Original article: general thoracic
Results of wedge resection for focal bronchioloalveolar carcinoma showing pure ground-glass attenuation on computed tomography

https://doi.org/10.1016/S0003-4975(01)03623-2Get rights and content

Abstract

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.

Section snippets

Patients

Between July 1996 and June 2001, 17 patients with focal peripheral BAC showing pure GGA on thin-section CT underwent pulmonary resection. GGA was defined as a hazy increased attenuation of the lung without obscuration of the underlying vascular marking [8].

Preoperative investigations

When a round-shaped GGA without central scar formation was detected on thin-section CT (Fig 1), repeat CT was performed 3 months later on suspicion of focal BAC. If the tumor size had increased or was unchanged, surgery was planned because

Patient characteristics

The patient characteristics are shown in Table 1. The patient population consisted of 4 men and 13 women with a mean age of 57.2 ± 10.5 years (range 39 to 72) at the time of surgery. All patients were asymptomatic and detected by chest CT scan. Among these patients, four lesions were detected in a CT mass-screening program, which we started on May 1997, and the remaining 13 patients were incidentally detected on CT during follow-up for other diseases. Fourteen (82.4%) patients had no smoking

Comment

Bronchioloalveolar carcinoma is considered to be one of the adenocarcinoma subtypes. The increasing incidence of BAC seems to be contributing to the dramatic rise in the number of cases of adenocarcinoma [9]. Although the original report of BAC described patients with advanced bilateral pulmonary tumors, more recent studies on BAC have focused on patients with early stage disease 10, 11.

The pathologic features of BAC are the presence of aerogenous spread and advance along the alveolar wall [12]

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