Approach to Metastasis-Suspected Nodule Accompanying Operable Non-Small Cell Lung Cancer
06 July 2013
10 November 2013
20 April 2014 (online)
Background Operability is difficult to determine in patients with additional pulmonary nodules in nonprimary lobes accompanying resectable lung cancer. Because these nodules could either be malignant or benign, the differential diagnosis is fundamental but still remains a diagnostic challenge. The aim of this study was to evaluate metastasis-suspected solid nodules in nonprimary lobes accompanying resectable non-small cell lung cancer (NSCLC).
Patients and Methods From 2003 to 2009, 2,997 patients underwent pulmonary resection for NSCLC. Among them, 62 patients who underwent pulmonary resection for additional nodules in nonprimary lobes to exclude metastasis were identified. Their medical records were analyzed retrospectively.
Results There were 48 males and 14 females, with a mean age of 61 years (range, 35–76 years). Tumors were located in ipsilateral nonprimary lobes in 16 patients, contralateral lobes in 21 patients, and bilateral lobes in 25 patients. Sixty-six resections were performed in the 62 patients including four cases of multiple resections. Forty-six nodules (70%) were pathologically confirmed as benign and 20 nodules (30%) were diagnosed with malignancy. The accuracy of radiologic malignancy diagnosis was 32% (20 out of 62). Two patients died of acute respiratory distress syndrome during the postoperative period. Both of these patients underwent lobectomy following additional resection for satellite nodules, which were located on the contralateral side.
Conclusion If patients have satellite nodules accompanying resectable NSCLC, aggressive pathological assessment should be considered. However, bilateral procedures can increase postoperative morbidity and mortality; therefore, staged operation or close follow-up might be the alternative strategy.
- 1 Goldstraw P, Crowley J, Chansky K , et al; International Association for the Study of Lung Cancer International Staging Committee; Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol 2007; 2 (8) 706-714
- 2 National Comprehensive Cancer Network. NCCN Clinical Practice Guideline. Available at: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp . Accessed March 17, 2013
- 3 Carretta A, Ciriaco P, Canneto B, Nicoletti R, Del Maschio A, Zannini P. Therapeutic strategy in patients with non-small cell lung cancer associated to satellite pulmonary nodules. Eur J Cardiothorac Surg 2002; 21 (6) 1100-1104
- 4 Kim YH, Lee KS, Primack SL , et al. Small pulmonary nodules on CT accompanying surgically resectable lung cancer: likelihood of malignancy. J Thorac Imaging 2002; 17 (1) 40-46
- 5 Yuan Y, Matsumoto T, Hiyama A , et al. The probability of malignancy in small pulmonary nodules coexisting with potentially operable lung cancer detected by CT. Eur Radiol 2003; 13 (11) 2447-2453
- 6 Yoon HI, Yim JJ, Lee CT , et al. Clinical characteristics of a second small nodule(s) associated with cT1-2N0M0 non-small-cell lung cancer. Lung 2006; 184 (5) 273-278
- 7 Ruppert AM, Lerolle U, Carette MF , et al. Coexisting pulmonary nodules in operable lung cancer: prevalence and probability of malignancy. Lung Cancer 2011; 74 (2) 233-238
- 8 Seo JB, Im JG, Goo JM, Chung MJ, Kim MY. Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics 2001; 21 (2) 403-417
- 9 Ng YL, Patsios D, Roberts H , et al. CT-guided percutaneous fine-needle aspiration biopsy of pulmonary nodules measuring 10. mm or less. Clin Radiol 2008; 63 (3) 272-277
- 10 Erasmus JJ, Connolly JE, McAdams HP, Roggli VL. Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions. Radiographics 2000; 20 (1) 43-58
- 11 Ost D, Fein AM, Feinsilver SH. Clinical practice. The solitary pulmonary nodule. N Engl J Med 2003; 348 (25) 2535-2542
- 12 Hasegawa M, Sone S, Takashima S , et al. Growth rate of small lung cancers detected on mass CT screening. Br J Radiol 2000; 73 (876) 1252-1259
- 13 Kim HK, Choi YS, Kim J, Shim YM, Lee KS, Kim K. Management of multiple pure ground-glass opacity lesions in patients with bronchioloalveolar carcinoma. J Thorac Oncol 2010; 5 (2) 206-210
- 14 Kim K, Kim HK, Park JS , et al. Video-assisted thoracic surgery lobectomy: single institutional experience with 704 cases. Ann Thorac Surg 2010; 89 (6) S2118-S2122
- 15 Park JS, Yang HC, Kim HK , et al. Sleeve lobectomy as an alternative procedure to pneumonectomy for non-small cell lung cancer. J Thorac Oncol 2010; 5 (4) 517-520
- 16 Gould MK, Maclean CC, Kuschner WG, Rydzak CE, Owens DK. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA 2001; 285 (7) 914-924