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. 2023 Apr 28;49(2):e20220433.
doi: 10.36416/1806-3756/e20220433. eCollection 2023.

CT features of osteosarcoma lung metastasis: a retrospective study of 127 patients

[Article in English, Portuguese]
Jéssica Albuquerque M Silva  1 , Edson Marchiori  2 , Viviane Brandão Amorim  1   3 , Miriam Menna Barreto  2
Affiliations

CT features of osteosarcoma lung metastasis: a retrospective study of 127 patients

[Article in English, Portuguese]
Jéssica Albuquerque M Silva et al. J Bras Pneumol. .

Abstract
in English, Portuguese

Objective: Osteosarcoma lung metastases have a wide variety of CT presentations, representing a challenge for radiologists. Knowledge of atypical CT patterns of lung metastasis is important to differentiate it from benign lung disease and synchronous lung cancer, as well as to determine the extent of primary disease. The objective of this study was to analyze CT features of osteosarcoma lung metastasis before and during chemotherapy.

Methods: Two radiologists independently reviewed chest CT images of 127 patients with histopathologically confirmed osteosarcoma treated between May 10, 2012 and November 13, 2020. The images were divided into two groups for analysis: images obtained before chemotherapy and images obtained during chemotherapy (initial CT examination).

Results: Seventy-five patients were diagnosed with synchronous or metachronous lung metastases. The most common CT findings were nodules (in 95% of the patients), distributed bilaterally (in 86%), with no predominance regarding craniocaudal distribution (in 71%). Calcification was observed in 47%. Less common findings included intravascular lesions (in 16%), cavitation (in 7%), and the halo sign (in 5%). The primary tumor size was significantly greater (i.e., > 10 cm) in patients with lung metastasis.

Conclusions: On CT scans, osteosarcoma lung metastases typically appear as bilateral solid nodules. However, they can have atypical presentations, with calcification being the most common. Knowledge of the typical and atypical CT features of osteosarcoma lung metastasis could play a key role in improving image interpretation in these cases.

Objetivo:: As metástases pulmonares do osteossarcoma têm uma grande variedade de apresentações tomográficas, o que é um desafio para os radiologistas. É importante conhecer os padrões tomográficos atípicos da metástase pulmonar para diferenciá-la de doença pulmonar benigna e câncer sincrônico de pulmão, bem como para determinar a extensão da doença primária. O objetivo deste estudo foi analisar as características tomográficas da metástase pulmonar do osteossarcoma antes da quimioterapia e durante a quimioterapia.

Métodos:: Dois radiologistas analisaram de modo independente as imagens de TC de tórax de 127 pacientes com osteossarcoma confirmado histopatologicamente, tratados entre 10 de maio de 2012 e 13 de novembro de 2020. As imagens foram divididas em dois grupos para a análise: imagens obtidas antes da quimioterapia e imagens obtidas durante a quimioterapia (TC inicial).

Resultados:: Setenta e cinco pacientes receberam diagnóstico de metástase pulmonar sincrônica ou metacrônica. Os achados tomográficos mais comuns foram nódulos (em 95% dos pacientes), distribuídos bilateralmente (em 86%), sem predominância de distribuição craniocaudal (em 71%). Observou-se calcificação em 47%. Alguns dos achados menos comuns foram lesões intravasculares (em 16%), escavação (em 7%) e o sinal do halo (em 5%). O tumor primário foi significativamente maior (> 10 cm) em pacientes com metástase pulmonar.

Conclusões:: Em imagens de TC, as metástases pulmonares do osteossarcoma tipicamente aparecem em forma de nódulos sólidos bilaterais. No entanto, podem ter apresentações atípicas, sendo a calcificação a mais comum. Conhecer as características tomográficas típicas e atípicas da metástase pulmonar do osteossarcoma pode ser fundamental para interpretar melhor as imagens nesses casos.

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Conflict of interest statement

CONFLICTS OF INTEREST: None declared.

Figures

Figure 1
Figure 1. A 72-year-old woman with primary osteosarcoma of the femur. In A and B, CT scans showing multiple nodules of various sizes in both lungs, with the largest nodule being on the right side and showing inner calcification. The patient died 9 months after treatment initiation.
Figure 2
Figure 2. A 44-year-old man with primary osteosarcoma of the femur. In A, B, and C, CT scans showing multiple calcified nodules and masses in both lungs.
Figure 3
Figure 3. A 16-year-old boy with primary osteosarcoma of the femur. In A and B, CT scans performed at the time of diagnosis, showing multiple cavitary lung lesions with bilateral pneumothorax. In C and D, CT scans performed 5 months after initiation of chemotherapy, showing growth of the nodules, which are surrounded by ground-glass halos (indicating hemorrhagic pulmonary metastases).
Figure 4
Figure 4. A 7-year-old boy with primary osteosarcoma of the femur. In A and B, CT scans showing calcified intravascular lung metastasis, which was confirmed by biopsy. In C and D, CT scans acquired 6 months later, showing progression of the lung lesions, with mass formation on the right.
Figure 5
Figure 5. A 15-year-old boy with primary osteosarcoma of the femur. In A and B, CT scans showing multiple irregularly shaped masses in both lungs, with invasion of the left main bronchus.
See this image and copyright information in PMC

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