European guidelines for the surgical management of pure ground-glass opacities and part-solid nodules: Task Force of the European Association of Cardio-Thoracic Surgery and the European Society of Thoracic Surgeons

Pulmonary nodules are often encountered by respiratory physicians, radiologists and thoracic surgeons alike. The European Association of Cardio-Thoracic Surgery and the European Society of Thoracic Surgeons established a multidisciplinary collaboration of clinicians (task force) with expertise in managing pulmonary nodules with the aim of producing the first joint comprehensive review of the scientific literature, with a specific focus on the management of pure ground-glass opacities and part-solid nodules. The scope of the document has been defined by the European Association of Cardio-Thoracic Surgery and European Society of Thoracic Surgeons governing bodies and focuses on 6 main areas of interest agreed upon by the task force. These include managing solitary and multiple pure ground-glass nodules and solitary part-solid nodules and identifying the non-palpable lesion, the role of minimally invasive surgery and the decision making behind sublobar versus lobar resection. The literature revealed that, with the increasing use of incidental computed tomography scans and computed tomography lung cancer screening programmes, the detection of early-stage lung cancer is going to increase, with a higher number of potential cancers presenting on the ground-glass and part-solid nodule spectrum. Given that the gold standard for improved survival is surgical resection, there is an urgent need for comprehensive characterization of these nodules and for guidelines that are directed towards their surgical management. It is recommended that standard decision-making tools be used to determine the risk of malignancy and thus guide referral for surgical management and that decisions for surgical resection be made in a multidisciplinary setting with equitable consideration given to radiologic characteristics, the evolution of the lesion, the presence of a solid component, patient fitness and patient co-morbidities. Given the recent surge in robust level I data comparing sublobar and lobar resection with the release of Japanese Clinical Oncology Group 0802 and Cancer and Leukemia Group B 140503 data, a global overview of an individual case must be adopted into clinical practice. This set of recommendations is based on the available literature; however, close collaboration in the design and conduct of randomized controlled trials is still of utmost importance to answer further questions in this rapidly evolving field.