Clinical Features And Treatment Strategies Of Pulmonary Glass-ground Opacity(GGO) Nodules:An Analysis Of 142 GGO Cases

Part ? :The Clinical Analysis of 89 Cases of Lung Solitary Ground-glass Opacity NodulesOBJECTIVE:To retrospectively analyze the basic clinical information,laboratory test results,pathological classification and HRCT features of lung solitary ground-glass opacity nodules and to summarize the factors predicting the benign and malignant ground-glass opacity nodules.MATERIALS and METHODS:From September 2016 to January 2018,89 solitary ground-glass opacity nodules pathologically confirmed in 89 patients who were received VATS in No.1 hospital of Jilin University were included in this study.All nodules were divided into two groups according to the pathology : begin/AAH GGO group and malignant GGO group(adenocarcinoma in situ,minimally invasive adenocarcinoma,invasive adenocarcinoma).Begin/AAH GGO group included 17 patients.Malignant GGO group included 72 patients.Using Microsoft Excel to establish a database about the clinic basic date,laboratory test results,pathology findings and HRCT features.Statistical analysis was performed using SPSS18.0 software.RESULTS:The Begin/AAH GGO group(n=17)included AAH(n=8),focal intersutial fibrosis(n=4),chronic pneumonia(n=3)and pulmonary hemorrhage(n=2).The malignant GGN group(n=72)included adenocarcinoma in situ(AIS)(n=11),minimally invasive adenocarcinoma(MIA)(n=8),invasiv adenocarcinoma(n=53).(1)Clinic basic date:there were no significant differences in age,sex,smoking history and clinical symptoms between benign/AAH and malignant GGO groups(P>0.05).(2)HRCT imaging features:there were significant differences in the size and nature of GGO nodules between benign/AAH andmalignant GGO groups(P<0.05).There was statistical difference in the marginal features(smooth,spiculation),boundary characteristics and pleural traction between the two groups(P<0.05).However,as for shape,lobular edges and air bronchogram,there was no significant difference between the two groups(P>0.05).(3)laboratory results:campared with the malignant GGO group,benign/AAH group had lower CYFRA21-1(P<0.05).The two groups in the CEA,NSE,CA19-9,blood leucocyte,red blood cell distribution width and serum prealbumin have no significant difference(P>0.05).(4)Pathology findings:the statistical analysis of histopathological subtypes and histopathological components in malignant GGO group showed invasive components such as acinar and papillary components can also be seen as GGO tumours on HRCT.Early stage lung adenocarcinoma represented by GGO is mainly composed of lepitic,acinar and papillary.CONCLUSION:1)There was no significant difference in age,sex,smoking history and symptoms between benign/AAH and malignant GGO nodules.2)GGO nodule which has features such as lager size,clear boundary,spiculation and pleural traction on HRCT prefer maligant GGO nodules.3)Blood CYFRA21-1 has certain significance in the prediction of benign and malignant of GGO nodules,while the CEA,NSE,CA19-9,leukocytes,red blood cell distribution width and prealbumin had little effect.4)Lepidic predominant adenocarcinoma,papillary adenocarcinoma and acinar adenocarcinoma may represented by GGO ground-glass nodules on HRCT at the early stage of disease.Early stage lung adenocarcinoma represented by GGO is mainly composed of lepitic,acinar and papillary.Part ? :Comparative Analysis of Clinical characteristics between multiple Ground-glass opacity nodules and solitary Ground-glass opacity noduleOBJECTIVE:To retrospectively compare the clinical basic information,pathological,and HRCTfeatures of persistent multiple groud-glass opacity(GGO)nodules with these of solitary nodules.MATERIALS and METHODS:From September 2016 to January 2018,113 GGO nodules pathologically confirmed in113 patients who were received VATS in No.1 hospital of Jilin University were included in this study.All nodules were divided into two groups according to the number of GGO nodules:multiple GGO group/solitary GGO group.Multiple GGO group included 24 patients and 53 GGO nodules.Solitary GGO group included 89 patients and 89 GGO nodules.Using Microsoft Excel to establish a database about the clinic basic date,pathologic findings,and HRCT features.Statistical analysis was performed using SPSS18.0 software.RESULTS:Multiple GGO nodules(n=53)included atypical adenomatous hyperplasia(AAH)(n=16),adenocarcinoma in situ(AIS)(n=6),minimally invasive adenocarcinoma(MIA)(n=8),invasiv adenocarcinoma(n=14),focal intersutial fibrosis(n=6)and pulmonary hemorrhage(n=3).Solitary GGO nodule(n=89)included AAH(n=8),AIS(n=11),MIA(n=8),invasive adenocarcinoma(n=53),focal intersutial fibrosis(n=4),chronic pneumonia(n=3)and pulmonary hemorrhage(n=2).(1)Clinic basic date:there were no significant differences in age,sex,smoking history and clinical symptoms between multiple GGO group and solitary GGO group(P>0.05)As for the sex,smoking history,there was no significant difference in the two groups(P>0.05).(2)HRCT imaging features:multiple GGO nodules were smaller(11.075mm±4.72)than solitary GGO nodules(15.06mm±5.59)(P=0.019).Pure GGO nodules(P=0.004),round or oval shape(P=0.024),and smooth margin(P=0.001)were more frequent in multiple GGO nodules.However,spiculated margin(P=0.001),and pleural retraction(P<0.001)were more frequent in solitary GGO nodules.As for lobular edges,air-bronchogram and border well-defined or not,there were no difference in the two groups(P>0.05).(3)Pathology findings:AAH(P=0.002)were more frequent in multiple GGO nodules,invasive adenocarcinoma(P<0.001)was more frequent in solitary GGO nodules.CONCLUSION:1)There is no significant difference in age,sex,smoking history and lesion location between multiple GGO nodules and solitary GGO nodules.2)Multiple ground-glass nodules had smaller diameter,plain glass nodules,smooth and round or oval nodules.3)solitary ground-glass opacity nodules had more opportunity to show the spiculated sign and pleural traction.