ArticleFrontiers in oncology2026
Is surgical lymph node assessment justified for ground glass opacity-dominant lung adenocarcinoma?
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: The necessity of lymph node dissection (LND) as part of curative-intent surgery for ground-glass opacity (GGO)-dominant lung adenocarcinoma has been called into question, given the favorable prognosis and indolent behavior of these tumors. However, the oncological safety of omitting LND in cases of GGO-dominant lung adenocarcinoma remains controversial, and current guidelines continue to recommend it. Methods: This study was designed as a retrospective, single-center cohort study. Patients with cT1N0M0 lung adenocarcinoma who underwent surgical resection between 2010 and 2023 were categorized as GGO-dominant or solid-dominant cohorts based on consolidation-to-tumor ratios in preoperative computed tomography scans. The primary endpoint was the incidence of occult lymph node (LN) metastasis. Results: A total of 726 consecutive patients were included in this study, categorized as GGO-dominant in 50 patients and solid-dominant in 676 patients. GGO-dominant tumors were more frequently observed in female patients (p = 0.03), whereas no significant differences were found between the groups with respect to age, smoking status, or ECOG performance status. GGO-dominant morphology was associated with lower pT stage and lower rates of pleural and lymphovascular invasion. The incidence of occult LN metastasis was 4% (n=2) in the GGO-dominant cohort and 11.8% (n=80) in solid-dominant cohort. Only solid tumor size was a significant predictor of occult LN metastasis in multivariable logistic regression (OR 1.39 per 5mm increase, 95% CI 1.10-1.77, p = 0.006). Survival analysis revealed a higher rate of freedom from recurrence (p = 0.04) and favorable trends in overall survival (p = 0.09) and recurrence-free survival (p = 0.086) in the GGO-dominant cohort. Conclusions: The hypothesis that GGO-dominant morphology reliably predicts negative lymph node involvement was not confirmed. These findings support the continued role of surgical nodal assessment for accurate pathological staging.
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