Limited resection trial for pulmonary ground-glass opacity nodules: fifty-case experience

J Thorac Cardiovasc Surg. 2005 May;129(5):991-6. doi: 10.1016/j.jtcvs.2004.07.038.


Objective: This study was undertaken to determine the recurrence rate after limited resection of small lung carcinoma and to evaluate intraoperative frozen-section examination accuracy for Noguchi classification.

Methods: Enrollment requirements were as follows: pulmonary nodule 2 cm or smaller, diagnosed or suspected clinical T1 N0 M0 carcinoma in the lung periphery, and ground-glass opacity findings and lack of evident pleural indentations or vascular convergence on high-resolution computed tomographic scan. A wedge or segmental resection specimen, removed with custom stapler cartridges, was immediately reinflated and examined by frozen-section with hematoxylin-eosin and Victoria blue-van Gieson stains. If the tumor was confirmed as Noguchi type A or B with resection margins greater than 1 cm, the patient was closed and followed up on an outpatient basis. End points were 5-year disease-free survival and intraoperative classification accuracy.

Results: From August 1998 through October 2002, a total of 50 patients were enrolled (20 men and 30 women, ages 30-77 years). Tumor sizes ranged from 2 to 21 mm (11 mm average). There were 2 Noguchi type A tumors, 23 Noguchi type B tumors, 15 Noguchi type C tumors, 5 atypical adenomatous hyperplasias, 4 fibroses, and 1 granuloma. Frozen-section accuracy was approximately 98% (39/40). One intraoperative type B diagnosis was revised to type C after postoperative pathologic study. No morbidity, mortality, or recurrence has been seen with a median follow-up of 50 months.

Conclusion: Noguchi type A and B tumors may well be in situ carcinomas, and frozen-section examination was highly accurate. Neither local recurrence nor distant metastases have been found to date. Limited resection initial results appear promising.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Algorithms
  • Decision Trees
  • Disease-Free Survival
  • Equipment Design
  • Female
  • Follow-Up Studies
  • Frozen Sections / methods*
  • Frozen Sections / standards
  • Humans
  • Intraoperative Care / methods*
  • Intraoperative Care / standards
  • Japan / epidemiology
  • Lung Neoplasms / classification
  • Lung Neoplasms / mortality
  • Lung Neoplasms / pathology*
  • Lung Neoplasms / surgery*
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Recurrence, Local / etiology
  • Neoplasm Staging / methods
  • Neoplasm Staging / standards
  • Patient Selection
  • Pneumonectomy / instrumentation
  • Pneumonectomy / methods*
  • Prognosis
  • Surgical Staplers
  • Thoracoscopy
  • Thoracotomy
  • Treatment Outcome