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Juan Crestanello
Francis Nichols
Stephen Cassivi
Claude Deschamps
Peter Pairolero
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J Thorac Cardiovasc Surg 2005;129:1196-1197
© 2005 The American Association for Thoracic Surgery

Letters to the Editor

Reply to the Editor

Mark Allen, MD, Juan Crestanello, MD, Francis Nichols, MD, Stephen Cassivi, MD, Claude Deschamps, MD, James Jett, MD, Stephen Swensen, MD, Peter Pairolero, MD

Department of Surgery, Mayo Foundation, Rochester, MN 55905

We appreciate Sortini and colleagues’ comments concerning our report regarding surgical intervention in patients enrolled in a computed tomography (CT) screening trial. The radiographic finding in nodules that we considered worrisome for cancer include spiculation, noncalcification, diameter greater than 7 mm, and enlargement on serial examination.

The question about ground-glass opacities observed on CT is important. Our current policy is to carefully observe ground-glass opacities that are less than 7.0 mm in diameter. If they enlarge, we would either perform a percutaneous needle biopsy or thoracoscopic wedge resection of the nodule to establish a histologic diagnosis.

Our report included 16 patients in the surgical group with ground-glass opacities. Six of these patients had nodules that were smaller than 1.0 cm; the stage was IA in 5 patients and IIIA in 1 patient. For the entire 16 patients with ground-glass opacities, the stage was IA in 13, IB in 1, and IIIA in 2. Our report, however, only examined those patients who underwent surgical intervention, so it does not represent a complete description of all patients in our CT screening trial with ground-glass opacities. We eagerly await continued reporting from the radiology literature about the entire spectrum of patients found to have ground-glass opacity on a screening CT.

The question regarding computer-aided diagnosis for enlargement of small nodules is provocative. Three-dimensional computer-aided diagnosis is clearly superior to 2-dimensional human measurement. This would be the preferred technique only when it can be smoothly automated for efficient use in day-to-day practice.1

References

  1. Revel MP, Lefort C, Bissery A, Bienvenu M, Aycard L, Chatellier G, et al. Pulmonary nodules. preliminary experience with three-dimensional evaluation. Radiology 2004;231:459-466.[Abstract/Free Full Text]




This Article
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Juan Crestanello
Francis Nichols
Stephen Cassivi
Claude Deschamps
Peter Pairolero
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Right arrow Lung - cancer
Right arrow Lung - other

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