Skip to main content

Pure Ground-Glass Nodules

  • Chapter
  • First Online:
Early-stage Lung Cancer
  • 1026 Accesses

Abstract

There is currently an attempt to establish a categorization system for ground-glass nodules to guide the management and prognosis of pulmonary adenocarcinoma, based on multidisciplinary consensus. Ground-glass lesions can present as part of various pathologic entities, including tumors, infections, focal hemorrhage, and focal interstitial fibrosis. Imaging features from a single CT examination are not sufficient for a definitive diagnosis of the lesions. Comparative studies with routine imaging follow-up are helpful for differentiation, particularly when a patient’s clinical status is considered. Rich vasculature within and/or around ground-glass nodules (GGNs) can form the characteristic “CTA-TA” sign during enhancement CT imaging. As a significant point of distinction and one of several key differentiation points between AIS and AAH, the CTA-TA sign will be discussed in detail in this chapter.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Tuddenham WJ. Glossary of terms for thoracic radiology: recommendations of the Nomenclature Committee of the Fleischner Society. AJR Am J Roentgenol. 1984;143(3):509–17. https://doi.org/10.2214/ajr.143.3.509.

    Article  CAS  PubMed  Google Scholar 

  2. Austin JH, Muller NL, Friedman PJ, Hansell DM, Naidich DP, Remy-Jardin M, Webb WR, Zerhouni EA. Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. Radiology. 1996;200(2):327–31. https://doi.org/10.1148/radiology.200.2.8685321.

    Article  CAS  PubMed  Google Scholar 

  3. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;246(3):697–722. https://doi.org/10.1148/radiol.2462070712.

    Article  PubMed  Google Scholar 

  4. Kawakami S, Sone S, Takashima S, Li F, Yang ZG, Maruyama Y, Honda T, Hasegawa M, Wang JC. Atypical adenomatous hyperplasia of the lung: correlation between high-resolution CT findings and histopathologic features. Eur Radiol. 2001;11(5):811–4. https://doi.org/10.1007/s003300000790.

    Article  CAS  PubMed  Google Scholar 

  5. Kim CF, Jackson EL, Woolfenden AE, Lawrence S, Babar I, Vogel S, Crowley D, Bronson RT, Jacks T. Identification of bronchioalveolar stem cells in normal lung and lung cancer. Cell. 2005;121(6):823–35. https://doi.org/10.1016/j.cell.2005.03.032.

    Article  CAS  PubMed  Google Scholar 

  6. Kim H, Park CM, Koh JM, Lee SM, Goo JM. Pulmonary subsolid nodules: what radiologists need to know about the imaging features and management strategy. Diagn Interv Radiol. 2014;20(1):47–57. https://doi.org/10.5152/dir.2013.13223.

    PubMed  Google Scholar 

  7. Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, Beer DG, Powell CA, Riely GJ, Van Schil PE, Garg K, Austin JH, Asamura H, Rusch VW, Hirsch FR, Scagliotti G, Mitsudomi T, Huber RM, Ishikawa Y, Jett J, Sanchez-Cespedes M, Sculier JP, Takahashi T, Tsuboi M, Vansteenkiste J, Wistuba I, Yang PC, Aberle D, Brambilla C, Flieder D, Franklin W, Gazdar A, Gould M, Hasleton P, Henderson D, Johnson B, Johnson D, Kerr K, Kuriyama K, Lee JS, Miller VA, Petersen I, Roggli V, Rosell R, Saijo N, Thunnissen E, Tsao M, Yankelewitz D. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol. 2011;6(2):244–85. https://doi.org/10.1097/JTO.0b013e318206a221.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Brownlee NA, Mott RT, Mahar A, Roggli VL. Mucinous (colloid) adenocarcinoma of the lung. Arch Pathol Lab Med. 2005;129(1):121–2. https://doi.org/10.1043/1543-2165(2005)129<121:mcaotl>2.0.co;2.

