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J Thorac Cardiovasc Surg 2005;129:1226-1231
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

Objective radiologic analysis of ground-glass opacity aimed at curative limited resection for small peripheral non-small cell lung cancer

^a Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kawasaki Medical School, Okayama, Japan
^b Department of Surgery, National Shikoku Cancer Center, Ehime, Japan
^c Department of Surgery, Sumitomo Besshi Hospital, Ehime, Japan

Received for publication July 1, 2004; revisions received October 14, 2004; accepted for publication October 28, 2004.

^_* Address for reprints: Masao Nakata, MD, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kawasaki Medical School, Matsushima 577, Kurashiki, Okayama, 701-0192, Japan (Email: mnakata{at}med.kawasaki-m.ac.jp).

OBJECTIVE: The aim of this study was to evaluate the efficacy of the objective radiologic analysis of high-resolution computed tomographic images of small peripheral non-small cell lung cancer and to select the candidates for curative limited resection.

METHODS: High-resolution computed tomographic images of 146 surgically resected T1 N0 M0 peripheral non-small cell lung cancers were analyzed by using National Institutes of Health image software and classified on the basis of the percentage of ground-glass opacity within the tumor.

RESULTS: Eighty-seven percent of tumors with ground-glass opacity ratios of 90% to 100% (type I) were diagnosed as noninvasive bronchioloalveolar carcinoma, whereas 55.6% of tumors with ground-glass opacity ratios of 50% to 89% (type II) consisted of adenocarcinoma. Tumors with ground-glass opacity ratios of 50% or more (type I/II) had no nodal involvement, whereas nodal metastases were identified in 20.0% of tumors with ground-glass opacity ratios of 10% to 49% (type III) and 24.4% of tumors with ground-glass opacity ratios of less than 10% (type IV). No tumors with ground-glass opacity ratios of 50% or more showed vessel infiltration, except for one lesion with a ground-glass opacity ratio of 50%. The 3-year disease-free survival was 97.7% for type I/II, 86.1% for type III, and 78.5% for type IV tumors.

CONCLUSIONS: The objective quantitative radiologic analysis with National Institutes of Health image software exhibited a good correlation with the histologic classification, pathologic invasiveness, and postoperative outcome of small peripheral lung cancer. Patients with tumors that have ground-glass opacity ratios of greater than 50% are considered to be possible candidates for limited pulmonary resection.

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