Analysis of pulmonary nodules in patients with high-grade soft tissue sarcomas

Nakamura, Tomoki; Matsumine, Akihiko; Matsusaka, Miki; Mizumoto, Keitaro; Mori, Mitsunori; Yoshizaki, Tomoya; Matsubara, Takehiro; Asanuma, Kunihiro; Sudo, Akihiro

doi:10.1371/journal.pone.0172148

Cited by 16 publications

(14 citation statements)

References 19 publications

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“…When a grade III primary STS with a 10 odds ratio (OR) of nodule malignancy has nodule size >5.6 mm or well-defined margins at CT scan, the risk of MTS increases by > 17 and > 13 times, respectively. The cutoff of 5.6 mm confirms previous studies by Nakamura et al [28] and Rissing et al [27,29]. This was also shown by Dudeck et al [5] who demonstrated that larger lung PNs in STS patients have high odds of being malignant.…”

Section: Discussionsupporting

confidence: 86%

“…On the other hand, false-negative CT findings are not infrequent with nodules identified at lung surgical palpation [25]. Therefore, CT screening of suspicious nodules is still an area of active research [5,26,27]. Furthermore, to the best of our knowledge, no study has yet been published that addresses the predictive value of clinical features on lung STS metastases.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and Radiologic Features Together Better Predict Lung Nodule Malignancy in Patients with Soft-Tissue Sarcoma

Tetta

Giugliano

Tonetti

et al. 2020

JCM

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We test the hypothesis that a model including clinical and computed tomography (CT) features may allow discrimination between benign and malignant lung nodules in patients with soft-tissue sarcoma (STS). Seventy-one patients with STS undergoing their first lung metastasectomy were examined. The performance of multiple logistic regression models including CT features alone, clinical features alone, and combined features, was tested to evaluate the best model in discriminating malignant from benign nodules. The likelihood of malignancy increased by more than 11, 2, 6 and 7 fold, respectively, when histological synovial sarcoma sub-type was associated with the following CT nodule features: size ≥ 5.6 mm, well defined margins, increased size from baseline CT, and new onset at preoperative CT. Likewise, in the case of grade III primary tumor, the odds ratio (OR) increased by more than 17 times when the diameter of pulmonary nodules (PNs) was >5.6 mm, more than 13 times with well-defined margins, more than 7 times with PNs increased from baseline CT, and more than 20 times when there were new-onset nodules. Finally, when CT nodule was ≥5.6 in size, it had well-defined margins, it increased in size from baseline CT, and when new onset nodules at preoperative CT were concomitant to residual primary tumor R2, the risk of malignancy increased by more than 10, 6, 25 and 28 times, respectively. The combination of clinical and CT features has the highest predictive value for detecting the malignancy of pulmonary nodules in patients with soft tissue sarcoma, allowing early detection of nodule malignancy and treatment options.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Clinical and Radiologic Features Together Better Predict Lung Nodule Malignancy in Patients with Soft-Tissue Sarcoma

Tetta

Giugliano

Tonetti

et al. 2020

JCM

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“…On multivariate analysis, findings which were BJR CT for trunk/extremity soft tissue sarcoma significantly predictive of metastases were multiple > 5 mm in size and the presence of cavitation. Nakamura et al 19 reported on chest CT findings in 124 patients with high-grade STS. Pulmonary nodules were identified at initial presentation in 39.5% of cases, of which almost 70% were benign while 26.5% were metastatic.…”

Section: Discussionmentioning

confidence: 99%

A review of staging chest CT in trunk and extremity soft tissue sarcoma

Saifuddin

Shafiq

Rajakulasingam

et al. 2020

The British Journal of Radiology

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Objectives: To determine the incidence of pulmonary metastases on chest CT in trunk and extremity soft tissue sarcoma based on two size criteria, and to identify factors associated with metastases. Methods: Retrospective review of chest CT studies in patients with trunk and extremity soft tissue sarcoma over an 18-month period. Data collected included patient age/sex, tumour location, size and relationship to fascia. All chest CTs were reviewed for the presence of metastases which were diagnosed according to two size criteria: multiple nodules > 5 mm in size or multiple nodules > 10 mm in size. Follow-up CT studies were reviewed in cases initially considered indeterminate. Results: 127 males and 73 females were included (mean age 57.1 years; range 10–90 years). 147 (73.5%) tumours were deep to the fascia and 53 (26.5%) superficial. Tumour size classified according to the 12 AJCC 2019 criteria was: T1 = 52, T2 = 76, T3 = 39, T4 = 33. Based on nodule size >5 mm, 73 (36.5%) patients had no metastases, 42 (21%) had metastases, while 85 (42.5%) studies were indeterminate. Based on nodule size >10 mm, 73 (36.5%) patients had no metastases, 28 (14%) had metastases, while 99 (49.5%) studies were indeterminate. Larger maximum dimension of the primary tumour was a risk factor for pulmonary metastases using both size criteria. Conclusion: The incidence of pulmonary metastases at presentation in trunk and extremity soft tissue sarcoma is 14–21%. 42.5–49.5% of chest CTs were indeterminate. Advances in knowledge: The incidence of pulmonary metastases at presentation in trunk and extremity soft tissue sarcoma is 14–21%. Indeterminate pulmonary nodules are also very common.

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“…Firstly, a misdiagnosis may occur for pulmonary lesions that are clinically diagnosed as benign. Some small pulmonary nodules with extremely long tumor doubling time, which were diagnosed as benign, might be metastatic sarcomas, although the doubling time of high-grade sarcomas is usually short (19). Secondly, SUV varies with several factors.…”

Section: Discussionmentioning

confidence: 99%

Is FDG-PET/CT Useful for Diagnosing Pulmonary Metastasis in Patients with Soft Tissue Sarcoma?

et al. 2018

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A significant relationship was observed between nodule size and maximum standardized uptake value (SUV). For nodules smaller than 5 mm, only 10 out of 76 metastatic pulmonary nodules exhibited FDG accumulation, showing a weak correlation between nodule size and SUV Conclusion: The role of FDG-PET/CT in differentiating metastatic from benign pulmonary nodules was unsatisfactory, especially for small nodules. Careful follow-up using CT scan may still be appropriate for diagnosing pulmonary nodules smaller than 5 mm.

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Analysis of pulmonary nodules in patients with high-grade soft tissue sarcomas

Cited by 16 publications

References 19 publications

Clinical and Radiologic Features Together Better Predict Lung Nodule Malignancy in Patients with Soft-Tissue Sarcoma

Clinical and Radiologic Features Together Better Predict Lung Nodule Malignancy in Patients with Soft-Tissue Sarcoma

A review of staging chest CT in trunk and extremity soft tissue sarcoma

Is FDG-PET/CT Useful for Diagnosing Pulmonary Metastasis in Patients with Soft Tissue Sarcoma?

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