Wei Li1, Fei Zhou2, Ziwei Wan3, Meiling Li4, Yuan Zhang5, Xiao Bao1, Lei Zhang6, Jingyun Shi7. 1. Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China. 2. Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China. 3. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China. 4. Department of Radiology, Shanghai General Hospital(South Branch), Shanghai Jiao Tong University School of Medicine, 650 Xinsongjiang Road, Shanghai, 201600, China. 5. Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China. 6. Department of Radiology, Shanghai General Hospital(South Branch), Shanghai Jiao Tong University School of Medicine, 650 Xinsongjiang Road, Shanghai, 201600, China. Electronic address: Zhanglei4302@hotmail.com. 7. Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zheng Min Road, Shanghai, 200433, China. Electronic address: Shijingyun89179@126.com.
Abstract
PURPOSE: The purpose of this study was to elucidate the clinicopathologic and lymph node metastatic characteristics in patients with adenocarcinoma manifested as persistent ground glass mass (GGM, ground glass opacity [GGO] exceeding 3 cm in diameter). MATERIALS AND METHODS: 304 patients with adenocarcinoma manifested as persistent GGM > 3 cm, who underwent complete surgical resection between November 2013 and December 2017 were included in this study. We elucidated the lymph node metastatic incidence and characteristics according to the primary tumor lobe location and extracted the associated clinicopathological factors, especially thin-section computed tomographic findings, with lymph node involvement. RESULTS: All of the GGMs were invasive adenocarcinoma in histopathology. The total incidence of lymph node metastasis was 2.0% (6/304). All of the 6 cases with hilar or mediastinal lymph node metastasis were manifested as solid-predominant GGM > 3 cm and no cases with lymph node metastasis were identified in GGO-predominant GGM > 3 cm. Lymph node metastases were more likely to present in younger patients (p = 0.032), tumors with solid size >2.0 cm (p = 0.000), more advanced clinical T stage (p = 0.000), radiological solid-predominant tumors (p = 0.002) and acinar-predominant or papillary-predominant adenocarcinoma (p = 0.002). As for solid-predominant GGMs >3 cm, lymph node metastases were more likely to be found in tumors with solid size >2.0 cm (p = 0.026), more advanced clinical T stage(p = 0.026), acinar-predominant or papillary-predominant adenocarcinoma (p = 0.029). Whole tumor size was not associated with the presence of lymph node metastases. There were 2 right upper-lobe cases with upper mediastinal lymph nodes skip metastasis without intrapulmonary, interlobar, and hilar lymph node metastasis. CONCLUSION: All of the GGMs >3 cm were invasive adenocarcinoma. The incidence of lymph node metastasis in GGO-predominant GGMs >3 cm was extremely low. Solid size would be a better predictor of lymph node metastasis than whole tumor size in sold-predominant GGMs >3 cm.
PURPOSE: The purpose of this study was to elucidate the clinicopathologic and lymph node metastatic characteristics in patients with adenocarcinoma manifested as persistent ground glass mass (GGM, ground glass opacity [GGO] exceeding 3 cm in diameter). MATERIALS AND METHODS: 304 patients with adenocarcinoma manifested as persistent GGM > 3 cm, who underwent complete surgical resection between November 2013 and December 2017 were included in this study. We elucidated the lymph node metastatic incidence and characteristics according to the primary tumor lobe location and extracted the associated clinicopathological factors, especially thin-section computed tomographic findings, with lymph node involvement. RESULTS: All of the GGMs were invasive adenocarcinoma in histopathology. The total incidence of lymph node metastasis was 2.0% (6/304). All of the 6 cases with hilar or mediastinal lymph node metastasis were manifested as solid-predominant GGM > 3 cm and no cases with lymph node metastasis were identified in GGO-predominant GGM > 3 cm. Lymph node metastases were more likely to present in younger patients (p = 0.032), tumors with solid size >2.0 cm (p = 0.000), more advanced clinical T stage (p = 0.000), radiological solid-predominant tumors (p = 0.002) and acinar-predominant or papillary-predominant adenocarcinoma (p = 0.002). As for solid-predominant GGMs >3 cm, lymph node metastases were more likely to be found in tumors with solid size >2.0 cm (p = 0.026), more advanced clinical T stage(p = 0.026), acinar-predominant or papillary-predominant adenocarcinoma (p = 0.029). Whole tumor size was not associated with the presence of lymph node metastases. There were 2 right upper-lobe cases with upper mediastinal lymph nodes skip metastasis without intrapulmonary, interlobar, and hilar lymph node metastasis. CONCLUSION: All of the GGMs >3 cm were invasive adenocarcinoma. The incidence of lymph node metastasis in GGO-predominant GGMs >3 cm was extremely low. Solid size would be a better predictor of lymph node metastasis than whole tumor size in sold-predominant GGMs >3 cm.