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EDITORIAL
Year : 2019  |  Volume : 15  |  Issue : 2  |  Page : 265-266

Computed tomography-guided percutaneous microwave ablation: A new weapon to treat ground-glass opacity–lung adenocarcinoma


1 Department of Radiology, Ben Gurion University, Beersheba, Israel, China
2 Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China

Date of Web Publication1-Apr-2019

Correspondence Address:
Dr. Xin Ye
Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_65_19

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How to cite this article:
Hertzanu Y, Ye X. Computed tomography-guided percutaneous microwave ablation: A new weapon to treat ground-glass opacity–lung adenocarcinoma. J Can Res Ther 2019;15:265-6

How to cite this URL:
Hertzanu Y, Ye X. Computed tomography-guided percutaneous microwave ablation: A new weapon to treat ground-glass opacity–lung adenocarcinoma. J Can Res Ther [serial online] 2019 [cited 2019 May 21];15:265-6. Available from: http://www.cancerjournal.net/text.asp?2019/15/2/265/255103



The increasingly widespread use of computed tomography (CT), the increased resolution of CT imaging and the advent of CT screening for lung cancer, will increase the incidence of ground-glass opacity (GGO) nodules detected and referred for diagnostic evaluation and management.

GGO nodules remain a diagnostic challenge. GGO nodules are defined radiologically as focal areas of slightly increased CT attenuation through which the normal lung parenchyma structures, airways, and vessels are visually preserved. GGO nodules also referred to as subsolid nodules, are radiologically divided into two categories: Pure GGO nodules, which contain no solid component and part-solid GGO nodules, which contain both a pure GGO region and a consolidated region (also called mixed GGO nodules). GGO is a rather unspecific radiologic feature seen in a number of clinical conditions involving different pathologic processes. Apart from malignant disease, GGO changes can represent atypical adenomatous hyperplasia, lung infections, hemorrhage, lung edema with fluid in the interstitium, patchy increased parenchymal perfusion (i.e., mosaic perfusion), or interstitial diseases some representing irreversible changes with future development of fibrosis. Solid transformation favors the diagnostic of malignancy. In semisolid pattern or CT solid pattern on CT, biopsy is essential. The accuracy rate of a CT-guided core needle biopsy for nodules with GGO depends on the lesion diameter and the proportion of the GGO component.[1],[2],[3],[4]

Several sets of guidelines are already available for the management of subsolid nodules found on CT scans screening. They include Fleischner Society, British Thoracic Society, Dutch-Belgian NELSON trial, and Japanese Society of CT Screening. All these guidelines (slightly differ) include growth in linear measures. Most studies have used linear measurements. An increase of 2 mm or more in the maximum diameter of a GGO nodule was considered significant and suggestive of malignancy. Growth in volume. A large amount of studies suggest that growth and solid transformation of GGO nodules are indicators of malignancy. Scan intervals and length of follow-up. Scan intervals and length of follow-up differ according with the patient history, risk factors (smoking) and size lesion. Persisting GGO nodules larger than 5 mm should be followed for at least 4 years.

The standard of care, surgical treatment of early lung cancer is still suggested as minimally invasive lobectomy with systematic lymph node dissection. In some cases, sublobar resection may offer the same long-term survival as lobectomy. Many of these patients are older with comorbidity diseases which limit surgical approach. The identification of so-called “high-risk” patients remains a clinical decision. A multidisciplinary team indicated the procedure that best met each patient's situation. Restricted cardiac and pulmonary function are the primary indication for alternative tumor therapy.

For high-surgical-risk patients, or refuse surgery the literature deal with promising results for minimally percutaneous invasive therapies such as image-guided radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation and laser-induced thermal ablation.[5],[6],[7],[8] All these procedures may be performed under conscious sedation or rarely general anesthesia and may be repeated. All of them reduced costs and short hospital stay.

Compare with RFA, MWA results in a much larger zone of active heating, a larger ablation zone, a shorter procedure time which could lead to a better local disease control and long-term survival. There are a few articles about the value of RFA or cryoablation in treating GGO–lung adenocarcinoma.[9],[10],[11] The use of MWA in treating GGO seldom mentions in literatures.

