From focal pulmonary pure ground-glass opacity nodule detected by low-dose computed tomography into invasive lung adenocarcinoma: A growth pattern analysis in the elderly

Background: Elderly patients are under-represented in studies of pure ground-glass opacity (pGGO) nodules; thus, this study analyzed the growth pattern and clinical outcomes of pGGO nodules in the elderly in order to help make treatment decisions.

Methods: We retrospectively reviewed patients aged over 60 years with screening-detected and pathologically confirmed growing focal pGGO nodules.

Results: During the study period, 858 subjects had undergone at least three low-dose computed tomography scans in our center. Twenty patients were treated for growing focal pGGO nodules. The median age at detection was 66 years (range: 60-80). The median time to an increase of at least 2 mm was 348 days (range: 98-1527) and to develop a solid portion, 1141 days (range: 480-3010). Seven patients had surgery for increased nodule size, four had surgery immediately after the solid portion appeared, and nine were treated after a median follow-up of 1153 days (range: 240-2342) since the solid portion developed. The median size of the solid component was 8 mm (2-13) before surgery. No recurrence was observed after a median follow-up of 41 months. Pathology revealed adenocarcinoma in situ in five patients, and minimally invasive or invasive adenocarcinoma in the remainder. The appearance of a solid portion was significantly associated with invasive adenocarcinoma compared to increased size alone (100% vs. 44.4%; P = 0.005).

Conclusions: pGGO nodules had an indolent growth pattern and good prognosis in our patient sample, even after the appearance of a solid portion. Therefore, minimally invasive surgery after the development of a solid component may be an option for the elderly.