The Clinical Approach to Nodular Ground Glass Opacity in the Lung

Choon-Taek Lee

doi:10.6058/jlc.2010.9.1.1

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Lee: The Clinical Approach to Nodular Ground Glass Opacity in the Lung

Original Article

J Lung Cancer 2010;9(1):1-8.

Published online: 10 January 2010

DOI: https://doi.org/10.6058/jlc.2010.9.1.1

The Clinical Approach to Nodular Ground Glass Opacity in the Lung

Choon-Taek Lee, M.D., Ph.D.

Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

Address for correspondence Choon-Taek Lee, M.D. Department of Internal Medicine, Seoul National University Bundang Hospital, 300, Gumi-dong, Bundang-gu, Seongnam 463-707, Korea Tel: 82-31-787-7002 Fax: 82-31-787-4052 E-mail: ctlee@snu.ac.kr

Received 31 May 2010 Accepted 6 June 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The introduction of low dose chest computed tomography for health screening in Korea has resulted in increased detection of solitary pulmonary nodules, including nodular ground glass opacity. In contrast to the classic solitary pulmonary nodule, nodular ground glass opacity (GGO) has special characteristics especially in Koreans. More than half of nodular GGOs are transient and they are caused by a pulmonary infiltrate of eosinophils. However, persistent nodular GGO (nGGO) showed a high malignant potential such as atypical adenomatous hyperplasia and bronchioloalveolar cell carcinoma. The increasing use of video assisted thoracoscopic surgery (VATS) for diagnosis and treatment is the current trend for managing nodular GGO. Even though lobectomy is still the standard management for malignant nGGO, limited resection (wide wedge resection or segmentectomy) is widely used for the small malignant GGO (Noguchi types A and B). Multifocal nodular GGOs are mostly of a synchronous origin rather than intrapulmonary metastasis. Therefore, aggressive surgical resection is warranted. This review contains the current concepts for managing nodular GGO and it especially focuses on the Korean data.

Keywords: Low dose CT, Nodular ground glass opacity, Video assisted thoracoscopic surgery

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Figures and Tables

Fig. 1.

Examples of nodular ground glass opacity (nGGO). (A) Pure nGGO. (B) Mixed nGGO. (C) Mixed nGGO.

Fig. 2.

Transient mixed nodular ground glass opacity (nGGO) (toxocariasis). (A) Mixed nGGO with ill-defined border. (B) Complete disappearance of nGGO after 3 months. This patient had a recent history of raw cow liver ingestion and showed blood eosinophilia and positive reaction to toxocara antigen.

Fig. 3.

Features of nodular ground glass opacity (nGGO) suggesting malignancy. (A) nGGO with air-bronchogram and pleural retraction. (B) nGGO with air-bronchogram, spiculated border with minimal fissural retraction and (C) nGGO with bubble lucency.

Fig. 4.

ACCP Recommended management algorithm for patients with SPN (including nGGO) (8∼30 mm in diameter). SPN: solitary pulmonary nodule, CT: computed tomography, pGGO: pure nodular ground glass opacity, HRCT: high-resolution CT, PET: positron emission tomography, VATS: video assisted thoracoscopic surgery (from Gould MK, et al. Chest 2007;132(3 Suppl):108S–130S, with permission from American College of Chest Physicians) (15).

Table 1.

Correlation between WHO Classification (2004), Noguchi Classification and Persistent CT GGO Findings (adapted from reference 12 with permission)

Noguchi Type (1995, small adenocarcinoma ＜2 cm)	WHO classification (2004)	GGO features in CT
	AAH	Pure GGO
A. Localized BAC	BAC (mucinous, nonmucinous and mixed	Pure GGO
	mucinous and nonmucinous or indeterminate)
B. Localized BAC with	BAC (mucinous, nonmucinous and mixed	GGO with possible solid
alveolar collapse	mucinous and nonmucinous or indeterminate)	component (mGGO)
C. Localized BAC with active	Adenocarcinoma, mixed subtype with	Part-solid nodule with increase in solid
fibroblastic proliferation	BAC component	component or solid nodule
D. Poorly differentiated	Solid adenocarcinoma with mucin	Part-solid nodule with greater increase in
		solid component or solid nodule
E. Tubular	Acinar adenocarcinoma	Part-solid nodule with greater increase in
		solid component or solid nodule
F. Papillary	Papillary adenocarcinoma	Part-solid nodule with greater increase in
		solid component or solid nodule

CT: computed tomography, GGO: ground glass opacity.

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