HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Haruhiko Nakayama Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nakayama, H. Articles by Ito, H. Search for Related Content PubMed Articles by Nakayama, H. Articles by Ito, H. Related Collections Related Article

---

Correspondence

Reply

Division of Thoracic Surgery, Thoracic Oncology, and Pathology, Kanagawa Cancer Center, Yokohama, 241-0815 Japan

(Email: nakayama-h{at}kcch.jp).

To the Editor:

We appreciate the comments by Pramesh and colleagues [1] concerning our article [2]. We would like to make the following comments concerning sublobar resection for possibly indolent adenocarcinomas (AC) as evaluated by high-resolution computed tomography (HRCT).

At present, we believe that lobectomy remains the standard procedure of choice for most peripheral, clinical T1N0M0 nonsmall cell lung cancers [3]. However, there is no doubt that the increased use of computed tomography (CT) coupled with advances in pathologic and CT evaluations of early AC of the lung have led many thoracic surgeons to reassess the potential benefits of sublobar resection for these indolent carcinomas. The histologic classification of the World Health Organization defines localized bronchioloalveolar carcinoma (BAC) as noninvasive AC without vascular, stromal, or pleural involvement [4]. Lymph node metastasis has not been found in patients with localized BAC. Therefore, sublobar resection may be an appropriate treatment option for patients with localized BAC or minimally invasive adenocarcinomas consisting mainly of BAC [5]. Because ground glass opacity (GGO) on HRCT images reflects the presence of BAC components, the proportion of GGO to the entire tumor is directly related to tumor histology and biological behavior. The tumor disappearance rate (TDR) on HRCT, evaluated in our study, more strongly correlates with the BAC proportion than does the GGO ratio [6]. On the basis of our results, we have a started prospective trial designed to clarify the feasibility of sublobar resection for small AC with a TDR of 50% or higher on HRCT images [7].

Recently, the Japan Clinical Oncology Group (JCOG) has completed a large, prospective, multicenter trial evaluating the relation between radiologic and pathologic findings in peripheral clinical T1N0M0 AC of the lung (JCOG 0201) [8]. In this trial, radiologic noninvasive cancer was defined as a tumor with a solid component equivalent to less than half of the maximum tumor dimension on preoperative HRCT imaging. A pathologic noninvasive AC was defined as a tumor with no lymph node metastasis, lymphatic invasion, or vascular invasion to be considered a candidate for limited resection. Patients underwent lobectomy and standard lymph node dissection. The primary endpoint was to determine the specificity of HRCT, defined as the proportion of patients with radiologically diagnosed invasive AC among patients with pathologically diagnosed invasive AC. The specificity and sensitivity of HRCT for the diagnosis of noninvasive AC were 96.4% and 30.4%, respectively. On the basis of the results of JCOG trial 0201, JCOG is planning a prospective phase 2 trial to study the feasibility of performing sublobar resection for small and indolent ACs having a tumor diameter of 2 cm or less and a solid component ratio of 25% or less on HRCT.

	References

Top References

 

1. Pramesh CS, Mistry RC, Purandare N, Agarwal JP. Can computed tomography guide the extent of surgery in early, resectable lung cancer?(letter) Ann Thorac Surg 2008;86:1723-1724.[Free Full Text]
2. Nakayama H, Yamada K, Saito H, et al. Sublobar resection for patients with peripheral small adenocarcinomas of the lung: surgical outcome is associated with features on computed tomographic imaging Ann Thorac Surg 2007;84:1675-1679.[Abstract/Free Full Text]
3. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer Ann Thorac Surg 1995;60:615-623.[Abstract/Free Full Text]
4. Travis WD, Colby TV, Corrin B, Shimosato Y, Brambilla E. Histologic typing of lung and pleural tumours. World Health Organization international histological classification of tumours. Berlin: Springer; 1999.
5. Rusch VW, Tsuchiya R, Tsuboi M, Pass HI, Grunenwald D, Goldstraw P. Surgery for bronchioloalveolar carcinoma and "very early" adenocarcinoma: an evolving standard of care? J Thorac Oncol 2006;1:S27-S31.
6. Okada M, Nishio W, Sakamoto T, et al. Correlation between computed tomographic findings, bronchioloalveolar carcinoma component, and biologic behavior of small-sized lung adenocarcinoma J Thorac Cardiovasc Surg 2004;127:857-861.[Abstract/Free Full Text]
7. Yoshida J, Ishii G, Nagai K, et al. Limited resection trial for pulmonary ground-glass opacity nodules: case selection based on high resolution computed tomography J Thorac Oncol 2007;2:S796-S797.
8. Suzuki K, Koike T, Shibata M, et al. Evaluation of radiologic diagnosis in peripheral clinical IA lung cancers – a prospective study for radiological diagnosis of peripheral early lung cancer (JCOG 0201) J Clin Oncol 2006;24:419S.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Haruhiko Nakayama Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nakayama, H. Articles by Ito, H. Search for Related Content PubMed Articles by Nakayama, H. Articles by Ito, H. Related Collections Related Article