title: Differential diagnosis and management of focal ground-glass opacities.
abstract: Focal pulmonary ground-glass opacities (GGOs) can be associated with bronchioloalveolar carcinoma. The present retrospective study aimed to test the validity of a multistep approach to discriminate malignant from benign localised (focal) GGOs, identifies useful diagnostic features on computed tomography (CT), and suggests appropriate management guidelines. A stepwise approach, including oral antibiotics, follow-up high-resolution CT (HRCT) 40-60 days later and CT-guided core biopsy, was used. All cases with localised GGOs detected since 2001 were reviewed. CT features were described according to a structured scheme. In total, 40 patients were evaluated. Of these, 11 patients were diagnosed with benign GGOs, 19 patients had lung cancer and 10 were undetermined. Nonpolygonal shape, apparent radial growth and clear-cut margins were associated with a malignant histology. The specificity of CT findings was low. Diagnostic accuracy increased after oral antibiotics, follow-up HRCT and percutaneous core biopsy. Overall, 18 patients underwent surgery for lung cancer. In conclusion, malignant ground-glass opacities have a fairly typical appearance, but some benign lesions closely mimic their malignant counterparts. The stepwise approach adopted in the present study increased the diagnostic specificity and reduced time to definitive diagnosis. Segmentectomy might be the ideal resection volume for such tumours.
authors.affiliation: Dept of Thoracic Surgery, IRCCS Istituto Clinico Humanitas, Milan, Italy. maurizio.infante@humanitas.it
authors.forename: M
authors.initials: M
authors.lastname: Infante
authors.forename: R F
authors.initials: RF
authors.lastname: Lutman
authors.forename: S
authors.initials: S
authors.lastname: Imparato
authors.forename: M
authors.initials: M
authors.lastname: Di Rocco
authors.forename: G L
authors.initials: GL
authors.lastname: Ceresoli
authors.forename: V
authors.initials: V
authors.lastname: Torri
authors.forename: E
authors.initials: E
authors.lastname: Morenghi
authors.forename: F
authors.initials: F
authors.lastname: Minuti
authors.forename: S
authors.initials: S
authors.lastname: Cavuto
authors.forename: E
authors.initials: E
authors.lastname: Bottoni
authors.forename: F
authors.initials: F
authors.lastname: Inzirillo
authors.forename: U
authors.initials: U
authors.lastname: Cariboni
authors.forename: V
authors.initials: V
authors.lastname: Errico
authors.forename: M A
authors.initials: MA
authors.lastname: Incarbone
authors.forename: G
authors.initials: G
authors.lastname: Ferraroli
authors.forename: G
authors.initials: G
authors.lastname: Brambilla
authors.forename: M
authors.initials: M
authors.lastname: Alloisio
authors.forename: G
authors.initials: G
authors.lastname: Ravasi
mesh_terms: D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008297:Male; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents