The Discussion Of Diagnostic And Therapeutic Strategy Of Small Peripheral Lung Adenocarcinoma With The Feathure Of GGO On CT

BackgroundIn recent years, the clinical use of high-resolution computed tomography has greatly advanced the diagnosis of small lesions of the peripheral lung. The thoracic surgeons are facing more and more such lesions, but how to diagnose and cope with them has become a problem. The small peripheral lung carcinoma are defined as the primary carcinomas whose diameter are smaller than 2cm and are originated from the epithelial cells of bronchus lower than the segmental ones. Such small lesions are often associated with ground-glass opacity in computed tomography findings. The noninvasive bronchioloalveolar carcinoma component with a replacement growth pattern of alveolar lining cells manifests as ground-glass opacity. FDG PET, that can reveal the malignant aggressiveness of a tumor based on preferential glucose uptake and metabolism has recently become available. The use of FDG PET in the evaluation of lung cancer is thought to assist in differentiating malignant pulmonary nodules from benign nodules and in detecting regional lymph nodes(N-staging) or distant metastases(M-staging). Bronchioloalveolar carcinoma is classified as a subset of lung adenocarcinoma, but has a distinct clinical presentation, tumor biology, and favorable prognosis. Generally, these lesions have comparatively low malignancy and better prognosis, so as for the ground-glass opacity type of tiny lesions, particularly those less than 1 cm in their greatest dimension, the question has been raised whether lobectomy is really needed. It is suggested that the suitability of limited resection including segmentectomy and wedge resection without any nodal dissections for these small lung adenocarcinomas by a lot of recent researches, but this procedure should be validated in future clinical trials.Objective and MethodThis research makes a summary of the pathologic features, biologic characters, natural history, medical images and surgerys of the small peripheral lung adenocarcinomas from consulting a lot of recent researches, in order to inform more about these particular carcinomas as the foundation of exploring the standard of proper treatment in the future.ConclusionsThe small peripheral lung adenocarcinomas with the features of GGO, especially the small adenocarcinomas including BAC represents a lot of unique pathologic, biologic characters and spescial natural history, medical images and surgerys. More and more surgeons have tried to use the minimal-ivasive operations such as the wedge resection or segmentectomy instead of the traditional lobectomy, because these lesions have lower invasiveness and better prognosis.A great deal of clinical trials need to be done to determine the suitable group of patients who are ought to be taken these minimal-invasive operations, while further researches in the relationship among the clinical images, biological characteristics and the pathologic features of the specific lesions are obviously more important, for example, make details of the inner relationships between the density and size of lesions presented on HRCT and the FDG uptake on FDG PET, or explore the relationship between the molecular mutation inside the tumor cells and the pathologic features, in order to get a persuasive conclusion.