Natural History of Preoperative Subcentimeter Pulmonary Nodules in Patients With Resectable Pancreatic Adenocarcinoma

Chang, Stephanie T.; Nguyen, Dennis C.; Raptis, Constantine A.; Menias, Christine O.; Zhou, Gongfu; Wang‐Gillam, Andrea; Linehan, David C.; Hawkins, William G.; Strasberg, Steven M.; Fields, Ryan C.

doi:10.1097/sla.0000000000000719

Cited by 23 publications

(25 citation statements)

References 26 publications

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“…As lung metastases were often accompanied with other organs’ metastases, discovery of lung metastases seldom changes the fact of M1 disease [21]. Second, while CT has high sensitivity to identifying indeterminate lung nodules (ILNs), the noncalcified lung nodules ≤1 cm in diameter, the low specificity of CT scan for metastatic lung nodule brings more queries than directions to approaches of the possible metastatic site [22,23]. Poruk et al reported that 183 (49%) of 374 PC patients had ≥1 ILNs at preoperative chest CT scan [22].…”

Section: Discussionmentioning

confidence: 99%

“…Second, while CT has high sensitivity to identifying indeterminate lung nodules (ILNs), the noncalcified lung nodules ≤1 cm in diameter, the low specificity of CT scan for metastatic lung nodule brings more queries than directions to approaches of the possible metastatic site [22,23]. Poruk et al reported that 183 (49%) of 374 PC patients had ≥1 ILNs at preoperative chest CT scan [22]. Their study revealed ILN as a lung metastasis in only one of six patients with pancreatic cancer who were undergoing lung resection.…”

Section: Discussionmentioning

confidence: 99%

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Lung Metastases in Patients with Stage IV Pancreatic Cancer: Prevalence, Risk Factors, and Survival Impact

Liu

Hung

Hsueh

et al. 2019

JCM

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The aim of this study was to evaluate the prevalence, the clinicopathological variables associated with probability of lung metastases, and the impact of lung metastases on survival outcome in patients with stage IV pancreatic cancer (PC) treated with palliative chemotherapy. A total of 654 patients with stage IV PC who underwent palliative chemotherapy from 2010–2016 were retrospectively enrolled in this study. Possible clinical variables associated with lung metastases and survival outcome were examined by univariate and multivariate analysis. Lung metastases were detected in 15.0% (3.4% with isolated lung metastases and 11.6% with synchronic metastases to lung and other organs). Female gender, poorly differentiated tumor grade, and large primary tumor size were independent risk factor in multivariate analysis. The median overall survival (OS) time was 6.5 months in the entire cohort, while the median OS was 11.8, 6.9, 7.7, 10.1, and 5.0 months for patients with isolated lung, isolated liver, isolated peritoneum, isolated distant lymph nodes, and multiple sites metastases, respectively. Isolated lung metastases were a better prognosticator for OS in univariate and multivariate analysis. This study utilized real-world clinical practice data to assess the prevalence, risk factors, and survival impact of lung metastases in patients with stage IV pancreatic cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lung Metastases in Patients with Stage IV Pancreatic Cancer: Prevalence, Risk Factors, and Survival Impact

Liu

Hung

Hsueh

et al. 2019

JCM

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“…A single study reported the median number of nodules as two, and observed six (17%) of IPNs that underwent enlargement [11]. The same study reported on the specific radiological characteristics of IPN; bilateral 4.3%, calcified 5.8%, solid 9.4% and spiculated 0.6% [11].…”

Section: Number Of Ipnmentioning

confidence: 98%

“…The cut-off size of IPN used by Chang et al [11] and Mehtsun et al [13] was under 1 cm; however, Poruk et al [12] used a range of over 1 cm but less than 3 cm. The other studies did not report the definition of IPN used in their analysis.…”

Section: Size Of Ipnmentioning

confidence: 99%

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Significance of indeterminate pulmonary nodules in resectable pancreatic adenocarcinoma—a review

Kuan

Dennison

Garcea

2021

Langenbecks Arch Surg

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Background The clinical significance of indeterminate pulmonary nodules (IPN) in patients with resectable pancreatic adenocarcinoma (PDAC) is unknown. The rate of detection on IPN has risen due to enhanced staging investigations to determine resectability. IPNs detected on preoperative imaging represent a clinical dilemma and complicate decision-making. Currently, there are no recommendations on the management of IPN. This review provides a comprehensive overview of the current knowledge on the natural history of IPN detected among patients with resectable PDAC. Methods A systematic review based on a search in Medline and Embase databases was performed. All clinical studies evaluating the significance of IPN in patients with resectable PDAC were included. PRISMA guidelines were followed. Results Five studies met the inclusion criteria. The total patient population was 761. The prevalence of IPN reported ranged from 18 to 71%. The median follow-up duration was 17 months. The median overall survival was 19 months. Patients with pre-operative IPN which subsequently progressed to clinically recognizable pulmonary metastases, ranged from 1.5 to 16%. Four studies found that there was no significant difference in median overall survival in patients with or without IPNs. Conclusion This is a first review on the significance of IPN in patients with resectable PDAC. The preoperative presence of IPN does not demonstrate an association with overall survival after surgery. The identification of IPN is a significant finding however it should not preclude patients with resectable PDAC from undergoing curative resection.

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The yield of chest computed tomography in patients with locally advanced pancreatic cancer

Suker

Koerkamp

Nuyttens

et al. 2020

Journal of Surgical Oncology

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Objective To evaluate the incidence of pulmonary metastases on chest computed tomography (CT) in patients with locally advanced pancreatic cancer (LAPC). Methods All patients diagnosed with LAPC in a single tertiary center (Erasmus MC) between October 2011 and December 2017 were reviewed. The staging chest CT scan and follow‐up chest CT scans were evaluated. Pulmonary nodules were divided into three categories: apparent benign, too small to characterize, and apparent malignant. Results In 124 consecutive patients diagnosed with LAPC, 119 (96%) patients underwent a staging chest CT scan at the initial presentation. In 88 (74%) patients no pulmonary nodules were found; in 16 (13%) patients an apparent benign pulmonary nodule was found, and in 15 (13%) patients a pulmonary nodule too small to characterize was found. Follow‐up chest CT scan(s) were performed in 111 (93%) patients. In one patient with either no pulmonary nodule or an apparent benign pulmonary nodule at initial staging, an apparent malignant pulmonary nodule was found on a follow‐up chest CT scan. However, a biopsy of the nodule was inconclusive. Of 15 patients in whom a pulmonary nodule too small to characterize was found at staging, 12 (80%) patients underwent a follow‐up CT scan; in 4 (33%) of these patients, an apparent malignant pulmonary nodule was found. Conclusion In patients with LAPC in whom at diagnosis a chest CT scan revealed either no pulmonary nodules or apparent benign pulmonary nodules, routine follow‐up chest CT scans is not recommended. Patients with pulmonary nodules too small to characterize are at risk to develop apparent malignant pulmonary nodules during follow‐up.

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Natural History of Preoperative Subcentimeter Pulmonary Nodules in Patients With Resectable Pancreatic Adenocarcinoma

Cited by 23 publications

References 26 publications

Lung Metastases in Patients with Stage IV Pancreatic Cancer: Prevalence, Risk Factors, and Survival Impact

Lung Metastases in Patients with Stage IV Pancreatic Cancer: Prevalence, Risk Factors, and Survival Impact

Significance of indeterminate pulmonary nodules in resectable pancreatic adenocarcinoma—a review

The yield of chest computed tomography in patients with locally advanced pancreatic cancer

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