GROUND-GLASS ATTENUATION IN NODULAR BRONCHIOLOALVEOLAR CARCINOMA - CTPATTERNS AND PROGNOSTIC VALUE

Purpose: The purpose of our study was to assess the CT patterns and pr ognostic value of ground-glass attenuation in nodular bronchioloalveol ar carcinoma (BAG). Method: We retrospectively reviewed CT examination s of 22 patients with 24 nodular BACs who underwent surgery. CT and pa thologic findings were analyzed and correlated with postoperative cour se of disease. Results: We detected five patterns of ground-glass atte nuation associated with nodular BAG: pure ground-glass nodule (n = 1), ground-glass nodule with superimposed lymphangitis (n = 1), nodule wi th mixed areas of ground-glass attenuation and consolidation (n = 2), ground-glass halo around nodule (halo sign) (n = 3), and nodule associ ated with a plurisegmental area of ground-glass attenuation (n = 1). T wo patients with the halo sign and a third patient with a plurisegment al area of ground-glass attenuation rapidly developed diffuse pulmonar y disease by bronchogenic spread and died a few months after surgery. Conclusion: Our series demonstrates that focal BAC may progress to dif fuse pulmonary involvement by bronchogenic spread. The presence of a l arge area of ground-glass attenuation associated with a nodular BAC mi ght be the CT sign of an aggressive biologic behavior. In these cases there is a high likelihood for diffuse disease to develop from broncho genic spread.