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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,6/16/2020,#,Focal Pulmonary Ground-Glass Opacities:,8/26/2024,1,Department of Radiology, The First Peoples Hospital of Yunnan Province,Li Peng, MD,Mobile Phone:,E-mail:,LP0871,GGOs,病灶,：,CT,表现与临床处置,Department of Radiology, The First Peoples Hospital of Yunnan Province,Focal Pulmonary Ground-Glass O,8/26/2024,2,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,INTRODUCTION,DEFINITION,Ground-Glass,Opacity(GGO):,a),A,focal, noncalcified lesion,with a,slight/mild increase in CT attenuation,b),which does not obscure,underlying,bronchial,structures,or,vascular,margins,c),on,high-resolution CT (HRCT,),scan,of,the,lung parenchyma.,d),GGO lesions can be either,homogeneous or heterogeneous.,With the popularization of computed tomography (CT) in clinical practice,and the introduction of mass screening,for early lung cancer with the use of,CT, the subtle nodules or focal ground-,glass opacity,(GGO) that can hardly be,discovered by the conventional chest,X-rays have increasingly been detected.,9/1/20232 云南省第一人民医院（昆华医院）放射科D,8/26/2024,3,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Schematic drawing of CT appearance of ground-glass opacity,(GGO). In the GGO lesion, preexisting anatomical structures,such as bronchus and blood vessels are apparent.,9/1/20233 云南省第一人民医院（昆华医院）放射科D,8/26/2024,4,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,A. Normal,B. Thickened,Alveolar,Septa,C. Partial Air Space,Filling With Debris,PATHOLOGY,GGO,may be caused by partial,airspace filling, partial collapse of,alveoli, interstitial thickening with,inflammation, edema, fibrosis,neoplastic proliferation, the normal,respiratory condition or increased,pulmonary capillary blood volume.,A,B,C,9/1/20234 云南省第一人民医院（昆华医院）放射科D,8/26/2024,5,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Various CT features of ground-glass opacities (GGOs),9/1/20235 云南省第一人民医院（昆华医院）放射科D,8/26/2024,6,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,pGGO,mGGO,CLASSIFICATION,GGO,can be classified as:,pure GGO,(,pGGO,),and,mixed,GGO,(,mGGO,),based on the,presence of solid component.,9/1/20236 云南省第一人民医院（昆华医院）放射科D,8/26/2024,7,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,The,Cons/Lesion ratio is defined as line B/line A,Largest,dimension of lesion: line A and solid attenuation: line B,A,B,9/1/20237 云南省第一人民医院（昆华医院）放射科D,8/26/2024,8,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,CT appearance of a solid,nodular lesion:,The CT density of the whole area is increased,and intrinsic structures are no longer,obvious,.,9/1/20238 云南省第一人民医院（昆华医院）放射科D,8/26/2024,9,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,(1mm-thick section),A mixed ground-glass opacity lesion with a central solid,component,An irregularly shaped solid mass without nodular ground-glass opacity,(5-mm-thick section),Pitfalls in the interpretation,of GGO on CT scanning,As recognition of GGO is based on a subjective,assessment of lung,attenuation, the,parameters,that can interfere with lung density,- Window widths and levels that are too narrow,can erroneously create the appearance of GGO,- In evaluating for GGO, collimation ideally should,be 1.0 to 1.5 mm, a tube current of 200400 mA,best imaged with high-resolution CT (HRCT),- A thicker collimation sometimes results in a,pseudo-GGO pattern,Lung attenuation normally increases,homogeneously with expiration. This increased,attenuation can obscure underlying pathologic,GGO.,Cardiac and respiratory motion also can create,pseudo-GGO,GGO in the gravity dependent portions of lungs,is often seen as a result of microatelectasis,9/1/20239 云南省第一人民医院（昆华医院）放射科D,8/26/2024,10,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Causes of a diffuse pattern of GGO on CT scanning, Acute rejection of lung transplantation, Adult respiratory distress syndrome, Edema, Extrinsic allergic alveolitis, Hemorrhage, Infectious pneumonia,PATTERNS of DISTRIBUTION(1),PATTERNS,of,DISTRIBUTION:,Diffuse Pattern of GGO(dGGO,),Involving both lungs or on one side,of the lung for more than two lobes,at the same time,9/1/202310 云南省第一人民医院（昆华医院）放射科,8/26/2024,11,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Causes of a focal pattern of GGO on CT scanning, Bronchiolitis obliterans organizing pneumonia,(BOOP), Bronchoalveolar lavage, Bronchioloalveolar cell carcinoma, Hemorrhage, Pulmonary infection,PATTERNS of DISTRIBUTION(2),Focal pattern of GGO(fGGO,),Confined to a lobe or a pulmonary,segment of one side of lung,9/1/202311 云南省第一人民医院（昆华医院）放射科,Focal