May 28, 2024

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Is Ground-glass opacity (GGO) really that terrible?

Is Ground-glass opacity (GGO) really that terrible?


Is Ground-glass opacity (GGO) really that terrible?  How many types are Ground-glass opacity nodules divided into?

Ground-glass opacity (hereinafter referred to as lung GGO) is an imaging name for a type of lung disease rather than a specific disease. It is different from solid nodules in CT appearance, and it can be observed through the blurred shadow formed by the lesion The original texture of the lungs, hence the name “ground glass” lesions, is essentially inflammation, bleeding, edema, fibrosis, or cancer.



01 How many types of ground glass nodules in the lungs are divided into?

Lung GGO can be divided into: pure ground glass lesions (pGGO), mixed ground glass lesions (mGGO) and solid nodules.

Studies have shown that 18% of pure ground glass nodules and 63% of mixed ground glass nodules in GGO are malignant. It is generally believed that there is a long-term evolution process from pGGO to complete solid nodules. An observational study on pGGO below 5mm showed that only 10% (45) of the nodules in 439 GGOs changed during the 6-year observation period, and only 4 of these 45 GGOs (0.9%) developed into invasive lung cancer, with an average of 3.6 years. Therefore, what we need to worry about and pay more attention to is the emergence and evolution of solid components in ground glass-like nodules.


02 What should I do if I find a ground glass nodule in the lung?

We should pay attention to lung GGO but don’t need to be overly anxious. Lung cancer characterized by ground-glass nodules is generally inert (slow development), relatively low in malignancy, and usually at an early stage, so the treatment effect is quite good.


For ordinary patients, we should bring relevant information to the hospital and follow the advice of specialists, instead of blindly learning through the Internet or talking about them with relatives and friends. This will easily lead to excessive anxiety.


When seeking medical treatment, doctors need to understand the previous examination data. Usually, for the lung GGO, if it can copy DICOM format image data on a U disk or CD, it is better for the doctor to judge the accuracy of the lesion. Experienced doctors will make comprehensive considerations based on CT image characteristics and the patient’s personal situation (including smoking, occupational exposure, family history, personal tumor history, and patient’s psychological wishes, etc.).


In the diagnosis and treatment of lung GGO, our thoracic surgery department in Renji Hospital has accumulated considerable experience, not only special needs clinics and expert clinics opened by well-known experts, but also special pulmonary nodules clinics opened for such situations And so on, can give proper disposal opinions and implement them properly.


03 Do all ground glass-like nodules need surgery?

As mentioned earlier, only 18% of pGGO is malignant. Therefore, for pGGO, we usually prefer follow-up observation. Most pGGOs are inert and have no significant changes in the long-term.


Western views such as Europe and the United States believe that the 6mm pGGO needs to be reviewed after an interval of 6-12 months. The current clear opinion is that surgical resection is required for persistent pGGO larger than 15mm or even 20mm, but there is no uniform surgical standard for pGGO smaller than 15mm. Usually doctors will make flexible treatment according to the size, density, morphological characteristics of the lesion and the patient’s wishes, and the therapeutic effect of this type of pGGO is very ideal, and the cure rate is close to 100%.


For mixed ground-glass lesions (mGGO), 63% are malignant lesions, and the actual component usually indicates the risk of infiltration, which requires more attention. For mGGO, we usually carry out short-term reexamination (3-6 months) after adequate anti-infective treatment. If the lesion is larger than 10mm, it gradually becomes larger, or if the actual component and the substantial component increase during follow-up, it Need active surgical treatment.


04 What is the treatment if there is no surgery?


At present, the surgical treatment of lung GGO usually adopts minimally invasive thoracoscopic surgery. Our Department of Thoracic Surgery of Renji Hospital is responsible for all kinds of thoracoscopic lobectomy/pulmonary segment resection, single-aperture approach and thoracoscopic surgery assisted by Da Vinci robot It is carried out routinely and is well received by the majority of patients. Some patients who are not suitable for surgery can also be treated with stereotactic radiotherapy (SBRT) or radiofrequency ablation.


All in all, lung cancer characterized by ground-glass lesions is usually inert, slow in progress, good treatment effects, and less traumatic during surgery. We should pay attention to but not be anxious, trust doctors, trust science, and treat them rationally.



(source:internet, reference only)

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