New Trends in Early-Stage Lung Cancer Presenting as Ground-Glass Opacities: Clinical, Pathological and Molecular Aspects

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Background

With the use of high-resolution chest imaging examination and lung cancer screening program, patients with early-stage lung cancer presenting as single or multiple ground-glass opacities (GGOs) are becoming a growing population worldwide. GGOs, mainly including pure GGO and part-solid GGO, often characterized as a focal area in the lung with increased attenuation on CT scan through which normal parenchymal structures can still be visualized. Lung cancers growing in a lepidic pattern can present as a GGO because the tumor cells grow only along the alveoli, therefore allowing aeration of the alveoli. Previous studies documented that lung cancer presenting as GGOs often represent relatively lower grade malignant lesions, such as atypical adenomatous hyperplasia, adenocarcinoma in situ, or minimally invasive adenocarcinoma. However, the presence of a solid component in GGO strongly indicates the presence of cancer invasion.

To our best knowledge, only a few studies investigated the characteristics of early-stage lung cancer presenting as GGOs, especially for multiple GGO lesions. The crucial issue is whether these multiple cancers should be diagnosed and treated as separate primary lesions or metastasis. Histological differences between the multiple lesions are reliable indicators, but it would be rather challenging if the multiple lesions are histologically same or similar. Molecular analysis, such as LOH, genetic and epigenetic changes, have been provided to define the relationship among multiple GGO lesions. However, there are still several controversies due to the high heterogeneity and insufficient understanding of clinicopathological characteristics of multiple lesions.

Despite surgical resection remains the most employed approach for the treatment of early-stage lung cancer, controversies over some issues still exist, especially in the treatment of multiple primary lung cancers. Recently, several novel strategies, such as SBRT, ablation and hybrid techniques have been developed to treat the multiple primary lung cancers. The targeted therapy and immunotherapy have also been provided in the treatment of multiple primary lung cancers. However, there is still a lack of high-level evidence that could guide multidisciplinary management of this disease.

This Research Topic aims to provide a forum to update and discuss the clinical characteristics, pathological findings, genetic or epigenetic changes that will help in diagnosis and treatment decisions in early-stage lung cancer presenting as ground-glass opacities in the form of Review and Original Research articles. Potential topics include but are not limited to the following:

1. New trends in clinical characteristics in the patients with early-stage lung cancer presenting as single or multiple GGOs
2. Evolving treatment strategies including surgery, immunotherapy, targeted therapy, SBRT, radiofrequency ablation and hybrid techniques in the treatment of multiple GGOs
3. Emerging biomarkers of diagnosis of early-stage multiple primary lung cancers
4. Current understanding of the genetic and epigenetic changes in early-stage lung cancer presenting as single or multiple GGOs

Keywords: lung cancer, early-stage, ground-glass opacities, multiple lesions, molecular change

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