GGO ( fGGO ),A common and non-specific finding of lung HRCT,Focal interstitial fibrosis, inflammation, and,hemorrhage.,Bronchioloalveolar carcinoma(BAC) and early-,staged adenocarcinoma(AC), as well as in their,precancerous lesions such as atypical,adenomatous hyperplasia(,AAH).,8/26/2024,12,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Malignant,Conditions,Benign,Conditions,Focal GGO ( fGGO ) Focal,8/26/2024,13,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Normal Cell,AAH,Precancerous Lesion,BAC,Ca. in situ,Local invasive,AC,Metastasis,Malignant transformation of,GGO:,A,replacement growth pattern along the,preexisting alveolar,w,all structures (,known as lepidic growth, named after butterflies. Order lepidoptera, alighting on a branch but not disturbing it.,),9/1/202313 云南省第一人民医院（昆华医院）放射科,8/26/2024,14,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Neoplastic GGO lesions are associated with three,pathological entities,According to the World Health Organization(WHO) histological classification of,lung and pleural tumors,Atypical adenomatous hyperplasia (AAH),Nonmucinous bronchioloalveolar carcinoma (BAC),Adenocarcinoma (AC) with mixed subtypes,AAH,BAC,AC,9/1/202314 云南省第一人民医院（昆华医院）放射科,8/26/2024,15,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,PATHOLOGY:,Atypical adenomatous hyperplasia (,AAH,),A,precancerous(preinvasive),lesion,Slightly atypical tumor cells line the involved,alveoli and respiratory bronchioles with,minimal associated inflammation. Involved,alveoli are frequently clustered around a,terminal bronchiole. The cells of AAH are,sparsely concentrated along the alveoli and,have dense nuclei with inconspicuous,nucleoli.,9/1/202315 云南省第一人民医院（昆华医院）放射科,8/26/2024,16,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,PATHOLOGY:,Nonmucinous bronchioloalveolar carcinoma (,BAC,),An adenocarcinoma with Clara cells and/or,type II pneumocytes growing along alveolar,walls, and without stromal invasion,does,not metastasize,to distant sites through the blood,or,lymphatics,.,“noninvasive” growth of the tumor,a,nd this lesion could be considered in situ,carcinom,a.,9/1/202316 云南省第一人民医院（昆华医院）放射科,8/26/2024,17,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,PATHOLOGY:,A,denocarcinoma(,AC,) with mixed subtypes,A mixture of histologic subtypes as well as obvious invasive growth.,Extension of nests of,gland-like,cells frequently containing mucus vacuoles into a proliferative, fibroblastic stroma with destruction of bronchi and alveolar walls.,Spread of invasive adenocarcinoma is typically by LN or hematogenous,metastasis.,9/1/202317 云南省第一人民医院（昆华医院）放射科,8/26/2024,18,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Major Pathological Changes In Lung Adenocarcinoma,Modified from the 2004 WHO Classification6 and the 2011 IASLC/ATS/ERS Classification of Lung,Adenocarcinoma, Atypical Adenomatous Hyperplasia (,AAH,), Adenocarcinoma In Situ (,AIS,), Minimally Invasive Adenocarcinoma (,MIA,), Invasive Adenocarcinoma,Preinvasive,Lesions,Adenocarcinoma,The,term,BAC is no longer used because,the tumors formerly,classified are now,classified into 5 different tumors,.,Invasive mucinous,adenocarcinoma is the term,recommended for,those tumors formerly classified as,mucinous BAC.,9/1/202318 云南省第一人民医院（昆华医院）放射科,8/26/2024,19,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Definitions,AAH,: A,bronchioloalveolar proliferation,that resembles,but,falls,short of criteria for BAC, nonmucinous type,.,-,100% 5-year disease-free survival (DFS,),AIS,:,A,glandular,proliferation measuring,3 cm or less that,has,pure,lepidic growth,lacking invasion,.,- 100,% 5-year disease-free survival (DFS,),MIA,: A,lepidic predominant,tumor measuring,3 cm or less,that,has 5 mm or less,of,an invasive component,.,- Near 100,% 5-year disease-free survival (DFS),Invasive,Adenocarcinomas,:,A lepidic predominant,formerly nonmucinous BAC pattern, with 5,mm invasion.,Best determined after using histologic subtyping to estimate,the percentages of the various histologic subtypes within a,tumo in a semiquantitative fashion in 5% to 10% increments.,- with,a,relatively poor,prognosis,9/1/202319 云南省第一人民医院（昆华医院）放射科,AAH,(,A) This millimeter-sized bronchioloalveolar proliferation is ill defined, with mild thickening of,the alveolar,walls,(HE,original magnification ,20,).,(,B) The alveolar walls show mild fibrous,thickening and,the hyperplastic pneumocytes show minimal atypia and there are gaps between the cells,(HE,original magnification,400,).,8/26/2024,20,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,AAH9/1/202320 