The article by Yang et al.[12] is a retrospective, multicenter study with a total of 51 patients-significant number compared with other published work. As an overall, the article is very well-being written. The introduction methods discussion and conclusion are comprehensive and very clear. The reference is covering most of the important articles. The technical success rate was 100%. There was no major complication after procedures. The procedure seems to be safe and effective technique. The follow-up confirmed the value of MWA in treating very early lung cancer. The results are encouraging and may represent a solution for inoperable patients and an alternative treatment of GGO. This is a very important article and great contribution for GGO-lung adenocarcinoma treatment. Certainly, there were some limitations in the article. The main limitations were its retrospective nature, relatively short followup duration after addressing GGO lesions, as well as small sample size.

Further prospective investigations with multicenter study and long-term follow-up would be necessary to better clarify the role of MWA as an alternative and possible first choice for GGO. Furthermore, MWA should be compared with other therapies, such as surgery, stereotactic radiotherapy, or other local ablation techniques.

In the near future, we believe that thermal ablation will definitely become a new weapon to treat GGO–lung adenocarcinoma.



 
 > References Top

1.
Yu H, Zhang C, Liu S, Jiang G, Li S, Zhang L, et al. Application value of coaxial biopsy system in needle cutting biopsy for focal ground glass-like density nodule. J Cancer Res Ther 2018;14:1509-14.  Back to cited text no. 1
    
2.
Hur J, Lee HJ, Nam JE, Kim YJ, Kim TH, Choe KO, et al. Diagnostic accuracy of CT fluoroscopy-guided needle aspiration biopsy of ground-glass opacity pulmonary lesions. AJR Am J Roentgenol 2009;192:629-34.  Back to cited text no. 2
    
3.
Yamauchi Y, Izumi Y, Nakatsuka S, Inoue M, Hayashi Y, Mukai M, et al. Diagnostic performance of percutaneous core needle lung biopsy under multi-CT fluoroscopic guidance for ground-glass opacity pulmonary lesions. Eur J Radiol 2011;79:e85-9.  Back to cited text no. 3
    
4.
Ji Z, Wang G, Chen B, Zhang Y, Zhang L, Gao F, et al. Clinical application of planar puncture template-assisted computed tomography-guided percutaneous biopsy for small pulmonary nodules. J Cancer Res Ther 2018;14:1632-7.  Back to cited text no. 4
    
5.
Xiong L, Dupuy DE. Lung ablation: Whats new? J Thorac Imaging 2016;31:228-37.  Back to cited text no. 5
    
6.
Nour-Eldin NA, Exner S, Al-Subhi M, Naguib NN, Kaltenbach B, Roman A, et al. Ablation therapy of non-colorectal cancer lung metastases: Retrospective analysis of tumour response post-laser-induced interstitial thermotherapy (LITT), radiofrequency ablation (RFA) and microwave ablation (MWA). Int J Hyperthermia 2017;33:820-9.  Back to cited text no. 6
    
7.
Ye X, Fan W, Wang H, Wang J, Wang Z, Gu S, et al. Expert consensus workshop report: Guidelines for thermal ablation of primary and metastatic lung tumors (2018 edition). J Cancer Res Ther 2018;14:730-44.  Back to cited text no. 7
    
8.
Yang X, Ye X, Huang G, Han X, Wang J, Li W, et al. Repeated percutaneous microwave ablation for local recurrence of inoperable stage I nonsmall cell lung cancer. J Cancer Res Ther 2017;13:683-8.  Back to cited text no. 8
    
9.
Kodama H, Yamakado K, Hasegawa T, Takao M, Taguchi O, Fukai I, et al. Radiofrequency ablation for ground-glass opacity-dominant lung adenocarcinoma. J Vasc Interv Radiol 2014;25:333-9.  Back to cited text no. 9
    
10.
Iguchi T, Hiraki T, Gobara H, Fujiwara H, Matsui Y, Soh J, et al. Percutaneous radiofrequency ablation of lung cancer presenting as ground-glass opacity. Cardiovasc Intervent Radiol 2015;38:409-15.  Back to cited text no. 10
    
11.
Kim KY, Jin GY, Han YM, Lee YC, Jung MJ. Cryoablation of a small pulmonary nodule with pure ground-glass opacity: A case report. Korean J Radiol 2015;16:657-61.  Back to cited text no. 11
    
12.
Yang X, Ye X, Lin Z, Jin Y, Zhang K, Dong Y, et al. Computed tomography-guided percutaneous microwave ablation for treatment of peripheral ground-glass opacity-lung adenocarcinoma: A pilot study. J Cancer Res Ther 2018;14:764-71.  Back to cited text no. 12
    




 

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