Page 29 - Delaware Medical Journal - November/December 2020

DIAGNOSIS
Fleischner Society recommends biopsy or surgical resection of part-solid 5-10mm GGOs if the nodule is 5mm or more and the lesion persists on repeat CT scans.10 Others suggest intervention when the GGO and/or the nodule increase in size.5
SURGERY
In a seminal article in 1995 that compared lobectomy with limited resection for T1 N0 lung tumors, Ginsberg concluded that lobectomy
was the procedure of choice for these lesions — the gold standard.11 While that mode of therapy has been firmly entrenched in the thoracic surgery literature for years, a number of investigators are now reporting that sublobar resection of CT-detected small lung tumors may be adequate for most
REFERENCES
patients; perhaps the “gold” standard has lost its luster.12,13
While Nakayama in a report in 2007 acknowledged that sublobar resection of pure ground-glass tumors was controversial, none of 46 tumors resected in his study recurred after
a mean follow-up of 70 months.13 Likewise, Yamashita reported no difference in recurrence rates when comparing sublobar resections and lobectomies in small CT-detected tumors.12 Although this is still an unsettled issue among surgeons, the trend has shifted to sublobar surgery when possible for CT-detected tumors.
CONCLUSION
The management of small peripheral lung tumors calls for a
multidisciplinary team of oncologists, radiologists, pathologists, and surgeons. This will ensure that collaborative decision making leads to sheltering patients from overdiagnosis and overtreatment when appropriate, and likewise leads to aggressive treatment for those patients whose nodules (by size and imaging features) suggest the potential for invasiveness and metastasis. It may well be that this approach will increase survival rates.
CONTRIBUTOR
JAMES F. LALLY, MD is a retired radiologist and a member of the Medical Society of Delaware Editorial Board. In the early 2000s, he was the principal radiologist in the Helen F. Graham Cancer Center’s early lung-cancer screening program.
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