires histopathological and immunohistochemical (IHC) examinations. Most of the SFTs are benign and present an indolent course. Larger tumors are more likely to be malignant and consequently associated with a worse prognosis. Despite having histopathological criteria for malignancy, the behavior of SFTs is challenging to predict. We report a case of giant intrapulmonary SFT of intermediate risk.

Cerebellar Haemangioblastoma: A Case Report

Haemangioblastomas are benign, highly vascular tumours containing neoplastic stromal cells with characteristic immunohistochemical features. They are slow-growing tumours with a solid or cystic pattern of unknown origin and are classified as Grade-I benign tumours. They mostly arise in the cerebellum, medulla and spinal cord and are histologically similar to the vascular lesions in the retina. Haemangioblastomas are the most frequent manifestations of an autosomal-dominant inherited syndrome, von Hippel-Lindau (VHL) disease but can also occur as sporadic non hereditary tumours. Hereby, the current case report is on a 53-year-old male who presented to the tertiary care hospital with a persistent headache for six weeks. Based on just the clinical history and examination, the patient was given a probable diagnosis of either cerebellar haemangioblastoma or cerebellar tumour. Magnetic Resonance Imaging (MRI) was performed, which suggested that the lesion could be a glioma or metastatic deposits from a different tumour. In view of these differentials, the patient underwent tumour excision and decompression via suboccipital craniectomy, and an extraventricular drainage was placed for ease of Cerebrospinal Fluid (CSF) drainage. With the help of histopathological diagnosis, the patient was diagnosed with an apparent sporadic type of cerebellar haemangioblastoma, but this can be confirmed only after detailed genetic screening.

A Giant Frontoethmoidal Sinus Osteoma Presenting With Frequent Sleep Apnea Attacks: A Case Report

Background: Paranasal sinus osteomas are benign, slow-growing tumors that are typically asymptomatic. However, in rare cases, these tumors can grow to a giant size and extend into neighboring structures such as the brain, orbit, or nasal cavity, leading to clinical symptoms. These symptoms may include chronic headaches, rhinorrhea, neurological deficits, and visual impairment. Case presentation: Here, we present the case of a 27-year-old male patient who presented to our hospital with chronic headaches and frequent sleep apnea. Upon rhinoscopic examination, mucosal polyposis was observed. Further evaluation through computed tomography revealed a giant fibroosseous tumor in the frontal sinus, which exhibited aggressive extension into the brain parenchyma. Contrast-enhanced magnetic resonance imaging confirmed the presence of a giant tumor with an 8 cm diameter, exerting a mass effect on the underlying brain tissue. To address this complex case, the patient underwent a combined transcranial and transnasal surgical approach. Following the surgery, the patient experienced significant improvement in his symptoms. Conclusions: This report highlights a rare case of sleep apnea secondary to a giant frontoethmoidal osteoma with intracranial extension. The presence of frontal sinus osteomas can lead to serious clinical consequences. Timely diagnosis and intervention are crucial to prevent intracranial extension and mitigate potential complications associated with these lesions.

FRACTIONAL DYNAMICS OF CHRONIC LYMPHOCYTIC LEUKEMIA WITH THE EFFECT OF CHEMOIMMUNOTHERAPY TREATMENT

Currently, immunotherapy is seen to be the most effective cancer treatment. This is especially true while treating chronic lymphocytic leukemia (CLL), a slow-growing B-lymphocyte neoplasm that gradually compromises the immune system. Mathematical modeling is acknowledged as a key technique for analyzing theoretical and practical challenges in this field of cancer research and others. We were inspired to develop a mathematical model because of its dearth in investigations of chemotherapy-induced immunotherapy for CLL. This study effort formulates the dynamics of lymphocytic leukemia utilizing fractional calculus to conceptualize the complex processes of this viral illness. The basic idea of fractional calculus has been shown using the Atangana–Baleanu framework. For the suggested model’s chaotic and dynamic behavior, a new numerical approach is described. We inspect the stability and convergence of the suggested numerical technique in our work. The fluctuation of various system input elements has demonstrated the oscillatory and chaotic behavior of the system. Moreover, we have demonstrated how the suggested mechanism of lymphocytic leukemia infection is affected by fractional order. Through numerical simulations, the most important input parameters are emphasized, and the policymakers are given control intervention suggestions.

Giant orbital schwannoma with cystic degeneration in a young female managed with extended enucleation

Schwannomas are benign, slow-growing, and noninvasive tumors. They account for 1% of all orbital tumors. A 32-year-old female patient presented with a large mass and proptosis of the right eye for 4 years. On imaging, a large well-defined mass, heterogeneous mass of the right orbit with the evidence of cystic degeneration, was present. On incisional biopsy, fusiform cells arranged in intertwine bundles with characteristic Verocay bodies (Antoni A) and multiple cystic regions (Antoni B patterns) were found. S-100 was found positive on IHC, and a diagnosis of schwannoma was made. Cystic degeneration in orbital schwannoma has also been reported but very rarely.

Rare Case of Multifocal Alveolar Echinococcosis.

Teaching Point: Hepatic alveolar echinococcosis can mimic a slow-growing tumor, and multi-organ involvement is rare; imaging has a crucial role in diagnosing this zoonosis that is endemic in the southern part of Belgium.

So Now We Know—Reflections on the Extent of Resection for Stage I Lung Cancer

Lobectomy has been the standard treatment for stage I lung cancer in healthy patients, largely based on a randomized trial published in 1995. Nevertheless, research has continued regarding the role of sublobar resection. Three additional randomized trials addressing resection extent in healthy patients have recently been published. These 4 trials involve differences in design, eligibility, interventions, and intraoperative processes. Patients were ineligible if intraoperative assessment demonstrated stage > IA or inadequate resection margins. All trials consistently show no differences in perioperative morbidity, mortality, and postoperative changes in lung function between sublobar resection and lobectomy—consistent with other nonrandomized evidence. Long-term outcomes are generally encouraging of lesser resection, but some inconsistencies are apparent. The 2 larger recent trials demonstrated no overall survival difference while the others suggested better survival after lobectomy versus sublobar resection. Recurrence-free survival was found to be the same after lobectomy versus sublobar resection in 3 trials, despite higher locoregional recurrences after sublobar resection. The low 5-year recurrence-free survival (64%, regardless of resection extent) in 1 recent trial highlights the need for further optimization. Thus, there is high-level evidence that sublobar resection is a reasonable alternative to lobectomy in healthy patients. However, variability in long-term results suggests that aspects of patients, tumors and interventions need to be better understood. Therefore, we propose to apply sublobar resection cautiously; especially because there are no short-term benefits. Sublobar resection requires careful attention to intraoperative details (nodes, margins), and may be best suited for less aggressive (eg, ground glass, slow growing) tumors.