Management for Residual Ground-Glass Opacity Lesions After Resection of Main Tumor in Multifocal Lung Cancer: A Case Report and Literature Review

Figures & data

Figure 1 The examination results of CT, serum tumor marker and FR+-CTC were described in chronological order, included the time before operation, follow-up without medication and after EGFR-TKI treatment. (A and B). CT image of unresected GGO lesions in left upper lobe (LUL) and right upper lobe (RUL) in patients, showing the enlargement and remission of lesions. The yellow arrows in A and B pointed to the location of lesions in the CT images. (C and D). Line chart showed the changes in value of serum tumor marker and FR+-CTC in different periods of time.

Table 1 Literatures Reporting the Management of Unresected GGO Lesions in SMPLC Patients

First Author	Object Properties	Pts* with Unresected GGOs	Pathology After the Initial Surgery (%)	Duration of Follow-Up (Range)	Pts* with Progressed Residual GGOs	Growth Rate of Progressed Lesion (Range)^a	Management of Residual GGOs
Hong Kwan Kim et al^Citation5 (2010)	GGO	18	Non-mucinous BAC: 26/39 (66.7) AAH: 10/39 (25.6) Anthracofibrosis: 2/39 (5.1) Mucinous BAC: 1/39 (2.6)	40.3 months (22–110)	0	NA	Observation: 18 (100.0%)
Sukki Cho et al^Citation17 (2013)	pure GGO	46	Benign 18/46 (39.1) Cancer 28/46 (60.9)	2 years+	7 (15.2%)	NA	Surgery: 46 (100.0%)
Yoshihisa Shimada et al^Citation3 (2015)	GGO	118 ^b	AIS: 5/67 (7.5) MIA: 5/67 (7.5) Invasive LUAD: 55/67 (82.1) LUSQ: 2/67 (2.9)	58.9 months (1.2–110.8)	9 (7.6%)^b	1373 days (350–5813)	Surgery: 1 (0.8%) Radiotherapy: 1 (0.8%) EGFR-TKI^c: 1 (0.8%) Observation: 115 (97.5%)
Chenyang Dai et al^Citation15 (2016)	pure GGO	36	LUAD: 67/71 (94.3) LUSQ: 2/71 (2.81) ASC: 2/71 (2.81)	29 months (12–55)	7 (19.4%)	16 months^d (7–37)	Surgery: 2 (5.6%) Radiotherapy: 2 (5.6%) Observation: 32 (88.9%)
Rebecca W. Gao et al^Citation16 (2017)	GGO	70	AAH or AIS: 5/70 (7.1) Cancer: 65/70 (92.9)	4.1±2.8 years	19 (27.1%)	NA	Surgery: 5 (7.1%) Radiotherapy: 6 (8.6%) Observation: 59 (84.3%)
Yoshihisa Shimada et al^Citation18 (2020)	GGO	116	AAH or AIS: 25/190 (13.1) Cancer: 165/190 (86.9)	1826 days (31–5342)	38 (32.8%)	1220 days (126–7183)	Surgery: 30 (25.9%) Radiotherapy: 1 (0.9%) Observation: 85 (73.3%)

Notes: *Pts = patients (NO.) ^aDoubling time, median (range). ^bHere 118 and 9 represented the number of GGO lesions, rather than patients. ^cThis patient was treated with EGFR-TKI gefitinib. ^dTime period here was the median follow-up time for growing GGOs to reach an increase of 2 mm.

Abbreviations: BAC, bronchioloalveolar carcinoma; AIS, adenocarcinoma in situ; AAH, atypical adenomatous hyperplasia; MIA, minimally invasive adenocarcinoma; LUAD, lung adenocarcinoma; LUSQ, lung squamous cell carcinoma.

Kim HK, Choi YS, Kim J, Shim YM, Lee KS, Kim K. Management of multiple pure ground-glass opacity lesions in patients with bronchioloalveolar carcinoma. J Thoracic Oncol. 2010;5:206–210.

 PubMed Web of Science ®Google Scholar

Cho S, Yang H, Kim K, Jheon S. Pathology and prognosis of persistent stable pure ground-glass opacity nodules after surgical resection. Ann Thorac Surg. 2013;96:1190–1195.23968760

 PubMed Web of Science ®Google Scholar

Shimada Y, Saji H, Otani K, et al. Survival of a surgical series of lung cancer patients with synchronous multiple ground-glass opacities, and the management of their residual lesions. Lung Cancer (Amsterdam, Netherlands). 2015;88:174–180.

 PubMed Web of Science ®Google Scholar

Dai C, Ren Y, Xie H, et al. Clinical and radiological features of synchronous pure ground-glass nodules observed along with operable non-small cell lung cancer. J Surg Oncol. 2016;113:738–744.27041153

 PubMed Web of Science ®Google Scholar

Gao RW, Berry MF, Kunder CA, et al. Survival and risk factors for progression after resection of the dominant tumor in multifocal, lepidic-type pulmonary adenocarcinoma. J Thorac Cardiovasc Surg. 2017;154.

 Web of Science ®Google Scholar

Shimada Y, Maehara S, Kudo Y, et al. Profiles of lung adenocarcinoma with multiple ground-glass opacities and the fate of residual lesions. Ann Thorac Surg. 2020;109:1722–1730.32057816

 PubMed Web of Science ®Google Scholar