AUTHOR=Wang Xin , Wu Manqi , Shen Haifeng , Nie Yuntao , Zhang Kai , Wei Zihan , Wang Ziyang , Yang Fan , Chen Kezhong 

TITLE=Comparison of Clinical and Pathological Characteristics Between Extremely Multiple GGNs and Single GGNs

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.725475

DOI=10.3389/fonc.2021.725475

ISSN=2234-943X

ABSTRACT=Objectives: To compare the clinical and pathological characteristics between patients undergoing surgery for extremely multiple GGNs and those for single GGNs.
Methods: We defined extremely multiple GGNs as follows: (i) number of GGNs ≥3, (ii) GGN diameter between 3 mm and 30 mm, and (iii) no less than 3 nodules that were surgically removed and pathologically diagnosed. Patients with extremely multiple GGNs and single GGNs who underwent surgery at the same time were retrospectively analyzed. Patients were divided into 3 groups according to the number of nodules: exceedingly multiple nodules (EMN) group (>10), highly multiple nodules (HMN) group (3–10) and single nodule (SN) group. The clinical and pathological characteristics, surgical methods and prognosis were analyzed.
Results: Ninety-nine patients with single nodules and 102 patients with extremely multiple nodules were enrolled. Among the patients with extremely multiple nodules, 43 (42.2%) had >10 nodules. There were no significant differences in demographic characteristics, such as age, sex and smoking history, between the groups, but there were differences in tumor characteristics. All patients with >10 nodules showed bilateral pulmonary nodules and presented with both pure and mixed GGNs. Single GGNs were smaller in diameter, and the proportion of mixed GGNs and pathologically invasive adenocarcinoma was lower than that of the primary nodules in the exceedingly multiple GGNs group (p<0.05). However, the proportion of both mixed GGNs and malignant nodules decreased significantly with the increasing number of total lesions. During postoperative follow-up, one patient in the highly multiple nodules group had local recurrence, and 16 (15.7%) patients in the extremely multiple GGNs group and 10 (9.8%) patients in the single GGN group had enlarged unresected GGNs or additional GGNs.
Conclusions: Our study revealed the clinical and pathologic characteristics, surgical methods, and prognosis of patients with extremely multiple GGNs and compared them with those of patients with single GGNs. Although the primary nodules in extremely multiple GGNs may have higher malignancy than those in the single nodule group, the proportion of both mGGNs and malignant nodules decreased significantly with the increasing number of lesions and the prognosis of patients with extremely multiple GGNs was satisfied.