What are the recommendations for a 60-year-old male with 9mm and 6mm ground glass opacities (GGOs) in the lungs?

From the Guidelines

For a 60-year-old male with 9mm and 6mm ground glass nodules, I recommend follow-up imaging according to the Fleischner Society guidelines, with a repeat chest CT scan in 6-12 months for the 9mm nodule and no routine follow-up for the 6mm nodule, unless it has suspicious imaging features that increase the malignancy risk 1. The Fleischner Society guidelines suggest that nodules less than 6 mm have a malignancy risk of less than 1% and do not require routine follow-up, unless they have suspicious features 1.

Key Considerations

• The 9mm nodule should be monitored with a repeat chest CT scan in 6-12 months, followed by another scan at 18-24 months if stability is observed, as recommended by the Fleischner Society guidelines 1.
• The timing of follow-up depends on risk factors such as smoking history, family history of lung cancer, and other lung diseases 1.
• These ground glass nodules are often benign, but monitoring is essential as some may represent early adenocarcinoma 1.
• No immediate biopsy or treatment is typically needed unless changes occur during follow-up 1.
• The patient should continue regular healthcare visits and avoid smoking if applicable 1.
• If the nodules grow or develop solid components during follow-up, further evaluation with PET scan or biopsy may be warranted 1.

Imaging Recommendations

• CT is widely recognized as the modality of choice to evaluate pulmonary nodules, and low-dose technique is recommended for CTs performed to follow lung nodules 1.
• IV contrast is not required to identify, characterize, or determine stability of pulmonary nodules in clinical practice 1.
• Standardization of acquisition and reconstruction CT protocols will ideally result in more accurate comparisons by reducing the risk of errors measuring nodule size, attenuation, and volume 1.

From the Research

Recommendations for a 60-year-old male with 9mm and 6mm ground glass nodules

• The patient's ground glass nodules (GGNs) are likely to be atypical adenomatous hyperplasia, bronchioloalveolar carcinoma (BAC), or adenocarcinoma with a predominant BAC component, as suggested by 2.
• A wedge resection is recommended as a treatment option for GGNs of BAC or adenocarcinoma with a predominant BAC component, in preference to lobectomy, according to 2.
• Positron emission tomography-computed tomography (PET-CT) may not be necessary for the diagnosis of pure GGO nodular lung adenocarcinoma, as it has a low detection rate for smaller GGNs and exhibits no clear advantage for pure GGNs, as stated in 3 and 4.
• However, PET-CT can be useful in evaluating the metabolic activity of GGNs and may help identify malignant lesions, as suggested by 3 and 5.
• A 3-year computed tomography (CT) follow-up is justified for patients with known pulmonary or extra-thoracic malignancies showing GGNs, due to the slow growth rate of these lesions, according to 5.
• The use of convolutional neural networks based on dual-time-point 18F-FDG PET/CT may be a valuable adjunct for predicting the malignant risk of GGNs, as demonstrated in 6.
• Brain magnetic resonance imaging (MRI) may not be necessary in the staging of pure GGO nodular lung adenocarcinoma, as the incidence of brain metastasis is low, as reported in 4.

Diagnostic and Therapeutic Measures

• CT-guided needle biopsy or thoracoscopic surgical resection may be considered for diagnostic purposes, as mentioned in 3.
• Minimally invasive surgery, including multiple resections, with preservation of lung volume and adequate imaging follow-up studies, is recommended for multiple malignant pure GGO nodules, according to 2.
• The role of PET-CT in the diagnosis and follow-up of GGNs should be carefully evaluated, considering its limitations and potential benefits, as discussed in 3, 5, and 6.