Results of wedge resection for focal bronchioloalveolar carcinoma showing pure ground-glass attenuation on computed tomography.

BACKGROUND Focal bronchioloalveolar carcinoma (BAC) showing pure ground-glass attenuation (GGA) on thin-section computed tomography (CT), which is considered to be an early-stage adenocarcinoma, has been diagnosed with increasing frequency due to the development and spread of the helical CT scanner. We discussed the appropriateness of limited resection for this type of lesion. METHODS Between July 1996 and June 2001, 17 patients with localized BAC showing "pure GGA" (GGA without central scar formation) on thin-section CT underwent limited pulmonary resections. The mean patient age was 57.2 +/- 10.5 years old. Among these patients, four tumors were detected in a CT mass-screening program and the others were incidentally detected on CT during follow-up for other diseases. Fourteen patients underwent thoracoscopic wedge resection, and 3 underwent segmentectomy because of tumor location. RESULTS The mean tumor diameter was 7.9 +/- 1.9 mm. On pathological examination, all tumors showed a pure bronchioloalveolar growth pattern and no evidence of stromal, vascular, or pleural invasion. The median follow-up time was 32.0 months, with no cancer death or relapse to date. CONCLUSIONS Focal BAC showing pure GGA on thin-section CT is peripheral in situ adenocarcinoma. Wedge resection by VATS is considered to be an appropriate treatment for this type of lung cancer. It can be a minimally invasive complete resection for this type of early cancer, and offer the best chance for long-term survival and good quality of life.

[1]  H Suzuki,et al.  The changes of the stromal elastotic framework in the growth of peripheral lung adenocarcinomas , 1996, Cancer.

[2]  S. Piantadosi,et al.  Recurrence and survival following resection of bronchioloalveolar carcinoma of the lung--The Lung Cancer Study Group experience. , 1989, Annals of surgery.

[3]  G. Watanabe,et al.  Should mediastinal nodal dissection be routinely undertaken in patients with peripheral small-sized (2 cm or less) lung cancer? Retrospective analysis of 225 patients. , 2001, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[4]  R. Hruban,et al.  K-ras oncogene activation in atypical alveolar hyperplasias of the human lung. , 1996, Cancer research.

[5]  H. Umezu,et al.  Early results of a prospective study of limited resection for bronchioloalveolar adenocarcinoma of the lung. , 2001, The Annals of thoracic surgery.

[6]  N. Santelmo,et al.  Bronchioloalveolar lung carcinoma: results of surgical treatment and prognostic factors. , 1998, Chest.

[7]  Feng Li,et al.  Mass screening for lung cancer with mobile spiral computed tomography scanner , 1998, The Lancet.

[8]  Y. Nishiwaki,et al.  Prognostic implications of fibrotic focus (scar) in small peripheral lung cancers , 1980, The American journal of surgical pathology.

[9]  J. Austin,et al.  Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. , 1996, Radiology.

[10]  Takaaki Ito,et al.  Cytodifferentiation of atypical adenomatous hyperplasia and bronchioloalveolar lung carcinoma: immunohistochemical and ultrastructural studies , 1997, Virchows Archiv.

[11]  Setsuo Hirohashi,et al.  Small adenocarcinoma of the lung. Histologic characteristics and prognosis , 1995 .

[12]  Y. Nishiwaki,et al.  Prognostic significance of the size of central fibrosis in peripheral adenocarcinoma of the lung. , 2000, The Annals of thoracic surgery.

[13]  B. Johnson,et al.  Clinical features of patients with stage IIIB and IV bronchioloalveolar carcinoma of the lung , 1999, Cancer.

[14]  S. Kido,et al.  Prognostic value of bronchiolo-alveolar carcinoma component of small lung adenocarcinoma. , 1999, The Annals of thoracic surgery.

[15]  E. Mark,et al.  Bronchoalveolar carcinoma: clinical, radiologic, and pathologic factors and survival. , 1999, The Journal of thoracic and cardiovascular surgery.

[16]  L. Bonomo,et al.  Bronchioloalveolar carcinoma of the lung , 1998, European Radiology.

[17]  S. Barsky,et al.  Rising incidence of bronchioloalveolar lung carcinoma and its unique clinicopathologic features , 1994, Cancer.

[18]  B. Gasser,et al.  Bronchoalveolar carcinoma: histopathologic study of evolution in a series of 105 surgically treated patients. , 1998, Chest.

[19]  W. Travis,et al.  United States lung carcinoma incidence trends: Declining for most histologic types among males, increasing among females , 1996, Cancer.

[20]  L V Rubinstein,et al.  Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. , 1995, The Annals of thoracic surgery.

[21]  K Kuriyama,et al.  Ground-glass opacity on thin-section CT: value in differentiating subtypes of adenocarcinoma of the lung. , 1999, AJR. American journal of roentgenology.

[22]  D. Sugarbaker,et al.  Bronchioloalveolar carcinoma of the lung: recurrences and survival in patients with stage I disease. , 2001, The Journal of thoracic and cardiovascular surgery.

[23]  K S Lee,et al.  Bronchioloalveolar carcinoma: focal area of ground-glass attenuation at thin-section CT as an early sign. , 1996, Radiology.

[24]  Y. Shimosato,et al.  Histological Typing of Lung and Pleural Tumours , 1999, World Health Organization.

[25]  M. Okada,et al.  Is segmentectomy with lymph node assessment an alternative to lobectomy for non-small cell lung cancer of 2 cm or smaller? , 2001, The Annals of thoracic surgery.