Video-assisted Thoracic Surgery for Pure Ground-glass Opacities 2 Cm or Less in Diameter

Background: Small, well-circumscribed pure ground-glass opacities on high-resolution computed tomography can represent either localized bronchioloalveolar carcinoma without foci of active fibroblastic proliferation, or atypical adenomatous hyperplasia. Since neither lesion displays lymph node metastasis, excellent prognosis can be expected even with limited surgical resection. In this study, video-assisted thoracic surgery was performed for patients with pure ground-glass-opacity to evaluate efficacy for both diagnostic and therapeutic purposes.

Methods: Thirty-nine patients with pure ground-glass opacity less than or equal to 2 cm in diameter (62 lesions) underwent video-assisted thoracic surgery with wedge resection as primary therapy. Histologic diagnoses were made according to Noguchi classifications.

Results: Single lesions were observed in 30 patients, with multiple lesions (mean, 4 lesions) in 9 patients. Twenty-eight patients underwent wedge resection. Seven patients underwent lobectomy or segmentectomy for technical reasons. Four patients underwent conversion of wedge resection to lobectomy (due to active fibroblastic proliferation in 2 patients, and other reasons in 2 patients). All procedures were performed under videoscopic observation. Histologic diagnoses comprised localized bronchioloalveolar carcinoma without active fibroblastic proliferation either alone or in combination with atypical adenomatous hyperplasia in 29 patients, atypical adenomatous hyperplasia in 8 patients, and localized bronchioloalveolar carcinoma with active fibroblastic proliferation in 2 patients. All patients with localized bronchioloalveolar carcinoma underwent follow-up for a median period of 29.3 months, and have survived without sign of recurrence.

Conclusions: Video-assisted thoracic surgery may be appropriate for management of small pure ground-glass opacities.