云南省第一人民医院（昆华医院）放,8/26/2024,21,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Nonmucinous,AIS,This,circumscribed,nonmucinous,tumor,grows purely with a lepidic pattern.,No foci,of invasion or scarring are seen.,9/1/202321 云南省第一人民医院（昆华医院）放射科,8/26/2024,22,Nonmucinous,MIA,(,A) This adenocarcinoma tumor consists primarily of lepidic growth with a small (,0.5cm,) area of invasion (bottom left),(HE,original magnification,100).,(,B) From the area of,invasion, these,acinar glands,are invading,in the fibrous stroma,(HE,original magnification,200,).,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,9/1/202322Nonmucinous MIA 云南省第,8/26/2024,23,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Major histologic patterns of invasive,adenocarcinoma,(A) Lepidic predominant pattern with mostly,lepidic,growth,(left) and an area of invasive acinar adenocarcinoma (right),(HE,original,magnification 100,).,(,B) Lepidic pattern consists of a proliferation type,II,pneumocytes,and C,lara,cells along the,surface alveolar,walls,(HE,original magnification 200).,(,C) Area of invasive acinar,adenocarcinoma (HE,original magnification 400).,(,D) Acinar adenocarcinoma,composed of,round to oval malignant glands invading a fibrous stroma,(HE,original magnification 200).,(E) Papillary adenocarcinoma consists of malignant cuboidal to columnar tumor cells growing on the surface of,fibrovascular cores,(HE,original magnification 100).,(,F) Micropapillary adenocarcinoma,consists of,small papillary clusters of glandular cells growing within,this,airspace, most of which do not show,fibrovascular,cores (HE,original magnification 200).,(,G) Solid adenocarcinoma with mucin consisting,of sheets,of tumor cells,with abundant,cytoplasm and,mostly vesicular,nuclei with several conspicuous,nucleoli. No,acinar, papillary, or lepidic patterns are seen, but multiple cells have intracytoplasmic basophilic,globules that,suggest intracytoplasmic mucin,(HE,original magnification 400).,(,H) Solid,adenocarcinoma with,mucin. Numerous intracytoplasmic droplets of mucin are highlighted with this mucicarmine stain (,original magnification,400).,9/1/202323 云南省第一人民医院（昆华医院）放射科,8/26/2024,24,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,The Relationship Between CT,Appearance and Histopathology,- Most nonsolid neoplastic GGOs are AAH,- Invasive growth is rarely seen in the pathology of nonsolid,GGO,- AIS: A,p,GGO if nonmucinous and a solid nodule if mucinous,- Nonmucinous MIA: A GGO with solid component measuring,5 mm or less,- Mucinous MIA presents as a solid nodule,By CT there is a good correlation,between amount,of the ground-glass component,and lepidic growth,on biopsy versus the solid,componenton,CT and the invasive components by biopsy.,9/1/202324 云南省第一人民医院（昆华医院）放射科,8/26/2024,25,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,GGO,One Manifestation Type,of Early-stage Lung Cancer,AAH,- preinvasive lesion,AIS,- preinvasive lesion,MIA,9/1/202325 云南省第一人民医院（昆华医院）放射科,8/26/2024,26,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,The Pathobiological Background,of Neoplastic GGO Lesions,More likely to arise in nonsmoking women in,their 50yr and 60yr,Tend to be multicentric, both synchronously,and heterochronously,9/1/202326 云南省第一人民医院（昆华医院）放射科,8/26/2024,27,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Significance,of Focal Ground-Glass Opacity,It is often difficult to identify the specific,cause of focal ground-glass opacity,because the CT feature may be found in,the presence of various pathologic entities, including a neoplasm, inflammation, focal hemorrhage, and focal interstitial fibrosis.,9/1/202327 云南省第一人民医院（昆华医院）放射科,8/26/2024,28,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Henschke et al.,Early Lung Cancer Action Project data(2002) AJR,233 positive results,fGGO,Malignant fGGO,Malignancy rate among findings of fGGO is much higher than the malignancy rate for solid nodules.,pGGO,with a solid,component,others,9/1/202328 云南省第一人民医院（昆华医院）放射科,8/26/2024,29,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Nakata et al. Focal Ground-Glass Opacity Detected by Low-Dose Helical CT (2002) Chest,42 persistent focal GGO lesions: 42 lesions had not changed in size or density during the observation period(range, 1 to 24 months),9/1/202329 云南省第一人民医院（昆华医院）放射科,8/26/2024,30,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Findings at resection of a GGO. Distribution of diagnoses of resected lesions for (,A) pure GGO and,(B) semisolid GGO lesions.,AAH - atypical adenomatous hyperplasia; Adeno - adenocarcinoma; AIS - adenocarcinoma in situ; F/U