Korean J Radiol.  2007 Feb;8(1):22-31. 10.3348/kjr.2007.8.1.22.

Nodular Ground-Glass Opacities on Thin-section CT: Size Change during Follow-up and Pathological Results

• Lee HJ
• Goo JM
• Lee CH
• Yoo CG
• Kim YT
• Im JG

• KMID: 753862
• DOI: http://doi.org/10.3348/kjr.2007.8.1.22

Abstract

OBJECTIVE
To evaluate the inter-group differences in growth and the pathological results of nodular ground-glass opacities (GGOs) according to their size and focal solid portions. MATERIALS AND METHODS: Ninety-six nodular GGOs in 55 individuals followed by CT for at least one month from an initial chest CT were included. Forty nodular GGOs in 30 individuals were pathologically confirmed to be: adenocarcinoma (n = 15), bronchioloalveolar carcinoma (BAC) (n = 11), atypical adenomatous hyperplasia (AAH) (n = 8), focal interstitial fibrosis (n = 5) and aspergillosis (n = 1). Lesions were categorized based on high-resolution CT findings: pure nodular GGO (PNGGO) < or = 10 mm, PNGGO > 10 mm, mixed nodular GGO (MNGGO) < or = 10 mm, and MNGGO > 10 mm. In each group, the change in size during the follow-up period, the pathological results and the rate of malignancy were evaluated. RESULTS: Three MNGGO lesions, and none of the PNGGO, grew during the follow-up period. Resected PNGGOs < or = 10 mm were AAH (n = 6), BAC (n = 5), and focal interstitial fibrosis (n = 1). Resected PNGGOs > 10 mm were focal interstitial fibrosis (n = 4), AAH (n = 2), BAC (n = 2), and adenocarcinoma (n = 2). Resected MNGGOs < or = 10 mm were adenocarcinoma (n = 2), and BAC (n = 1). Resected MNGGOs > 10 mm were adenocarcinoma (n = 11), BAC (n = 3), and aspergillosis (n = 1). CONCLUSION: Mixed nodular GGOs (MNGGOs) had the potential for growth; most were pathologically adenocarcinoma or BAC. By contrast, PNGGOs were stable for several months to years; most were AAH, BAC, or focal interstitial fibrosis.

Keyword

Lung, CT; Lung, nodule; Lung neoplasms; Lung neoplasms, diagnosis

MeSH Terms

Tomography, X-Ray Computed/*methods
Middle Aged
Male
Lung Neoplasms/pathology/radiography
Lung Diseases/pathology/*radiography
Humans
Female
Aged, 80 and over
Aged
Adult
Adenocarcinoma/pathology/radiography

Figure

• 

  Fig. 1 Pure nodular ground-glass opacity in the right upper lobe confirmed as atypical adenomatous hyperplasia in a 62-year-old woman.A. Initial CT shows 8 mm pure nodular ground-glass opacity in the right upper lobe.B. Thin-section CT after 10 months shows persistent pure nodular ground-glass opacity with the same size. The lesion was pathologically confirmed by right upper lobectomy. She had a history of curative resection of adenocarcinoma in the left upper lobe one year before.

• 

  Fig. 2 Pure nodular ground-glass opacity in the right upper lobe confirmed as atypical adenomatous hyperplasia in a 58-year-old man.A. Initial thin-section CT shows a 15 mm pure nodular ground-glass opacity in the right upper lobe.B. On thin-section CT after 2 months, an interval change was not noted. An additional two pure nodular ground-glass opacities were found in the right upper lobe and one in the right middle lobe. All lesions were pathologically confirmed as atypical adenomatous hyperplasia by multifocal wedge resection.

• 

  Fig. 3 Pure nodular ground-glass opacity in the right upper lobe confirmed as adenocarcinoma in a 67-year-old man.A, B. Axial and coronal-reformatted images of thin-section CT shows 25 mm pure nodular ground-glass opacity in the right upper lobe. The lesion was pathologically confirmed by right upper lobectomy.

• 

  Fig. 4 Pure nodular ground-glass opacity in the right upper lobe confirmed as focal interstitial fibrosis in a 61-year-old man.A. Thin-section CT shows 30 mm pure nodular ground-glass opacity in the right upper lobe.B. On follow-up CT scan after seven months, an interval change was not noted. The lesion was pathologically confirmed by right upper lobectomy. On pathologic slides, focal interstitial fibrosis with exuberant type II pneumocyte proliferation and alveolar macrophage collection were found. The cause of the focalinterstitial fibrosis was not confirmed.

• 

  Fig. 5 Mixed nodular ground-glass opacity in the right lower lobe confirmed as adenocarcinoma in a 61-year-old man.A, B. Axial and coronal-reformatted images of thin-section CT shows 21 mm mixed nodular ground-glass opacity in right upper lobe. An elongated shaped solid portion was noted in the lesion (arrows). The lesion was pathologically confirmed by right lower lobectomy.

• 

  Fig. 6 Mixed nodular ground-glass opacity in the left upper lobe confirmed as aspergillosis in a 52-year-old woman. Thin-section CT shows 23 mm mixed nodular ground-glass opacity in the left upper lobe. Multifocal solid portions were seen in the lesion. The lesion was pathologically confirmed by CT-guided cutting needle biopsy. She also had fungal sinusitis in the right maxillary sinus.

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