title: How should we manage small focal pure ground-glass opacity nodules on high-resolution computed tomography? A single institute experience.
abstract: BACKGROUND
  Although the detection of pure ground-glass opacity (p-GGO) nodules on high-resolution chest computed tomography (HRCT) often implies a diagnosis of lung adenocarcinoma, the management of p-GGO nodules remains under discussion.
  
  
  OBJECTIVE
  To assess the correlation between the radiological and pathological diagnoses of small p-GGO on HRCT.
  
  
  METHODS
  This is a single-institution retrospective study. We analyzed 89 consecutive patients, including 33 patients with resected p-GGO nodule(s) equal or less than 20 mm in maximal diameter on axial images of HRCT.
  
  
  RESULTS
  Thirty-nine patients underwent locoregional treatment (Treatment group), including surgical resection in 33 and stereotactic body radiation therapy in six. The remaining 50 patients were observed (Observation group) using periodic chest HRCT. The median follow-up time was 30.4 (4.9-102.5) months in the Treatment group and 44.8 (0.4-1125.8) months in the Observation group. During the follow-up period, the p-GGO nodules increased in size in eight patients over a median of 20.6 (12.1-50.6) months, with increased attenuation in three patients over a median of 20.6 (12.1-50.6) months, and either decreased in size or disappeared in four patients over a median of 6.9 (2.0-11.2) months. Thirty-three patients with 47 nodules underwent surgical resection, including 41 adenocarcinomas, one neuroendocrine tumor, three cases of atypical adenomatous hyperplasia and two benign lesions. The frequency of invasive adenocarcinoma was higher among the larger p-GGO nodules.
  
  
  CONCLUSIONS
  Careful observation and decision making with respect to the timing of intervention in cases of p-GGO nodules are warranted.
authors: Department of Thoracic Oncology, National Kyushu Cancer Center, Japan. Electronic address: yamaguchi.m@nk-cc.go.jp.
authors: Masafumi
authors: M
authors: Yamaguchi
authors: Department of Diagnostic Imaging and Nuclear Medicine, National Kyushu Cancer Center, Japan.
authors: Akio
authors: A
authors: Furuya
authors: Department of Thoracic Oncology, National Kyushu Cancer Center, Japan.
authors: Makoto
authors: M
authors: Edagawa
authors: Department of Pathology, National Kyushu Cancer Center, Japan.
authors: Kenichi
authors: K
authors: Taguchi
authors: Department of Thoracic Oncology, National Kyushu Cancer Center, Japan.
authors: Shinichiro
authors: S
authors: Shimamatsu
authors: Department of Thoracic Oncology, National Kyushu Cancer Center, Japan.
authors: Gouji
authors: G
authors: Toyokawa
authors: Department of Thoracic Oncology, National Kyushu Cancer Center, Japan.
authors: Ryo
authors: R
authors: Toyozawa
authors: Department of Thoracic Oncology, National Kyushu Cancer Center, Japan.
authors: Kaname
authors: K
authors: Nosaki
authors: Department of Thoracic Oncology, National Kyushu Cancer Center, Japan.
authors: Fumihiko
authors: F
authors: Hirai
authors: Department of Thoracic Oncology, National Kyushu Cancer Center, Japan.
authors: Takashi
authors: T
authors: Seto
authors: Department of Thoracic Oncology, National Kyushu Cancer Center, Japan.
authors: Mitsuhiro
authors: M
authors: Takenoyama
authors: Department of Thoracic Oncology, National Kyushu Cancer Center, Japan.
authors: Yukito
authors: Y
authors: Ichinose
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011230:Precancerous Conditions / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Lung adenocarcinoma; Pure ground-glass opacity nodules