Surgical approach for ground glass opacities

Ground glass opacities (GGOs) are focal areas of increased attenuation on computed tomography (CT) that can be present in numerous benign and malignant conditions. This increasingly prevalent entity poses a clinical dilemma for both diagnosis and management. The purpose of this narrative review is to present the most up-to-date evidence and address the nuanced decision making faced by surgeons in the management of GGOs. Several international guidelines on lung nodule management include GGOs; however, there is no consensus on when invasive diagnostic testing is required, which GGOs need surgical resection, or what techniques should be used. GGO localization is the first step to surgical planning for this entity, as these small, subsolid lesions are challenging to identify intraoperatively. Techniques range from widely used CT-guided percutaneous procedures to more technologically advanced methods requiring navigational bronchoscopy. Balancing lung preservation and oncologic outcomes is another evolving area; determining the efficacy of sublobar resection (i.e., wedge resection, segmentectomy) is increasingly necessary as GGOs become more prevalent in the aging population. The management of GGOs is an evolving topic. Overall, the term "ground glass opacities" likely represents a heterogeneous entity that is in many ways biologically distinct from traditional solid non-small cell lung cancers and deserves further investigation to determine the best management strategies going forward.