mo, follow-up period (in months); N pts, number of patients,.,(,Part (A) and (B) Data from Refs),- pure GGO,- semisolid GGO,Among GGOs that were resected, most were AIS or AC.,The rate of AC is increased if there is a solid component.,9/1/202330 云南省第一人民医院（昆华医院）放射科,8/26/2024,31,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Diagnosis according to size. Diagnosis according to size for (A) pure GGO and (B) semisolid GGO.,AAH - atypical adenomatous hyperplasia; Adeno - adenocarcinoma; AIS - adenocarcinoma in situ; F/U mo, follow-up period (in months); N pts, number of patients; NSCLC, nonsmall cell lung carcinoma.,(Part (A)and (B) Data from Refs),- pure GGO,- semisolid GGO,Pure GGO,Less than or equal to 10 mm in size, the,chance of invasive AC seems to be minimal,and there is about a 25% chance of AIS.,Greater than 10mmin size have a higher,risk of AIS ( 40%),and a small risk of AC ( 20%).,GGO with a solid component,Even if the lesion is less than or equal to 10 mm, about 50% have AIS,and about 25% have AC.,Most semisolid lesions greater than 10 mm have AIS or AC.,The presence of a solid portion seems,to be more significant,Size is critical of evaluation,9/1/202331 云南省第一人民医院（昆华医院）放射科,8/26/2024,32,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Outcomes during observation. Outcomes of GGO lesions after a period of observation.,BAC, bronchioloalveolar carcinoma; F/U mo, follow-up period (in months); N pts, number of patients. (Data from Refs),Persistent,GGO: the lesion appears unchanged during a,period of approximately 2 to 3 months., The,most ( 95%) lesions that disappear do so within the first,3 months.,Most lesions either remained the same or decreased in size., A decrease in size cannot be taken as an indication that a,lesion is benign and may be associated with the development,of a solid component., The incidence of development of a solid component seems to,be low., There was no sign of a plateau that could support termination,of follow-up after a certain point.,9/1/202332 云南省第一人民医院（昆华医院）放射科,8/26/2024,33,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Diagnoses during observation. Diagnoses made during observation.,AAH, atypical adenomatous hyperplasia; Adeno, adenocarcinoma; AIS, adenocarcinoma in situ; F/U mo, follow-up period (in months); N pts, number,of patients. (Data from Refs),Among lesions that were observed, approximately 5%,were eventually found to be AC, and approximately 10%,to 30% were AIS.,The incidence of AC may be slightly higher in patients,with semisolid lesions or in patients with a history of,non-small cell lung carcinoma(NSCLC).,9/1/202333 云南省第一人民医院（昆华医院）放射科,8/26/2024,34,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,AAH,in a 53-year-old,woman.,(a) Thin-section CT image (1mm thick) shows an 11-mm well-defined nodular ground-,glass opacity without a solid component in the lower lobe.,(b) Photomicrograph(x100; HE) shows thickened alveolar walls lined by an intermittent,single layer of atypical cuboidal pneumocytes.,a,b,Malignant neoplastic diseases, manifested as fGGO,9/1/202334 云南省第一人民医院（昆华医院）放射科,8/26/2024,35,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,a,b,c,Concurrent,AAH,and,adenocarcinoma,in a 71-year-old woman.,(a) Thin-section CT image(1mm thick) shows an 18-mm-diameter mGGO with a solid component in the upper lobe of the right lung and a 10-mm pGGO in the lower lobe of the left lung.,(b) Photomicrograph of a resected specimen (,X,40; HE) from a superior segment of the lower lobe of the left lung shows atypical epithelial cell proliferation along thickened alveolar septa,findings suggestive of atypical adenomatous hyperplasia.,(c) Photomicrograph of a histologic slice (,X,40; HE) from the right upper lobectomy specimen shows adenocarcinoma,with carcinoma of the bronchioloalveolar subtype at the periphery of the lesion.,9/1/202335 云南省第一人民医院（昆华医院）放射科,8/26/2024,36,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunnan Province,Localized,Bronchioloalveolar Carcinoma,in,a 63-year-old woman,.,(a),Thin-section CT image(1mm thick) shows a 10-mm well-defined nodular ground-glass opacity without a solid component in the lower lobe of the right lung. Note the presence of pulmonary vessels in the lesion.,(b),Photomicrograph of a histologic specimen (x100; HE) shows replacement of the alveolar lining by neoplastic columnar epithelium, without evidence of stromal invasion.,a,b,9/1/202336 云南省第一人民医院（昆华医院）放射科,8/26/2024,37,云南省第一人民医院（昆华医院）放射科,Department of Radiology, The First Peoples Hospital of Yunn
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