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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Harvey I. Pass Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pass, H. I. Search for Related Content PubMed Articles by Pass, H. I. Related Collections Lung - cancer Related Article

Ann Thorac Surg 2002;73:392-393
© 2002 The Society of Thoracic Surgeons

Invited commentary

^a Division of Cardiothoracic Surgery, Harper Hospital, Suite 2102, Harper Professional Building, 3990 John R, Detroit, MI 48201, USA

e-mail: hpass{at}dmc.org

The article by Kodama and associates should be regarded as a ground breaking contribution to the study of the natural history of early lung cancer. The pure ground glass opacity (PGGO) is a wispy, diagnostically frustrating pulmonary "infiltrate" which is being detected with increasing frequency as the size of the pixels necessary for computerized tomographic resolution decreases. Presently, the management of the PGGO is more controversial than the management of the "mixed GGO" whose solid component is invariably found to have an adenocarcinoma/bronchoalveolar element. The unknown natural history of the PGGO is addressed in a subset of 19 PGGOs from their institutional total of 49, which makes this series one of the largest, if not the largest, in the literature. The uniqueness of having a population of GGOs which have been followed for more than two years without intervention, of which 10 are eventually resected, allows the investigators to comment not only on the natural history, but on the evolving surgical philosophy and techniques for localization and resection. The actual indications for resection remain vague and growth of a PGGO does not seem to be a failsafe for neoplasm since only 4 of 7 growing PGGOs were malignant, and 1 of the 3 non-growing lesions proved to be bronchoalveolar cancer. Neither initial size nor degree of growth corre-lated with pathologic diagnosis, but the take-home mes-sage is that PGGOs in patients with a previous history of lung cancer (n = 5) have a high rate of malignancy (n = 4). The authors have stressed that intraoperative localization can be problematic and the use of preoperative, percutaneous marking with indocyanine green may help. It is encouraging that complete resections could be accomplished with a wedge or segmentectomy, but the long-term repercussions of this conservative approach on survival or recurrence remain anecdotal at this time.

The article should stimulate thoracic surgeons to think about how their practices will be impacted by ongoing, research-oriented screening programs and how these lesions should be handled in a consistent manner. That’s just the rub ... there is no consistent manner to handle these lesions. The dilemma begs for an international consortium of dedicated lung cancer screening clinical researchers, such as the International Early Lung Cancer Action Project, to form a retrospective and prospective registry of PGGOs in order answer basic radiographic, cytologic, pathologic and therapeutic questions. Thoracic surgeons should develop a strategic plan of collaboration with the large lung cancer screening consortia that will lead to trials which may justify "less than lobectomy" solutions for these patients. Moreover, the first order of business may be a randomized trial of surgical intervention versus continued surveillance in order to sort out overdiagnosis issues in ongoing lung cancer screening studies. Who knows? Maybe a feathery infiltrate detected by computerized tomography will lead to exciting translation opportunities for a whole generation of thoracic oncologists. Even better ... it may help us to improve the 14% five year survival in lung cancer patients by giving us hints about the molecular nature of the beast.

Related Article

Natural history of pure ground-glass opacity after long-term follow-up of more than 2 years

Ken Kodama, Masahiko Higashiyama, Hideoki Yokouchi, Koji Takami, Keiko Kuriyama, Yoko Kusunoki, Tomio Nakayama, and Fumio Imamura
Ann. Thorac. Surg. 2002 73: 386-392. [Abstract] [Full Text] [PDF]

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				Y. Ohta, Y. Shimizu, T. Kobayashi, O. Matsui, H. Minato, I. Matsumoto, and G. Watanabe Pathologic and Biological Assessment of Lung Tumors Showing Ground-Glass Opacity Ann. Thorac. Surg., April 1, 2006; 81(4): 1194 - 1197. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Harvey I. Pass Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pass, H. I. Search for Related Content PubMed Articles by Pass, H. I. Related Collections Lung - cancer Related Article