    PubMed  Google Scholar 

  9. Leibovich SJ, Wiseman DM. Macrophages, wound repair and angiogenesis. Prog Clin Biol Res. 1988;266:131–45.

    CAS  PubMed  Google Scholar 

  10. Weidner N, Carroll PR, Flax J, Blumenfeld W, Folkman J. Tumor angiogenesis correlates with metastasis in invasive prostate carcinoma. Am J Pathol. 1993;143(2):401–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Weidner N, Semple JP, Welch WR, Folkman J. Tumor angiogenesis and metastasis—correlation in invasive breast carcinoma. N Engl J Med. 1991;324(1):1–8. https://doi.org/10.1056/nejm199101033240101.

    Article  CAS  PubMed  Google Scholar 

  12. Bergers G, Benjamin LE. Tumorigenesis and the angiogenic switch. Nat Rev Cancer. 2003;3(6):401–10. https://doi.org/10.1038/nrc1093.

    Article  CAS  PubMed  Google Scholar 

  13. Mori K, Saitou Y, Tominaga K, Yokoi K, Miyazawa N, Okuyama A, Sasagawa M. Small nodular lesions in the lung periphery: new approach to diagnosis with CT. Radiology. 1990;177(3):843–9. https://doi.org/10.1148/radiology.177.3.2243999.

    Article  CAS  PubMed  Google Scholar 

  14. Yang X, Yan H, Liu H, Xie Y, Hu M, Soimakallio S. Vascular manifestations of small solitary pulmonary masses. Angiographic-pathologic correlations and clinical significance. Investig Radiol. 1996;31(5):275–9.

    Article  CAS  Google Scholar 

Suggested Readings

  1. Aberle DR, Berg CD, Black WC, Church TR, Fagerstrom RM, Galen B, Gareen IF, Gatsonis C, Goldin J, Gohagan JK, Hillman B, Jaffe C, Kramer BS, Lynch D, Marcus PM, Schnall M, Sullivan DC, Sullivan D, Zylak CJ. The National Lung Screening Trial: overview and study design. Radiology. 2011;258(1):243–53. https://doi.org/10.1148/radiol.10091808.

    Article  PubMed  Google Scholar 

  2. Akashita S, Tachibana Y, Sakamaki K, Sogawa K, Inoue T. Detection of pure ground-glass nodules in the lung by low-dose multi-detector computed tomography, with use of an iterative reconstruction method: a comparison with conventional image reconstruction by the filtered back-projection method. Jpn J Radiol. 2015;33(3):113–21. https://doi.org/10.1007/s11604-014-0384-z.

    Article  PubMed  Google Scholar 

  3. Ashida C, Zerhouni EA, Fishman EK. CT demonstration of prominent right hilar soft tissue collections. J Comput Assist Tomogr. 1987;11(1):57–9.

    Article  CAS  PubMed  Google Scholar 

  4. Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, Byers T, Colditz GA, Gould MK, Jett JR, Sabichi AL, Smith-Bindman R, Wood DE, Qaseem A, Detterbeck FC. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA. 2012;307(22):2418–29. https://doi.org/10.1001/jama.2012.5521.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Bak SH, Lee HY, Kim JH, Um SW, Kwon OJ, Han J, Kim HK, Kim J, Lee KS. Quantitative CT scanning analysis of pure ground-glass opacity nodules predicts further CT scanning change. Chest. 2016;149(1):180–91. https://doi.org/10.1378/chest.15-0034.

    Article  PubMed  Google Scholar 

  6. Chang B, Hwang JH, Choi YH, Chung MP, Kim H, Kwon OJ, Lee HY, Lee KS, Shim YM, Han J, Um SW. Natural history of pure ground-glass opacity lung nodules detected by low-dose CT scan. Chest. 2013;143(1):172–8. https://doi.org/10.1378/chest.11-2501.

    Article  PubMed  Google Scholar 

  7. Cho S, Yang H, Kim K, Jheon S. Pathology and prognosis of persistent stable pure ground-glass opacity nodules after surgical resection. Ann Thorac Surg. 2013;96(4):1190–5. https://doi.org/10.1016/j.athoracsur.2013.05.062.

