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The Journal of Clinical Oncology Opacity of Pure Ground Glass: Possible Overdi- agnosis? Gustav Peter Blom, Espen Ruud and Arne Borthne *Corresponding author Haseem Ashraf, Centre for Diagnostic Imaging - Thoracic Section, Akershus University Hospital, Loerenskog, Norway.
Received Date : April 12, 2024 Accepted Date : April 14, 2024 Published Date : May 14, 2024 INTRODUCTION A 75-year-old woman who is healthy, active, and does not smoke was recommended to have a routine chest x-ray due to inadvertent weight reduction over time. Following a chest x-ray (Figure 1) that revealed diffuse consolidation in the right lower lobe, the patient was scheduled for a CT scan of the thorax (Figure 2) within the following month. A 15 × 13 mm ambiguous ground glass opacity lesion was visible on the CT scan of the right lower lobe. The patient was referred for a CT-guided lung biopsy due to the possibility of a malignant outcome (Figure 3). The patient experienced a right-sided pneumothorax during the biopsy, but it resolved with the use of a surgical tube. Histopathological diagnosis Lower lobe resection (right) showing a nonmucinous adenocarcinoma in situ.14 mm lesion, centrally situated. Marginaries for free resection. Pathological stage: pTis for AJCC1 and UICC2. Treatment The patient underwent a thoracascopic lobectomy of the lower lobe on the right side. After that, the patient had an annual CT thorax scan as a follow-up. DISCUSSION Lesions with ground glass opacity frequently indicate slowly developing ambiguous lesions with the potential to become malignant [1]. According to certain research, ground glass opacity lesions are linked to female sexual activity [2]. There is ongoing discussion on the histological classification of these lesions [3]. Here, we’re referring to the most recent categorization that hasn’t been included to the WHO classification [4]. A histological continuum from atypical adenomatous hyperplasia through adenocarcinoma in situ (bronchioloalveolar carcinoma) to adenocarcinoma with primarily lepidic growth has been documented for ground glass opacity lesions [5]. The pathologist frequently finds it challenging to distinguish between these diagnoses using a needle biopsy sample. There was still some doubt as to whether the tumor was invasive cancer even from the resection specimen from this patient. It is suggested to follow up on pure ground glass opacity lesions for a longer period of time before undergoing invasive diagnostic treatment (6). If a ground glass nodule persists longer than 5 mm, it does not need to be followed up on.annually for a minimum of three years [7]. Because of its limited utility and potential for deception, positron emission tomography scans of pure ground glass opacity are not advised [7]. A biopsy or surgical resection should be explored in cases where there is solid change or rapid expansion of pure ground glass opacity lesions, as these are indicative of malignancy [8]. CONCLUSION It is currently unclear how dangerous pure ground glass opacity lesions can be. It is possible that some ground glass nodules are overdiagnosed because not all of them will progress to clinically relevant malignant illness [9]. 1 American Joint Cancer Committee 2 International Cancer Control Union REFERENCES 1. Hasegawa M, Sone S, Takashima S. Growth rate of small lung cancers detected on mass CT screening. The British Journal of Radiology 2000;73: 1252-1259. 2. Tae JK, Jin MG, Kyung WL. Clinical, pathological and thin- section CT features of persistent multiple ground-glass opacity nodules: Comparison with solitary ground-glass opacity nodule. Lung Cancer 2009; 171-178. 3. Jin N, Sloane PJ. Evaluation of pure ground glass pulmonary nodule: a case report. J Community Hosp Intern Med Perspect 2014; 4. 4. Tumours of the lung - WHO Classification: http://www. Research Article 1www.directivepublications.org
The Journal of Clinical Oncology iarc.fr/en/publications/pdfs-online/pat-gen/bb10/ bb10-chap1.pdf. 5. Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, et al. Diagnosis of lung adenocarcinoma in resected specimens: implications of the 2011 International Association for the Study of Lung Cancer/ American Thoracic Society/European Respiratory Society classification. Arch Pathol Lab Med 2013; 137: 685-705. 6. MacMahon H, Austin JH, Gamsu G, Herold CJ, Jett JR, et al. Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: A Statement from the Fleischner Society. Radiology 2005; 237: 395-340. 7. Masao N, Hideyuki S, Ichiro T. Focal Ground-Glass Opacity Detected by Low-Dose Helical CT. Chest 2002; 121: 1464-1467. 8. Truong MT, Ko JP, Rossi SE, Rossi I, Viswanathan C, et al. Update in the Evaluation of the Solitary Pulmonary Nodule. Radio Graphics 2014; 34:1658–1640. 9. Goo JM, Park CM, Lee HJ. Ground-glass nodules on chest CT as imaging biomarkers in the management of lung adenocarcinoma. AJR Am J Roentgenol 2011; 196: 533- 543. Research Article 2www.directivepublications.org
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