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. 2016 Feb 3;2(3):138-144.
doi: 10.1200/JGO.2015.002089. eCollection 2016 Jun.

Pulmonary Nodules in Patients With Nonpulmonary Cancer: Not Always Metastases

Rafael Caparica  1 , Milena Perez Mak  1 , Claudio Henrique Rocha  1 , Pedro Henrique Isaacsson Velho  1 , Publio Viana  1 , Mauricio R L Moura  1 , Marcos Roberto Menezes  1 , Marcelo B P Amato  1 , Olavo Feher  1
Affiliations

Pulmonary Nodules in Patients With Nonpulmonary Cancer: Not Always Metastases

Rafael Caparica et al. J Glob Oncol. .

Abstract

Introduction: The differential diagnosis of pulmonary nodules (PNs) includes metastases, lung cancers, infectious diseases, and scar tissue, among others. Because data regarding whether and when to perform a PN biopsy in patients with cancer are scarce, clinicians tend to assume that PNs are metastatic disease based solely on imaging. The current study evaluated the findings of PN biopsies in a population of patients with cancer and sought to determine the variables that correlated with higher odds of metastatic disease.

Patients and methods: We conducted a retrospective, single-institution study that included consecutive patients with nonpulmonary solid malignancies who underwent PN biopsy from January 2011 to December 2013. Imaging and clinical variables were analyzed by logistic regression to determine the correlation between such variables and the odds of metastatic disease. Patients with previously known metastatic disease or primary hematologic malignancies were excluded.

Results: Two hundred twenty-eight patients were included in the study. Metastatic disease was found in 146 patients (64%), 60 patients (26.3%) were diagnosed with a second primary lung tumor, and 22 patients (9.6%) had no cancer on biopsy. On multivariate analysis, the presence of multiple PNs (> 5 mm) and cavitation/necrosis were the only variables associated with higher odds (P < .05) of metastatic disease. We registered six (2.6%) procedure complications demanding active interventions, and no procedure-related death occurred.

Conclusion: Multiple PNs (> 5 mm) and cavitation were the two characteristics associated with the highest chances of metastatic disease. Our findings demonstrate that PNs should not be assumed to be metastases without performing a biopsy. This assumption may lead to high rates of misdiagnosis. Tissue sampling is fundamental for accurately diagnosing patients with cancer.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or jco.ascopubs.org/site/ifc. Rafael CaparicaNo relationship to discloseMilena Perez MakNo relationship to discloseClaudio Henrique RochaNo relationship to disclosePedro Henrique Isaacsson VelhoNo relationship to disclosePublio VianaNo relationship to discloseMauricio R.L. MouraNo relationship to discloseMarcos Roberto MenezesHonoraria: HealthTronicsMarcelo B.P. AmatoHonoraria: Covidien Research Funding: Covidien (Inst), Dixtal Biomédica Ltda (Inst)Olavo FeherNo relationship to disclose

Figures

Fig 1
Fig 1
The data collection flowchart. PN, pulmonary nodule.
Fig 2
Fig 2
Computed tomography–guided pulmonary nodule biopsy performed on a patient included in the present study.
Fig 3
Fig 3
Computed tomography-guided pulmonary nodule biopsy performed on a patient included in the present study.
See this image and copyright information in PMC

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