Natural history of ground-glass nodules detected on the chest computed tomography scan after major lung resection.

BACKGROUND

Detection of ground-glass nodules (GGNs) on computed tomography (CT) is increasing due to advances in CT technology and the findings of the National Lung Screening Trial. Ground-glass nodules are detected on screening chest CTs and CT scans after lung resection surgery. It is important to investigate the natural history of GGNs as it is not yet well known, and a standardized approach to manage them has not been established.

METHODS

We selected patients who presented with GGNs on chest CT taken after major lung resection. One hundred thirty-nine GGNs were detected in 92 patients and followed up for longer than 1 year. Characteristics of GGN, size, presence of a solid component and multiplicity, and demographic data of patients such as history of smoking and malignant disease were analyzed to identify factors that affected GGN growth.

RESULTS

During the follow-up period (mean 44.4 months), 23 GGNs showed a significant increase in size. The only predictor for the growth of GGNs was the presence of a solid component (p < 0.001). Pathologic diagnosis was made in 14 patients. Of those, 10 GGNs including 7 primary lung adenocarcinomas were diagnosed as malignant. Three of 4 benign lesions were diagnosed as atypical adenomatous hyperplasia. There were no mortalities directly related to GGNs.

CONCLUSIONS

In GGNs detected on CT scans of patients who had undergone major lung resection, the presence of a solid component was the only factor that could predict nodule growth. Although the majority of growing GGNs were adenocarcinoma, the clinical course seemed to be indolent.