Abstract
BACKGROUND: This study utilized next-generation sequencing (NGS) to analyze genetic information and gene mutation-related loci in ground glass nodules (GGN) with multiple (≥2) lesions. Pathological findings were then correlated to distinguish between multiple primary lung cancers (MPLC) and pulmonary metastasis (PM). METHODS: A cohort of 20 individuals who underwent surgical resection for ground glass nodules (GGN) was included. Final diagnosis and restaging were determined based on the analysis of clinical characteristics and NGS single-target genetic detection. RESULTS: Histopathological, immunohistochemical staining, and NGS analyses identified 48 tissue samples from 20 cases of multiple malignant nodules. A total of 66 gene mutations were identified, with four cases classified as PM. Notably, four patients with intrapulmonary metastases exhibited concurrent mutations in the epidermal growth factor receptor (EGFR) (50 %) and Kirsten ratsarcoma viral oncogene homolog (KRAS). Comparatively, the prevalence of EGFR mutations in PM patients was significantly higher than that in primary lesions. CONCLUSION: Genomic analysis of multiple lung adenocarcinomas enables the determination of the clonal status of tumor cells across various lesions. When gene mutation sites in multiple lesions are identical and mutation abundance is significantly elevated, early intrapulmonary metastasis may be diagnosed.