    Article  PubMed  Google Scholar 

  8. Gaeta M, Barone M, Russi EG, Volta S, Casablanca G, Romeo P, La Spada F, Minutoli A. Carcinomatous solitary pulmonary nodules: evaluation of the tumor-bronchi relationship with thin-section CT. Radiology. 1993;187(2):535–9. https://doi.org/10.1148/radiology.187.2.8475303.

    Article  CAS  PubMed  Google Scholar 

  9. Gao F, Li M, Ge X, Zheng X, Ren Q, Chen Y, Lv F, Hua Y. Multi-detector spiral CT study of the relationships between pulmonary ground-glass nodules and blood vessels. Eur Radiol. 2013;23(12):3271–7. https://doi.org/10.1007/s00330-013-2954-3.

    Article  PubMed  Google Scholar 

  10. Hall FM. Fleischner Society glossary of terms: infiltrates. Radiology. 2008;248(3):1083. https://doi.org/10.1148/radiol.2483080610.

    Google Scholar 

  11. Hendee WR, O'Connor MK. Radiation risks of medical imaging: separating fact from fantasy. Radiology. 2012;264(2):312–21. https://doi.org/10.1148/radiol.12112678.

    Article  PubMed  Google Scholar 

  12. Henschke CI, Yankelevitz DF, Libby DM, Pasmantier MW, Smith JP, Miettinen OS. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med. 2006;355(17):1763–71. https://doi.org/10.1056/NEJMoa060476.

    Article  PubMed  Google Scholar 

  13. Ichinose J, Kohno T, Fujimori S, Harano T, Suzuki S, Fujii T. Invasiveness and malignant potential of pulmonary lesions presenting as pure ground-glass opacities. Ann Thorac Cardiovasc Surg. 2014;20(5):347–52.

    Article  PubMed  Google Scholar 

  14. Kaneda H, Nakano T, Taniguchi Y, Saito T, Konobu T, Saito Y. A decrease in the size of ground glass nodules may indicate the optimal timing for curative surgery. Lung Cancer. 2014;85(2):213–7. https://doi.org/10.1016/j.lungcan.2014.05.015.

    Article  PubMed  Google Scholar 

  15. Kitami A, Sano F, Hayashi S, Suzuki K, Uematsu S, Kamio Y, Suzuki T, Kadokura M, Omatsu M, Kunimura T. Correlation between histological invasiveness and the computed tomography value in pure ground-glass nodules. Surg Today. 2016;46(5):593–8. https://doi.org/10.1007/s00595-015-1208-1.

    Article  PubMed  Google Scholar 

  16. Kudo Y, Matsubayashi J, Saji H, Akata S, Shimada Y, Kato Y, Kakihana M, Kajiwara N, Ohira T, Nagao T, Ikeda N. Association between high-resolution computed tomography findings and the IASLC/ATS/ERS classification of small lung adenocarcinomas in Japanese patients. Lung Cancer. 2015;90(1):47–54. https://doi.org/10.1016/j.lungcan.2015.07.007.

    Article  PubMed  Google Scholar 

  17. Lim HJ, Ahn S, Lee KS, Han J, Shim YM, Woo S, Kim JH, Yie M, Lee HY, Yi CA. Persistent pure ground-glass opacity lung nodules ≥10 mm in diameter at CT scan: histopathologic comparisons and prognostic implications. Chest. 2013;144(4):1291–9. https://doi.org/10.1378/chest.12-2987.

    Article  PubMed  Google Scholar 

  18. Mathews JD, Forsythe AV, Brady Z, Butler MW, Goergen SK, Byrnes GB, Giles GG, Wallace AB, Anderson PR, Guiver TA, McGale P, Cain TM, Dowty JG, Bickerstaffe AC, Darby SC. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ. 2013;346:f2360. https://doi.org/10.1136/bmj.f2360.

    Article  PubMed  PubMed Central  Google Scholar 

  19. McCollough CH. Automated data mining of exposure information for dose management and patient safety initiatives in medical imaging. Radiology. 2012;264(2):322–4. https://doi.org/10.1148/radiol.12121152.

