title: Surgical resection of nodular ground-glass opacities without percutaneous needle aspiration or biopsy.
abstract: BACKGROUND
  Percutaneous needle aspiration or biopsy (PCNA or PCNB) is an established diagnostic technique that has a high diagnostic yield. However, its role in the diagnosis of nodular ground-glass opacities (nGGOs) is controversial, and the necessity of preoperative histologic confirmation by PCNA or PCNB in nGGOs has not been well addressed.
  
  
  METHODS
  We here evaluated the rates of malignancy and surgery-related complications, and the cost benefits of resecting nGGOs without prior tissue diagnosis when those nGGOs were highly suspected for malignancy based on their size, radiologic characteristics, and clinical courses. Patients who underwent surgical resection of nGGOs without preoperative tissue diagnosis from January 2009 to October 2013 were retrospectively analyzed.
  
  
  RESULTS
  Among 356 nGGOs of 324 patients, 330 (92.7%) nGGOs were resected without prior histologic confirmation. The rate of malignancy was 95.2% (314/330). In the multivariate analysis, larger size was found to be an independent predictor of malignancy (odds ratio, 1.086; 95% confidence interval, 1.001-1.178, p =0.047). A total of 324 (98.2%) nGGOs were resected by video-assisted thoracoscopic surgery (VATS), and the rate of surgery-related complications was 6.7% (22/330). All 16 nGGOs diagnosed as benign nodules were resected by VATS, and only one patient experienced postoperative complications (prolonged air leak). Direct surgical resection without tissue diagnosis significantly reduced the total costs, hospital stay, and waiting time to surgery.
  
  
  CONCLUSIONS
  With careful selection of nGGOs that are highly suspicious for malignancy, surgical resection of nGGOs without tissue diagnosis is recommended as it reduces costs and hospital stay.
authors.forename: Jaeyoung
authors.initials: J
authors.lastname: Cho
authors.forename: Sung-Jun
authors.initials: SJ
authors.lastname: Ko
authors.forename: Se Joong
authors.initials: SJ
authors.lastname: Kim
authors.forename: Yeon Joo
authors.initials: YJ
authors.lastname: Lee
authors.forename: Jong Sun
authors.initials: JS
authors.lastname: Park
authors.forename: Young-Jae
authors.initials: YJ
authors.lastname: Cho
authors.forename: Ho Il
authors.initials: HI
authors.lastname: Yoon
authors.forename: Sukki
authors.initials: S
authors.lastname: Cho
authors.forename: Kwhanmien
authors.initials: K
authors.lastname: Kim
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Jheon
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ctlee@snu.ac.kr.
authors.forename: Choon-Taek
authors.initials: CT
authors.lastname: Lee
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012307:Risk Factors; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden