Management strategy and role of thermal ablation in ground-glass nodules / 中国胸心血管外科临床杂志

ABSTRACT

@#The majority of incidentally found and screen-detected lung cancer is manifested as ground-glass nodule (GGN), which is more likely to be detected in the young people, women and non-smokers. An appropriate management strategy for GGN can not only reduce the mortality of lung cancer but also minimize overtreatment. Although most of persistent GGNs are finally diagnosed as adenocarcinoma or precursor glandular lesions, the GGN-featured lung cancer is characterized as indolent growth or even non-growth. Therefore, scheduled follow-up might be safe for the special radiologic type under a certain condition. We should design the individualized diagnosis and treatment strategy for each patient. The treatment decision-making depends on various factors, including invasion, dynamic change, efficacy and safety of the treatment, as well as physical and psychic condition of the patients. Different from other types of lung cancer, the indolent feature of GGN-featured lung cancer allows a long time to intervene. Therefore, the determination of proper timing for intervention should be made cautiously. Surgical resection is still the principal treatment for GGN-featured lung cancer. However, there is still no consensus on the optimal surgical approach for GGN-featured lung adenocarcinoma. Currently, sublobar resection without lymphadenectomy has been recommended to the patients with precursor glandular lesions. In light of the GGN-featured lung cancer which generally represents a local lesion, local ablation therapies have been used in those patients, especially in the ones who are inoperable or refuse to undergo surgery. The percutaneous local ablation includes different techniques radiofrequency ablation, microwave ablation and argon-helium cryoablation. The local ablation is safe, minimally invasive and repeatable. In addition, it offers the advantage to biopsy and treatment synchronously. Percutaneous ablation has the potential to be an alternative of surgery to cure GGN-featured lung cancer based on emerging evidences. The efficacy of transbronchial ablation guided by  ultrasound or electromagnetic navigational system in the treatment of GGN-featured lung cancer has been primarily validated. As a developing technology, it might be a promising approach but needs further exploration. With the advance in ablation technology, we do believe that the interventional therapy will play an equal role as surgery in curative treatment of GGN-featured lung cancer in the future. Personalized treatment considering the condition of patients and the features of the lesion will maximize the benefit of every patient. This article will explore the diagnosis and treatment strategies of GGN on the basis of further understanding of GGN, and introduce the application of ablation therapy in GGN from the perspective of respiratory intervention.