Key Factors For
GGO Surgery

Key Factors for GGO Surgery

Whether lung GGO requires surgery depends on its size and density.

Medical consensus recommends active treatment for GGOs larger than 0.7–0.8 cm.

For GGOs between 0.5–0.7 cm, density becomes the deciding factor.

CT imaging evaluates density, with a lesion considered high-density if the ratio of its solid component diameter to total diameter exceeds 50%.

Patients with a family history of lung cancer or a smoking history are also advised to confirm the diagnosis through biopsy.

Non-Surgical GGO Management

If surgery is not immediately required, the thoracic surgeon will recommend regular CT imaging to monitor changes in the GGO:

a. ＜0.5 cm: Follow-up every 6–12 months
b. 0.5–0.7 cm, density ＜50%: Follow-up every 3–6 months
c. 0.5–0.7 cm, density ＞50%: Follow-up every 3 months

If the GGO remains stable for two years, annual follow-ups may be sufficient.

Consistent imaging settings (e.g., slice thickness) are advised for accurate comparisons.

GGO Diagnosis: CT-Guided Biopsy

There are 3 methods to diagnose lung GGO, depending on its location and density.

CT-guided biopsy uses real-time imaging to target and sample the lesion.

For small lesions or those deep in the lung, near fissures, or close to major blood vessels, results may be inconclusive, requiring alternative diagnostic methods.

Possible complications include pneumothorax, hemothorax, or air embolism if the lesion is near blood vessels.

Preoperative imaging can help minimize these risks.

GGO Diagnosis: Bronchoscopic Biopsy

Bronchoscopic biopsy uses a bronchoscope or ultrasound guidance to sample GGO tissue.

This method is limited to lesions within or near the bronchial tree or adjacent lymph nodes.

GGO Diagnosis: Surgical Biopsy

Surgical biopsy is performed when a GGO is highly suspected to be malignant, with no other suspicious lesions and the patient is fit for curative resection.

This approach allows for a definitive diagnosis while enabling immediate treatment if malignancy is confirmed through intraoperative frozen biopsy, reducing the need for multiple procedures.

High-Risk Malignant GGO

Thoracic surgeons first perform a thoracoscopic biopsy of the GGO.

If intraoperative frozen biopsy confirms malignancy, curative resection is conducted through a single-port thoracoscopy, based on preoperative imaging and the patient’s heart and lung function.