Pulmonary resection for bilateral multiple focal lesions of ground-glass attenuation

Abstract

Atypical adenomatous hyperplasia (AAH) and bronchioalveolar carcinoma (BAC) often occur as multiple focal lesions, showing ground-glass attenuation (GGA) on high resolution CT (HRCT) scans. Here we report consecutive nine cases of bilateral multiple lesions of GGA, more than three lesions at least per patient, operated on from 1992 to 2008. The male-to-female ratio was 2 : 7. They had a total of 60 lesions, including 53 GGA lesions. Thirty-two GGA focal lesions were surgically resected, and their histological types included AAH in six lesions, BAC in 16, others in five, and non-neoplastic in five. There were two deaths. One patient died of contralateral lymph node recurrence and the other died of residual pure GGA growth despite stereotactic radiation therapy (SRT). In the survived patients, no new lesions have appeared, and their lesions remain less than 9 mm in diameter showing no increasing tendency. It might be desirable to perform radical surgical resection for focal lesions of GGA more than 10 mm in diameter. Only unresectable lesions should be indicated further treatments including re-operation, SRT, radiofrequency ablation and molecular targeting therapy.