J Lung Cancer.  2010 Jun;9(1):1-8. 10.6058/jlc.2010.9.1.1.

The Clinical Approach to Nodular Ground Glass Opacity in the Lung

• Lee CT

• KMID: 2200020
• DOI: http://doi.org/10.6058/jlc.2010.9.1.1

Abstract

The introduction of low dose chest computed tomography for health screening in Korea has resulted in increased detection of solitary pulmonary nodules, including nodular ground glass opacity. In contrast to the classic solitary pulmonary nodule, nodular ground glass opacity (GGO) has special characteristics especially in Koreans. More than half of nodular GGOs are transient and they are caused by a pulmonary infiltrate of eosinophils. However, persistent nodular GGO (nGGO) showed a high malignant potential such as atypical adenomatous hyperplasia and bronchioloalveolar cell carcinoma. The increasing use of video assisted thoracoscopic surgery (VATS) for diagnosis and treatment is the current trend for managing nodular GGO. Even though lobectomy is still the standard management for malignant nGGO, limited resection (wide wedge resection or segmentectomy) is widely used for the small malignant GGO (Noguchi types A and B). Multifocal nodular GGOs are mostly of a synchronous origin rather than intrapulmonary metastasis. Therefore, aggressive surgical resection is warranted. This review contains the current concepts for managing nodular GGO and it especially focuses on the Korean data.

Keyword

Low dose CT; Nodular ground glass opacity; Video assisted thoracoscopic surgery

MeSH Terms

Eosinophils
Glass
Hyperplasia
Korea
Lung
Mass Screening
Neoplasm Metastasis
Solitary Pulmonary Nodule
Thoracic Surgery, Video-Assisted
Thorax

Figure

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  Fig. 1. Examples of nodular ground glass opacity (nGGO). (A) Pure nGGO. (B) Mixed nGGO. (C) Mixed nGGO.

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  Fig. 2. Transient mixed nodular ground glass opacity (nGGO) (toxocariasis). (A) Mixed nGGO with ill-defined border. (B) Complete disappearance of nGGO after 3 months. This patient had a recent history of raw cow liver ingestion and showed blood eosinophilia and positive reaction to toxocara antigen.

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  Fig. 3. Features of nodular ground glass opacity (nGGO) suggesting malignancy. (A) nGGO with air-bronchogram and pleural retraction. (B) nGGO with air-bronchogram, spiculated border with minimal fissural retraction and (C) nGGO with bubble lucency.

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  Fig. 4. ACCP Recommended management algorithm for patients with SPN (including nGGO) (8∼30 mm in diameter). SPN: solitary pulmonary nodule, CT: computed tomography, pGGO: pure nodular ground glass opacity, HRCT: high-resolution CT, PET: positron emission tomography, VATS: video assisted thoracoscopic surgery (from Gould MK, et al. Chest 2007;132(3 Suppl):108S–130S, with permission from American College of Chest Physicians) (15).

Reference

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