Partly solid pulmonary nodules: waiting for change or surgery outright?

It has been assumed that if the prognosis and rate of lymph node metastases differ between two groups of patients being followed up for partly solid tumours, those with an increased solid component and those without change, these differences can help to decide on the time of surgery for patients with partly solid tumours. Therefore, this study compared the differences in pathological results and prognosis after surgical resection between patients with no change and and those with change in partly solid tumours during the preoperative period.

Surgery was performed in patients who had an increased size of the solid component during the follow-up observation of partly solid tumours, as well as patients who had no change in the size of the solid component during a certain period of time. The 'No change group' in this study comprised those who had no change in at least two chest computed tomography scans during a minimum period of 6 months, but who underwent surgery.

Twenty-four patients were enrolled in this study. Among these patients, 14 were included in the No change group, and ten were included in the 'Change group'. There was no difference in the ratio of other postoperative pathological results, adenocarcinoma in situ, minimally invasive adenocarcinoma or invasive adenocarcinoma between the two groups. There was no difference in the pathological size of the tumour, including the in situ component between the two groups, but the size of the invasive component in the Change group was 2.5-fold that of the No change group, a statistically significant difference. During the median follow-up period of 59 months, neither recurrence nor cancer-related deaths occurred.

The pathological results and prognosis of lung cancer patients with persistent partly solid tumours who develop changes in their lesions after a certain period of follow-up time were not different from those of patients who did not develop any changes in the lesions. Therefore, surgery can be deferred until those lesions demonstrate changes in size or growth in their solid component when the overall size of ground-glass opacity (GGO) is less than 3 cm and the proportion of GGO is greater than 50%.