Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

Are There Any Additional Benefits to Performing Positron Emission Tomography/Computed Tomography Scans and Brain Magnetic Resonance Imaging on Patients with Ground-Glass Nodules Prior to Surgery?

  • Song, Jae-Uk (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Song, Junwhi (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Kyung Jong (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Hojoong (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kwon, O Jung (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Joon Young (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Jhingook (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Han, Joungho (Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Um, Sang-Won (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2017.03.17
  • Accepted : 2017.07.06
  • Published : 2017.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: A ground-glass nodule (GGN) represents early-stage lung adenocarcinoma. However, there is still no consensus for preoperative staging of GGNs. Therefore, we evaluated the need for the routine use of positron emission tomography/computed tomography (PET)/computed tomography (CT) scans and brain magnetic resonance imaging (MRI) during staging. Methods: A retrospective analysis was undertaken in 72 patients with 74 GGNs of less than 3 cm in diameter, which were confirmed via surgery as malignancy, at the Samsung Medical Center between May 2010 and December 2011. Results: The median age of the patients was 59 years. The median GGN diameter was 18 mm. Pure and part-solid GGNs were identified in 35 (47.3%) and 39 (52.7%) cases, respectively. No mediastinal or distant metastasis was observed in these patients. In preoperative staging, all of the 74 GGNs were categorized as stage IA via chest CT scans. Additional PET/CT scans and brain MRIs classified 71 GGNs as stage IA, one as stage IIIA, and two as stage IV. However, surgery and additional diagnostic work-ups for abnormal findings from PET/CT scans classified 70 GGNs as stage IA, three as stage IB, and one as stage IIA. The chest CT scans did not differ from the combined modality of PET/CT scans and brain MRIs for the determination of the overall stage (94.6% vs. 90.5%; kappa value, 0.712). Conclusion: PET/CT scans in combination with brain MRIs have no additional benefit for the staging of patients with GGN lung adenocarcinoma before surgery.

