From focal pulmonary pure ground-glass opacity nodule detected by low-dose computed tomography into invasive lung adenocarcinoma: A growth pattern analysis in the elderly

Background Methods Elderly patients are under-represented in studies of pure ground-glass opacity (pGGO) nodules; thus, this study analyzed the growth pattern and clinical outcomes of pGGO nodules in the elderly in order to help make treatment decisions. We retrospectively reviewed patients aged over 60 years with screening-detected and pathologically confirmed growing focal pGGO nodules. Results Conclusions During the study period, 858 subjects had undergone at least three low-dose computed tomography scans in our center. Twenty patients were treated for growing focal pGGO nodules. The median age at detection was 66 years (range: 60-80). The median time to an increase of at least 2 mm was 348 days (range: 98-1527) and to develop a solid portion, 1141 days (range: 480-3010). Seven patients had surgery for increased nodule size, four had surgery immediately after the solid portion appeared, and nine were treated after a median follow-up of 1153 days (range: 240-2342) since the solid portion developed. The median size of the solid component was 8 mm (2-13) before surgery. No recurrence was observed after a median follow-up of 41 months. Pathology revealed adenocarcinoma in situ in five patients, and minimally invasive or invasive adenocarcinoma in the remainder. The appearance of a solid portion was significantly associated with invasive adenocarcinoma compared to increased size alone (100% vs. 44.4%; P = 0.005). pGGO nodules had an indolent growth pattern and good prognosis in our patient sample, even after the appearance of a solid portion. Therefore, minimally invasive surgery after the development of a solid component may be an option for the elderly.