New horizons in surgical treatment of ground-glass nodules of the lung: experience and controversies

Figures & data

Table 1 Comparison of the characteristics of pure GGNs and mixed GGNs

GGN category	pGGN	mGGN
Common pathology type	AAH, AIS, and MIA	MIA, invasive adenocarcinoma
Pleural and lymphatic invasion	Rare	More frequent
Micropapillary component	Rare	More frequent
CTR	0	Between 0 and 1
Spiculated border	Less frequent	More frequent
Recurrence rate	Lower	Higher

Abbreviations: AAH, atypical adenomatous hyperplasia; AIS, adenocarcinoma in situ; CTR, consolidation/tumor ratio; GGN, ground-glass nodule; MIA, minimally invasive adenocarcinoma; pGGN, pure GGN.

Figure 1 The pulmonary nodule was located by the hookwire insertion.

Notes: Surgical photograph shows hookwire (arrow) traversing pleural space and entering lung parenchyma. The picture was taken in the operating room of Shanghai Pulmonary Hospital.

Figure 2 The deep lesion was located by the microcoil on the visceral pleura surface under thoracoscopic guidance.

Note: From Sui X, Zhao H, Yang F, Li JL, Wang J. Computed tomography guided microcoil localization for pulmonary small nodules and ground-glass opacity prior to thoracoscopic resection. J Thorac Dis. 2015;7:1580–1587. With permission from AME Publishing Company.¹⁴

Figure 3 Schematic diagram of “trailing method” for deploying the microcoil.

Notes: (A) The distance between needle tip and outside the parietal pleura was measured and marked on the guide wire; (B) the guide wire was inserted into the needle and advanced to the marked location. The distal part of the microcoil was deployed and coiled in the lung parenchyma; (C) the guide wire was held in place, and the needle was withdrawn slowly. When the needle was withdrawn beyond the parietal pleura, the needle and guide wire were withdrawn simultaneously; (D) the microcoil was deployed with the proximal part coiling beyond the parietal pleura and the distal part anchoring in the lung parenchyma. From Sui X, Zhao H, Yang F, Li JL, Wang J. Computed tomography guided microcoil localization for pulmonary small nodules and ground-glass opacity prior to thoracoscopic resection. J Thorac Dis. 2015;7:1580–1587. With permission from AME Publishing Company.¹⁴

Table 2 Comparison of frozen section and final pathology reveals that most discrepant cases were the underestimation of AIS and MIA

Frozen section diagnosis	Final pathology								Total (n=803)
	AAH (n=32)		AIS (n=126)		MIA (n=273)		IA (n=372)
	Number	%	Number	%	Number	%	Number	%
AAH	32	100	27	21.4	7	2.6	0	0	66
AIS	0	0	93	73.8	57	20.9	6	1.6	156
MIA	0	0	1	0.8	206	75.5	17	4.6	224
IA	0	0	0	0	2	0.7	347	93.3	349
Benign lesion	0	0	5	4.0	1	0.4	2	0.5	8

Note: Liu S, Wang R, Zhang Y, et al. Precise diagnosis of intraoperative frozen section is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinoma. J Clin Oncol. 34:307–313. Reprinted with permission © 2016 American Society of Clinical Oncology. All rights reserved.⁴⁰

Abbreviations: AAH, atypical adenomatous hyperplasia; AIS, adenocarcinoma in situ; IA, invasive adenocarcinoma; MIA, minimally invasive adenocarcinoma.

SuiXZhaoHYangFLiJLWangJComputed tomography guided microcoil localization for pulmonary small nodules and ground-glass opacity prior to thoracoscopic resectionJ Thorac Dis201571580158726543605

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LiuSWangRZhangYPrecise diagnosis of intraoperative frozen section is an effective method to guide resection strategy for peripheral small-sized lung adenocarcinomaJ Clin Oncol20163430731326598742

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