Clinical Significance of Incidental Pulmonary Nodules in Esophageal Cancer Patients

Madani, Amin; Spicer, Jonathan; Alcindor, Thierry; David, Marc; Vanhuyse, Marie; Asselah, Jamil; Mulder, David S.; Ferri, Lorenzo

doi:10.1007/s11605-013-2339-6

Cited by 13 publications

(6 citation statements)

References 18 publications

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“…Although the clinical significance and natural history of SRIF are still undetermined, it is highly prevalent, and characterization as SRIF in diagnostic reports is preferable to non-specific descriptions of subpleural fibrosis to prevent misinterpretation as potential UIP, which is characterized by a different histologic pattern of subpleural fibrosis and has a poor prognosis. Consistent with other histopathology studies [2,3,25], interstitial and peribronchial non-necrotizing granulomas were common, identified in 8% of patients in this series. This HP-like pattern has been previously described as a secondary cell-mediated response adjacent to malignant tumors or in regional lymph nodes [26]; however, we also observed granulomas in patients with benign diagnoses, suggesting that the pattern is likely not wholly attributable to antitumor response.…”

Section: Discussionsupporting

confidence: 92%

Incidental nonneoplastic parenchymal findings in patients undergoing lung resection for mass lesions

et al. 2019

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The prevalence of incidental non-neoplastic lung disease in patients undergoing resection for mass lesions is unknown. We determined the prevalence and characteristics of parenchymal findings in patients with lung nodules, aiming to increase awareness of findings that could potentially impact patient management. 397 patients with benign or malignant mass lesions with available presurgical chest computed tomography scans resected between January 2001 and July 2015 were included. Retrospective histologic assessment of parenchymal abnormalities in at least one section of grossly normal lung was performed for each case by two pulmonary pathologists and correlated with original pathology reports, clinical history, and radiologic findings. 233 women and 164 men underwent resections for carcinomas (78%) or benign nodules (22%). 101 (25%) patients showed parenchymal abnormalities, including 14 patients with multiple findings. The most common abnormal findings were fibrotic interstitial changes (10%), including usual interstitial pneumonia (1%), followed by granulomatous processes (8%). Other findings included aspiration (4%), intravascular thrombi (2%), Langerhans cell histiocytosis (1.5%), small airway obliteration (1%),

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Section: Discussionsupporting

confidence: 92%

Incidental nonneoplastic parenchymal findings in patients undergoing lung resection for mass lesions

et al. 2019

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“…Pulmonary nodules are incidental lesions that are frequently identified on imaging for other clinical indications. The subsequent management and follow-up of these lesions is variable and largely dependent on the nodule size, imaging modality and associated clinical features [ 17 – 19 ]. Wu et al [ 20 ] suggest that small pulmonary nodules in patients less than 50 years old with no history of malignancy are unlikely to be of clinical significance.…”

Section: Discussionmentioning

confidence: 99%

Incidentalomas during imaging for primary hyperparathyroidism—incidence and clinical outcomes

et al. 2015

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BackgroundImaging for pre-operative localisation of parathyroid glands in primary hyperparathyroidism is now routine. This has led to the detection of incidental lesions (incidentalomas) in other organs, the nature of which is not well characterised.The aim of this study was to determine the incidence, characteristics and outcomes in patients who had incidental findings on parathyroid imaging.MethodsRecords of patients who underwent imaging for primary hyperparathyroidism over 2 years were reviewed to identify incidental lesions detected on parathyroid imaging. Patients with persistent or renal hyperparathyroidism were excluded. Details on the management of detected incidentalomas were obtained from patient records.ResultsIncidentalomas were identified in 17 of 170 patients (10 %) undergoing parathyroid imaging. Incidentalomas included thyroid (n = 11), breast (n = 3), lateral compartment of the neck (n = 1), lung (n = 1) and clavicle (n = 1). However, no disease of clinical significance needing treatment was detected on further investigation.ConclusionsAlthough a significant proportion of patients undergoing parathyroid imaging had incidental lesions detected, these seem to be of little clinical significance. The morbidity and cost of further interventions on these incidentalomas need to be weighed against the benefits of routine imaging in improving outcomes of first-time surgery in patients with primary hyperparathyroidism.

