Clinical Versus Pathological Staging in Patients with Resected Ground Glass Pulmonary Lesions

Overview

Journal Diagnostics (Basel)

Specialty Radiology

Date 2025 Jan 8

PMID 39767235

Authors

Dan Levy Faber

Abed Agbarya

Andrew Lee

Yael Tsenter

Sonia Schneer

Yulia Robitsky Gelis

Ronen Galili

Affiliations

Soon will be listed here.

Abstract

Background: A ground glass nodule (GGN) is a radiologically descriptive term for a lung parenchymal area with increased attenuation and preserved bronchial and vascular structures. GGNs are further divided into pure versus subsolid lesions. The differential diagnosis for GGNs is wide and contains a malignant possibility for a lung adenocarcinoma precursor or tumor. Clinical and pathological staging of GGNs is based on the lesions' solid component and falls into a specific classification including T0 for TIS, T1mi for minimally invasive adenocarcinoma (MIA) and T1abc for lepidic predominant adenocarcinoma (LPA) according to the eighth edition of the TNM classification of lung cancer. Correlation between solid parts seen on a CT scan and the tumor pathological invasive component is not absolute.

Methods: This retrospective study collected the data of 68 GGNs that were operated upon in Carmel Medical Center. A comparison between preoperative clinical staging and post-surgery pathological staging was conducted.

Results: Over a third of the lesions, twenty-four (35.3%), were upstaged while only four (5.9%) lesions were downstaged. Another third of the lesions, twenty-three (33.8%), kept their stage. In three (4.4%) cases, premalignant lesion atypical adenomatous hyperplasia (AAH) was diagnosed. Ten (14.7%) cases were diagnosed as non-malignant on final pathology. These findings show an overall low agreement between the clinical and pathological stages of GGNs.

Conclusions: The relatively high percentage of upstaging tumors detected in this study and the overall safe and short surgical procedure advocate for surgical resection even in the presence of a significant number of non-malignant lesions that retrospectively do not mandate intervention at all.

References

Aberle D, Adams A, Berg C, Black W, Clapp J, Fagerstrom R . Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011; 365(5):395-409. PMC: 4356534. DOI: 10.1056/NEJMoa1102873. View

AlShammari A, Patel A, Boyle M, Proli C, Gallesio J, Wali A . Prevalence of invasive lung cancer in pure ground glass nodules less than 30 mm: A systematic review. Eur J Cancer. 2024; 213:115116. DOI: 10.1016/j.ejca.2024.115116. View

Detterbeck F, Homer R . Approach to the ground-glass nodule. Clin Chest Med. 2011; 32(4):799-810. DOI: 10.1016/j.ccm.2011.08.002. View

Park C, Goo J, Lee H, Lee C, Chun E, Im J . Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up. Radiographics. 2007; 27(2):391-408. DOI: 10.1148/rg.272065061. View

Ram D, Egan H, Ramanathan T . Ground glass opacity: can we correlate radiological and histological features to plan clinical decision making?. Gen Thorac Cardiovasc Surg. 2022; 70(11):971-976. DOI: 10.1007/s11748-022-01826-2. View

Kakinuma R, Muramatsu Y, Kusumoto M, Tsuchida T, Tsuta K, Maeshima A . Solitary Pure Ground-Glass Nodules 5 mm or Smaller: Frequency of Growth. Radiology. 2015; 276(3):873-82. DOI: 10.1148/radiol.2015141071. View

Austin J, Muller N, Friedman P, Hansell D, Naidich D, Remy-Jardin M . Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. Radiology. 1996; 200(2):327-31. DOI: 10.1148/radiology.200.2.8685321. View

Migliore M, Fornito M, Palazzolo M, Criscione A, Gangemi M, Borrata F . Ground glass opacities management in the lung cancer screening era. Ann Transl Med. 2018; 6(5):90. PMC: 5890046. DOI: 10.21037/atm.2017.07.28. View

Bray F, Laversanne M, Sung H, Ferlay J, Siegel R, Soerjomataram I . Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024; 74(3):229-263. DOI: 10.3322/caac.21834. View

10.

Perez-Johnston R, Araujo-Filho J, Connolly J, Caso R, Whiting K, Tan K . CT-based Radiogenomic Analysis of Clinical Stage I Lung Adenocarcinoma with Histopathologic Features and Oncologic Outcomes. Radiology. 2022; 303(3):664-672. PMC: 9131171. DOI: 10.1148/radiol.211582. View

11.

Gould M, Donington J, Lynch W, Mazzone P, Midthun D, Naidich D . Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013; 143(5 Suppl):e93S-e120S. PMC: 3749714. DOI: 10.1378/chest.12-2351. View

12.

Panunzio A, Sartori P . Lung Cancer and Radiological Imaging. Curr Radiopharm. 2020; 13(3):238-242. PMC: 8206195. DOI: 10.2174/1874471013666200523161849. View

13.

Kim H, Shim Y, Lee K, Han J, Yi C, Kim Y . Persistent pulmonary nodular ground-glass opacity at thin-section CT: histopathologic comparisons. Radiology. 2007; 245(1):267-75. DOI: 10.1148/radiol.2451061682. View

14.

Young T, Salehi-Rad R, Ronaghi R, Yanagawa J, Shahrouki P, Villegas B . Predictors of Invasiveness in Adenocarcinoma of Lung with Lepidic Growth Pattern. Med Sci (Basel). 2022; 10(3). PMC: 9326548. DOI: 10.3390/medsci10030034. View

15.

Cardillo G, Petersen R, Ricciardi S, Patel A, Lodhia J, Gooseman M . European guidelines for the surgical management of pure ground-glass opacities and part-solid nodules: Task Force of the European Association of Cardio-Thoracic Surgery and the European Society of Thoracic Surgeons. Eur J Cardiothorac Surg. 2023; 64(4). DOI: 10.1093/ejcts/ezad222. View

16.

Weichert W, Warth A . Early lung cancer with lepidic pattern: adenocarcinoma in situ, minimally invasive adenocarcinoma, and lepidic predominant adenocarcinoma. Curr Opin Pulm Med. 2014; 20(4):309-16. DOI: 10.1097/MCP.0000000000000065. View

17.

Travis W, Asamura H, Bankier A, Beasley M, Detterbeck F, Flieder D . The IASLC Lung Cancer Staging Project: Proposals for Coding T Categories for Subsolid Nodules and Assessment of Tumor Size in Part-Solid Tumors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol. 2016; 11(8):1204-1223. DOI: 10.1016/j.jtho.2016.03.025. View

18.

Callister M, Baldwin D, Akram A, Barnard S, Cane P, Draffan J . British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax. 2015; 70 Suppl 2:ii1-ii54. DOI: 10.1136/thoraxjnl-2015-207168. View

19.

MacMahon H, Naidich D, Goo J, Lee K, Leung A, Mayo J . Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. 2017; 284(1):228-243. DOI: 10.1148/radiol.2017161659. View

20.

Yamada N, Kusumoto M, Maeshima A, Suzuki K, Matsuno Y . Correlation of the solid part on high-resolution computed tomography with pathological scar in small lung adenocarcinomas. Jpn J Clin Oncol. 2008; 37(12):913-7. DOI: 10.1093/jjco/hym133. View