Evaluation Of Mediastinal Lymph Node Dissection In Pulmonary Ground-glass Opacity Tumor

Objective:Long-term clinical observation revealed that non-small cell lung cancer(NSCLC)showed a ground-glass(GGO)opacity under CT,have a better prognosis than other types of lung cancer.Although the current thoracic surgery has formed some norms for the treatment of pulmonary grinding glass nodules,these treatment measures have not formed a unified and more detailed treatment guidelines,among which the scope of lymph node dissection is more controversial.As GGO becomes more common in thoracic surgery,and the demand for more precise treatment of ground glass nodules becomes more and more demanding.The aim of this study was to evaluate the necessity of mediastinal lymph node dissection in NSCLC with preoperative CT findings of GGO.Methods:From April 2019 to September 2019 in Shengjing Hospital affiliated to China Medical University,the chest CT examination in our hospital indicated that the lung was ground-glass opacity tumor,and the mediastinal lymph nodes were sampled by radical resection of lung cancer,lung segment / partial resection,and the clinical data of 312 patients with final pathological diagnosis of non-small cell lung cancer were obtained.On the basis of clinical experience,we divided the pulmonary ground-glass opacity into low-density ground-glass opacity without solid components,solid components <50% medium-density ground-glass nodules and 50%≤ solid components <80% high-density ground-glass nodules according to the density and the degree of promiscuity a total of three groups.The pathological features and lymph node metastasis of the three groups were analyzed.Results:There was no significant difference in postoperative pathological features among the three groups(P>0.05).9 of 312 patients found lymph node metastasis,a total of 1972 lymph node clearance group,three groups of glassy lung cancer lymph node metastasis rate difference was statistically significant(P<0.05).Lymph node metastasis was not found in 153 cases of low-density ground-glass-like lung cancer(0/796);lymph node metastasis was 0.12%(2/872)in 121 cases of high-density ground-glass-like lung cancer,and the difference between the two was not statistically significant(P=0.501);and lymph node metastasis was 3.29% in 38 cases ofhigh-density ground-glass opaicty,which was significantly different from that of low medium-density ground-glass opacity.The difference between the N1 transfer rate of2.8%(4.143)and the N2(6/161)transfer rate of 3.72% in high-density ground glass nodules was not statistically significant.Conclusion:Lymph node dissection can not be performed in low-density GGO in the NSCLC range of glass-like variable diameter ≤4 cm,pure groud-glass opacity and mixed ground-glass without solid components.Segmental mediastinal lymph node sampling can be considered in 50% GGO with solid components with high density(40-50%)and diameter exceeding 3 cm.Systematic mediastinal lymphadenectomy is required ≤50% of solid components <80% of high density mixed GGO.