    Article  PubMed  Google Scholar 

  20. Mets OM, de Jong PA, Scholten ET, Chung K, van Ginneken B, Schaefer-Prokop CM. Subsolid pulmonary nodule morphology and associated patient characteristics in a routine clinical population. Eur Radiol. 2017;27(2):689–96. https://doi.org/10.1007/s00330-016-4429-9.

    Article  PubMed  Google Scholar 

  21. Moon Y, Sung SW, Lee KY, Sim SB, Park JK. Pure ground-glass opacity on chest computed tomography: predictive factors for invasive adenocarcinoma. J Thorac Dis. 2016;8(7):1561–70. https://doi.org/10.21037/jtd.2016.06.34.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Park CM, Goo JM, Lee HJ, Kim KG, Kang MJ, Shin YH. Persistent pure ground-glass nodules in the lung: interscan variability of semiautomated volume and attenuation measurements. AJR Am J Roentgenol. 2010;195(6):W408–14. https://doi.org/10.2214/ajr.09.4157.

    Article  PubMed  Google Scholar 

  23. Sakai N, Yabuuchi H, Kondo M, Kojima T, Nagatomo K, Kawanami S, Kamitani T, Yonezawa M, Nagao M, Honda H. Volumetric measurement of artificial pure ground-glass nodules at low-dose CT: comparisons between hybrid iterative reconstruction and filtered back projection. Eur J Radiol. 2015;84(12):2654–62. https://doi.org/10.1016/j.ejrad.2015.08.018.

    Article  PubMed  Google Scholar 

  24. Sawada S, Yamashita N, Sugimoto R, Ueno T, Yamashita M. Long-term outcomes of patients with ground-glass opacities detected using CT scanning. Chest. 2017;151(2):308–15. https://doi.org/10.1016/j.chest.2016.07.007.

    Article  PubMed  Google Scholar 

  25. Sim HJ, Choi SH, Chae EJ, Kim HR, Kim YH, Kim DK, Park SI. Surgical management of pulmonary adenocarcinoma presenting as a pure ground-glass nodule. Eur J Cardiothorac Surg. 2014;46(4):632–636.; discussion 636. https://doi.org/10.1093/ejcts/ezu007.

    Article  PubMed  Google Scholar 

  26. Tamura T, Satoh H. Quantitative CT scanning analysis of pure ground-glass opacity nodules predicts further CT change. Chest. 2016;149(6):1586–7. https://doi.org/10.1016/j.chest.2016.03.062.

    Article  PubMed  Google Scholar 

  27. Thrall JH. Radiation exposure in CT scanning and risk: where are we? Radiology. 2012;264(2):325–8. https://doi.org/10.1148/radiol.12121137.

    Article  PubMed  Google Scholar 

  28. van Riel SJ, Sanchez CI, Bankier AA, Naidich DP, Verschakelen J, Scholten ET, de Jong PA, Jacobs C, van Rikxoort E, Peters-Bax L, Snoeren M, Prokop M, van Ginneken B, Schaefer-Prokop C. Observer variability for classification of pulmonary nodules on low-dose CT images and its effect on nodule management. Radiology. 2015;277(3):863–71. https://doi.org/10.1148/radiol.2015142700.

    Article  PubMed  Google Scholar 

  29. Yamaguchi M, Furuya A, Edagawa M, Taguchi K, Shimamatsu S, Toyokawa G, Toyozawa R, Nosaki K, Hirai F, Seto T, Takenoyama M, Ichinose Y. How should we manage small focal pure ground-glass opacity nodules on high-resolution computed tomography? A single institute experience. Surg Oncol. 2015;24(3):258–63. https://doi.org/10.1016/j.suronc.2015.08.004.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Guozhen Zhang .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Singapore Pte Ltd. and People's Military Medical Press

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Zhang, G., Zheng, X. (2018). Pure Ground-Glass Nodules. In: Zheng, X., Li, M., Zhang, G. (eds) Early-stage Lung Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-10-7596-4_6

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-7596-4_6

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-7595-7

  • Online ISBN: 978-981-10-7596-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics