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• W2158205801 abstract "We are really grateful to the letter by Cubuk and Yucel [1] regarding our recent study [2], and we are delighted by their thoughtful insights into our results. Owing to the recent improvements in thin-section computed tomography (CT), smaller and fainter lung cancers, including sub-centimetre lung cancers, are being discovered in recent practice. Of these, lung adenocarcinomas showing a wide area of ground-grass opacity (GGO) are considered to have a good prognosis and, in most cases, their pathological features are minimally invasive [3]. Traditionally, however, postoperative nodal involvement is found in 15–20% of cases even in patients with clinical stage IA NSCLC showing a radiologically solid appearance [4, 5]. Therefore, radiologically determined solid lung cancer was considered to have more malignant potential compared with a tumour with GGO component, regardless of how small it is. These observations clearly indicated that ‘tumour size less than 1 cm’ does not indicate the absence of tumour spread, and limited resection should not necessarily be indicated even for solid sub-centimetre lesions, especially in patients with high SUVmax and a radiological pure-solid appearance on thin-section CT [2]. As mentioned by authors, the invasiveness of the tumour is declared to be an important determinant of recurrence and survival. In this context, the differentiation degree of the tumour could be a prognostic factor in lung cancer, and the authors recommended lobectomy for pathologically high-grade tumours in sub-centimetre nodules. However, the intraoperative evaluation of pathological tumour differentiation appears to be difficult to be routinely performed in clinical practice. Our study focuses on analyses that predict pathological invasiveness based on the nodal metastases. This is because only clinical predictors can determine the proper surgical modes. In these contexts, we believe that radiological findings and SUVmax level are the useful clinical predictors of pathological nodal involvement. From this result, a thorough intraoperative evaluation of lymph nodes is needed to prevent loco-regional failure, if limited surgery is indicated for solid sub-centimetre lung cancer. The role of FDG-PET in the evaluation of sub-centimetre lesions remains unclear [6]. Based on our study, however, FDG-PET is expected to be effective for predicting postoperative lymph node involvement and loco-regional recurrence in some selected patients with sub-centimetre lung cancer showing a pure-solid appearance on thin-section CT, because of the possibility that they are sensitive to FDG due to their invasive nature [2]. Finally, even in cases of sub-centimetre lung cancer, lymph node metastasis is frequently observed in patients with radiologically pure-solid nodule, especially for tumours that show a high SUVmax. Hopefully, our study will pave the way for a more refined treatment strategy in dealing with sub-centimetre lung cancer." @default.
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• W2158205801 date "2015-04-08" @default.
• W2158205801 modified "2023-10-16" @default.
• W2158205801 title "Reply to Cubuk and Yucel" @default.
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• W2158205801 doi "https://doi.org/10.1093/ejcts/ezv129" @default.
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