Original article: general thoracic
A clinicopathological study of resected subcentimeter lung cancers: a favorable prognosis for ground glass opacity lesions

Presented at the Poster Session of the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.
https://doi.org/10.1016/S0003-4975(03)00835-XGet rights and content

Abstract

Background

Owing to the advent of refined chest computed tomography (CT) images with higher resolution and CT screening programs, more faint and smaller lung cancers are being discovered. These include small-sized lung cancers such as those with a subcentimeter diameter, which had never been picked up on the routine chest roentgenogram films. However their clinicopathologcial characteristics with special reference to the proper surgical mode are not fully described so far.

Methods

During a 10-year period from 1991 through 2000 a total of 1,769 lung tumors were resected at the National Cancer Center Hospital, Tokyo. According to the pathology files of these patients, 51 patients had a primary tumor with the diameter of 1 cm or less. Three tumors arising in the bronchial lumina of hilum with a squamous cell carcinoma histology were excluded and the remaining 48 tumors of peripheral origin were studied. The clinicopathological features were analyzed according to three types of appearance on high-resolution CT: non-solid ground glass opacity (GGO) type (n = 19); part-solid GGO type (n = 9); and solid type (n = 20). Non-solid GGO is made up of homogeneous moderate increased density on CT, which cannot obscure the bronchovascular structure, whereas partly solid GGO contains a mere solid part but did not exceed 50% of the whole area (n = 9). All other lesions were considered solid type.

Results

For the three types of lesions, the distribution of age and sex was similar with the average age of 61 years and an almost even distribution of male/female patients. Although 6 patients had symptoms, the symptoms were not associated with the nodule itself. Twenty-six patients (54%) were screen-detected (16 chest roentgenogram films and 10 CT scans) and the others were detected by incidentally taken chest roentgenogram film or CT for other reasons than nodules detected. Two squamous carcinomas were positive for sputum cytology. Preoperative cytologic/histologic diagnosis was given in 14 patients (29%). The histologic type of GGO lesion was bronchioloalveolar carcinoma in all 28 cases. In solid lesions, besides 16 adenocarcinomas 2 cases of squamous cell carcinoma, 1 case each of small cell carcinoma and carcinoid tumor was seen. Lymph node involvement was seen only in 3 patients with solid lesions (N1 in 2 patients, N2 in 1 patient). As for operative mode, the limited resection was performed for 15 GGO lesions (54%) and 4 solid lesions (20%). Tumor recurrence was seen in 2 patients with solid lesions—1 in bone and the other in locoregional lymph node, and the former died of disease.

Conclusions

Among subcentimeter lung cancers, GGO lesions (both non-solid and part-solid) constitute true early lung cancers. Since they have minimal or no invasive growth, limited resection for cure is justified. Conversely the solid lesion had significant invasive features such as lymph node metastasis. Lobectomy should remain as the standard mode of surgery despite such small size.

Section snippets

Patients

For the 10-year period from January 1991 through December 2000 there were 1,769 pulmonary resections for primary lung cancer including low-grade malignancy at the National Cancer Center Hospital, Tokyo. Among these the diameter of resected primary tumor was 1.0 cm or less in 51 patients (subcentimeter lung cancers). The location of tumor was central in the bronchial lumen in 3 patients and peripheral in the lung parenchyma in 48 patients. The clinicopathological characteristics of these 48

Results

The clinicopathological aspects of 48 subcentimeter cancers were analyzed according to the three types of lesion.

Comment

Owing to the advent of new technology in CT scanning such small-sized lung cancers as those of subcentimeter size are being found in a daily practice. Subcentimeter lung cancers still belong to a rare category of tumor size as lung cancer and most of them are expected to be in an early stage of the disease. In the present series however the lymph node metastasis was seen in 3 (15%) of 48 patients with subcentimeter lung cancer and furthermore 2 of them had recurrence of the tumor. These

Acknowledgements

Supported in part by a Grant-in-Aid for Cancer Research (Grant 11-19) from the Ministry of Health and Welfare, Japan

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