Lung Nodules in Melanoma Patients: Morphologic Criteria to Differentiate Non-Metastatic and Metastatic Lesions

Abstract

Lung nodules are frequent findings in chest computed tomography (CT) in patients with metastatic melanoma. In this study, we assessed the frequency and compared morphologic differences of metastases and benign nodules. We retrospectively evaluated 85 patients with melanoma (AJCC stage III or IV). Inclusion criteria were ≤20 lung nodules and follow-up using CT ≥183 days after baseline. Lung nodules were evaluated for size and morphology. Nodules with significant growth, nodule regression in line with RECIST assessment or histologic confirmation were judged to be metastases. A total of 438 lung nodules were evaluated, of which 68% were metastases. At least one metastasis was found in 78% of patients. A 10 mm diameter cut-off (used for RECIST) showed a specificity of 95% and a sensitivity of 20% for diagnosing metastases. Central location (n = 122) was more common in metastatic nodules (p = 0.009). Subsolid morphology (n = 53) was more frequent (p < 0.001), and calcifications (n = 13) were solely found in non-metastatic lung nodules (p < 0.001). Our data show that lung nodules are prevalent in about two-thirds of melanoma patients (AJCC stage III/IV) and the majority are metastases. Even though we found a few morphologic indicators for metastatic or non-metastatic lung nodules, morphology has limited value to predict the presence of lung metastases.

Keywords: malignant melanoma; multi-detector computed tomography; pulmonary nodules.

Figure 1

Characteristics of lung nodules. (a): solid nodule; (b): part-solid nodule; (c): ill-defined margin; (d): lobulated margin; (e): spiculated margin; (f): pleural retraction; (g): feeding vessel; (h): air bronchogram.

Figure 2

Flow chart illustrating derivation of our final study cohort. American Joint Committee on Cancer (AJCC). Computed Tomography (CT).

Figure 3

Receiver Operating Characteristic (ROC) curve illustrating the Area Under the Curve (AUC) for average nodule diameter (blue), maximum long axis diameter (red) and nodule volume (green) to predict metastases. There were no significant differences between ROC curves calculated with DeLong’s test (p = 0.059–0.325).