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“…This report also strongly supports our results, but there are many differences from our study in terms of the historical context, treatment, and the size of nodules. In the third report, 30 patients with lung nodules showed no increase in the size of the nodules on follow-up CT at 9 months (range, 3-40) after esophagectomy [25]. However, our study differed in that our patients had squamous cell carcinoma, a larger number of nodules were evaluated, and our follow-up period was longer.…”

Section: Discussionmentioning

confidence: 63%

“…According to those guidelines, if a patient has a pulmonary solid nodule <10 mm as a maximal diameter, nodule progression should be monitored whether or not the patient is a smoker. Three previous studies reported on the outcome of pulmonary nodules in esophageal cancer patients who had both resectable cancer and minute pulmonary nodules after subtotal esophagectomy [23][24][25]. In the first report, only 3 esophageal cancer patients (9%) proved to develop metastatic pulmonary disease in the follow-up who had pulmonary nodules found in their preoperative stage, and received NAC followed by surgery [23].…”

Section: Discussionmentioning

confidence: 99%

Are Incidental Minute Pulmonary Nodules Ultimately Determined to Be Metastatic Nodules in Esophageal Cancer Patients?

et al. 2021

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Purpose: Esophageal cancer patients may simultaneously have resectable esophageal cancer and undiagnosable incidental minute solid pulmonary nodules. While the latter is rarely metastatic, only a few studies have reported on the outcomes of such nodules after surgery. In this retrospective study, we assessed the incidence of such nodules, the probability that they are ultimately metastatic nodules, and the prognosis of patients after esophagectomy according to the metastatic status of the nodules. Methods: Data of 398 patients who underwent esophagectomy for resectable esophageal cancer between January 2012 and December 2016 were collected. We reviewed computed tomography (CT) images from the first visit and searched for incidental minute pulmonary nodules <10 mm in size. We followed the outcomes of these nodules and compared the characteristics of metastatic and nonmetastatic nodules. We also assessed the prognosis of patients whose minute pulmonary nodules were metastatic. Results: Among the patients who underwent esophagectomy, 149 (37.4%) had one or more minute pulmonary nodules, with a total of 285 nodules. Thirteen (4.6%) of these nodules in 12 (8.1%) patients were ultimately diagnosed as being metastatic. Thirteen (8.7%) patients experienced recurrence at a different location from where the nodules were originally identified. Characteristics of the metastatic nodules were not unique in terms of size, SUVmax, or location in the lungs. Two-year and 5-year overall survival rates of patients whose nodules were metastatic were 64.2 and 32.1%, respectively. Conclusion: The rate of minute pulmonary nodules which were ultimately metastatic was 4.6%. Our findings suggest that esophagectomy followed by the identification of minute pulmonary nodules is an acceptable strategy even if the nodules cannot be diagnosed as being metastatic on the first visit CT due to their small size.

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Clinical Significance of Incidental Pulmonary Nodules in Esophageal Cancer Patients

Abstract: Incidental pulmonary nodules in the absence of extra-pulmonary metastases in esophageal cancer patients are rarely metastases and should not bias caregivers towards palliative therapy.

Cited by 13 publications

References 18 publications

Incidental nonneoplastic parenchymal findings in patients undergoing lung resection for mass lesions

Incidental nonneoplastic parenchymal findings in patients undergoing lung resection for mass lesions

Incidentalomas during imaging for primary hyperparathyroidism—incidence and clinical outcomes

Are Incidental Minute Pulmonary Nodules Ultimately Determined to Be Metastatic Nodules in Esophageal Cancer Patients?

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