Keywords

References

  1. Henschke CI, McCauley DI, Yankelevitz DF, Naidich DP, Mc- Guinness G, Miettinen OS, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999;354:99-105. https://doi.org/10.1016/S0140-6736(99)06093-6
  2. Kim HY, Shim YM, Lee KS, Han J, Yi CA, Kim YK. Persistent pulmonary nodular ground-glass opacity at thin-section CT: histopathologic comparisons. Radiology 2007;245:267-75. https://doi.org/10.1148/radiol.2451061682
  3. Suzuki K, Asamura H, Kusumoto M, Kondo H, Tsuchiya R. “Early” peripheral lung cancer: prognostic significance of ground glass opacity on thin-section computed tomographic scan. Ann Thorac Surg 2002;74:1635-9. https://doi.org/10.1016/S0003-4975(02)03895-X
  4. Matsuguma H, Yokoi K, Anraku M, Kondo T, Kamiyama Y, Mori K, et al. Proportion of ground-glass opacity on high-resolution computed tomography in clinical T1 N0 M0 adenocarcinoma of the lung: a predictor of lymph node metastasis. J Thorac Cardiovasc Surg 2002;124:278-84. https://doi.org/10.1067/mtc.2002.122298
  5. Park JY, Jang SH. Epidemiology of lung cancer in Korea: recent trends. Tuberc Respir Dis 2016;79:58-69. https://doi.org/10.4046/trd.2016.79.2.58
  6. Chang B, Hwang JH, Choi YH, Chung MP, Kim H, Kwon OJ, et al. Natural history of pure ground-glass opacity lung nodules detected by low-dose CT scan. Chest 2013;143:172-8. https://doi.org/10.1378/chest.11-2501
  7. Takizawa T, Terashima M, Koike T, Watanabe T, Kurita Y, Yokoyama A, et al. Lymph node metastasis in small peripheral adenocarcinoma of the lung. J Thorac Cardiovasc Surg 1998;116:276-80. https://doi.org/10.1016/S0022-5223(98)70127-8
  8. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: non-small cell lung cancer [Internet]. Fort Washington: National Comprehensive Cancer Network; 2017 [cited 2017 Feb 10]. Available from: https://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
  9. Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system. Chest 2009;136:260-71. https://doi.org/10.1378/chest.08-0978
  10. Lee HY, Lee KS, Han J, Kim BT, Cho YS, Shim YM, et al. Mucinous versus nonmucinous solitary pulmonary nodular bronchioloalveolar carcinoma: CT and FDG PET findings and pathologic comparisons. Lung Cancer 2009;65:170-5. https://doi.org/10.1016/j.lungcan.2008.11.009
  11. Lee HY, Lee KS, Kim BT, Cho YS, Lee EJ, Yi CA, et al. Diagnostic efficacy of PET/CT plus brain MR imaging for detection of extrathoracic metastases in patients with lung adenocarcinoma. J Korean Med Sci 2009;24:1132-8. https://doi.org/10.3346/jkms.2009.24.6.1132
  12. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008;246:697-722. https://doi.org/10.1148/radiol.2462070712
  13. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti AE. AJCC cancer staging manual. 7th ed. New York: Springer;2010.
  14. Jung EJ, Lee JH, Jeon K, Koh WJ, Suh GY, Chung MP, et al. Treatment outcomes for patients with synchronous multiple primary non-small cell lung cancer. Lung Cancer 2011;73:237-42. https://doi.org/10.1016/j.lungcan.2010.11.008
  15. Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, et al. International Association for the Study of Llung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011;6:244-85. https://doi.org/10.1097/JTO.0b013e318206a221
  16. Park HY, Kim YH, Kim H, Koh WJ, Suh GY, Chung MP, et al. Routine screening by brain magnetic resonance imaging decreased the brain metastasis rate following surgery for lung adenocarcinoma. Lung Cancer 2007;58:68-72. https://doi.org/10.1016/j.lungcan.2007.04.010
  17. Sawada S, Komori E, Nogami N, Segawa Y, Shinkai T, Yamashita M. Evaluation of lesions corresponding to groundglass opacities that were resected after computed tomography follow-up examination. Lung Cancer 2009;65:176-9. https://doi.org/10.1016/j.lungcan.2008.11.013
  18. Hattori A, Suzuki K, Matsunaga T, Fukui M, Kitamura Y, Miyasaka Y, et al. Is limited resection appropriate for radiologically “solid” tumors in small lung cancers? Ann Thorac Surg 2012;94:212-5. https://doi.org/10.1016/j.athoracsur.2012.03.033
  19. Ye B, Cheng M, Li W, Ge XX, Geng JF, Feng J, et al. Predictive factors for lymph node metastasis in clinical stage IA lung adenocarcinoma. Ann Thorac Surg 2014;98:217-23. https://doi.org/10.1016/j.athoracsur.2014.03.005
  20. Toloza EM, Harpole L, McCrory DC. Noninvasive staging of non-small cell lung cancer: a review of the current evidence. Chest 2003;123(1 Suppl):137S-46S. https://doi.org/10.1378/chest.123.1_suppl.137S
  21. Yi JG, Marom EM, Munden RF, Truong MT, Macapinlac HA, Gladish GW, et al. Focal uptake of fluorodeoxyglucose by the thyroid in patients undergoing initial disease staging with combined PET/CT for non-small cell lung cancer. Radiology 2005;236:271-5. https://doi.org/10.1148/radiol.2361041007
  22. Zhuang H, Hickeson M, Chacko TK, Duarte PS, Nakhoda KZ, Feng Q, et al. Incidental detection of colon cancer by FDG positron emission tomography in patients examined for pulmonary nodules. Clin Nucl Med 2002;27:628-32. https://doi.org/10.1097/00003072-200209000-00004
  23. Gill RS, Perry T, Abele JT, Bedard EL, Schiller D. The clinical significance of incidental intra-abdominal findings on positron emission tomography performed to investigate pulmonary nodules. World J Surg Oncol 2012;10:25. https://doi.org/10.1186/1477-7819-10-25
  24. Fraker DL, Skarulis M, Livolsi V. Thyroid tumors. In: Devita VT, Hellman S, Rosenberg SA, editors. Cancer: principles and practice of oncology. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 1740-63.
  25. Grossmann I, Avenarius JK, Mastboom WJ, Klaase JM. Preoperative staging with chest CT in patients with colorectal carcinoma: not as a routine procedure. Ann Surg Oncol 2010;17:2045-50. https://doi.org/10.1245/s10434-010-0962-y
  26. Burt M, Heelan RT, Coit D, McCormack PM, Bains MS, Martini N, et al. Prospective evaluation of unilateral adrenal masses in patients with operable non-small-cell lung cancer. Impact of magnetic resonance imaging. J Thorac Cardiovasc Surg 1994;107:584-8.
  27. Stone WZ, Wymer DC, Canales BK. Fluorodeoxyglucose-positron-emission tomography/computed tomography imaging for adrenal masses in patients with lung cancer: review and diagnostic algorithm. J Endourol 2014;28:104-11. https://doi.org/10.1089/end.2013.0380

Cited by

  1. Staging Work-up for Early Lung Cancer: The More the Better? vol.80, pp.4, 2017, https://doi.org/10.4046/trd.2017.0100