Limited resection trial for pulmonary ground-glass opacity nodules: fifty-case experience.
OBJECTIVE
This study was undertaken to determine the recurrence rate after limited resection of small lung carcinoma and to evaluate intraoperative frozen-section examination accuracy for Noguchi classification.


METHODS
Enrollment requirements were as follows: pulmonary nodule 2 cm or smaller, diagnosed or suspected clinical T1 N0 M0 carcinoma in the lung periphery, and ground-glass opacity findings and lack of evident pleural indentations or vascular convergence on high-resolution computed tomographic scan. A wedge or segmental resection specimen, removed with custom stapler cartridges, was immediately reinflated and examined by frozen-section with hematoxylin-eosin and Victoria blue-van Gieson stains. If the tumor was confirmed as Noguchi type A or B with resection margins greater than 1 cm, the patient was closed and followed up on an outpatient basis. End points were 5-year disease-free survival and intraoperative classification accuracy.


RESULTS
From August 1998 through October 2002, a total of 50 patients were enrolled (20 men and 30 women, ages 30-77 years). Tumor sizes ranged from 2 to 21 mm (11 mm average). There were 2 Noguchi type A tumors, 23 Noguchi type B tumors, 15 Noguchi type C tumors, 5 atypical adenomatous hyperplasias, 4 fibroses, and 1 granuloma. Frozen-section accuracy was approximately 98% (39/40). One intraoperative type B diagnosis was revised to type C after postoperative pathologic study. No morbidity, mortality, or recurrence has been seen with a median follow-up of 50 months.


CONCLUSIONS
Noguchi type A and B tumors may well be in situ carcinomas, and frozen-section examination was highly accurate. Neither local recurrence nor distant metastases have been found to date. Limited resection initial results appear promising.
Yoshida
Junji
J
Department of Thoracic Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan. jyoshida@east.ncc.go.jp
Nagai
Kanji
K
Yokose
Tomoyuki
T
Nishimura
Mitsuyo
M
Kakinuma
Ryutaro
R
Ohmatsu
Hironobu
H
Nishiwaki
Yutaka
Y
D000328:Adult; D000368:Aged; D000465:Algorithms; D003663:Decision Trees; D018572:Disease-Free Survival; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005629:Frozen Sections / Q000379:methods* / Q000592:standards; D006801:Humans; D007430:Intraoperative Care / Q000379:methods* / Q000592:standards; D007564:Japan / Q000453:epidemiology; D008175:Lung Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology; D009367:Neoplasm Staging / Q000379:methods / Q000592:standards; D018579:Patient Selection; D011013:Pneumonectomy / Q000295:instrumentation / Q000379:methods*; D011379:Prognosis; D013528:Surgical Staplers; D013906:Thoracoscopy; D013908:Thoracotomy; D016896:Treatment Outcome