Solitary Pulmonary Lesion in Patients with History of Malignancy: Primary Lung Cancer or Metastatic Cancer?

Jin, Ke; Wang, Kexi; Zhang, Huizhong; Pan, Yuejiang; Cao, Ding; Wang, Minghui; Chen, Ju; Wu, Duoguang; Chen, Boshen; Xie, Xuan

doi:10.1245/s10434-018-6360-6

Cited by 8 publications

(7 citation statements)

References 36 publications

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“…28 Nonetheless, there are several articles that state the opposite. 24,29 We did not find any family history of cancer or adjuvant therapy as a factor of NLC in our study.…”

Section: Discussioncontrasting

confidence: 65%

“…Size and SUV max of the PLs were investigated as predictive factors of NLC; some sources stated (<3 cm) smaller lesions 29 while several others expressed that larger lesions (>3 cm) were more frequent in their studied NLC groups. 17 Nakadate et al revealed that NLC patients had significantly larger PLs, which also have significantly higher SUV max uptakes than PM patients.…”

Section: Discussionmentioning

confidence: 99%

“…Spiculation is present in approximately 90% of primary lung carcinomas, but it has not been reported to be specific to lung carcinoma. 36 Several studies have reported spiculation as the superior radiological sign in detecting primary lung cancer in patients with PLs after previous carcinoma, 17,29 whereas others speculated that lepidic growth was an important radiological finding for discrimination between NLC and PM. 37,38 In our study, there was no statistically significant radiological sign specific to either of the groups; spiculation was the better predictive radiological sign for NLC patients, of whom 38% (n = 12) presented spiculation, while it was observed in only 17% of the PM group (n = 4).…”

Section: Discussionmentioning

confidence: 99%

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Clinical and surgical approaches for malignant pulmonary lesions after a previous extrapulmonary malignancy

Seyrek¹,

Cansever

Bedirhan

2021

ANZ Journal of Surgery

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Background: In our study, since the operative histopathological distinction of new malignant pulmonary lesions as either a primary lung cancer or a pulmonary metastasis is difficult, we aimed to identify the clinical variables which might allow distinction between a new lung cancer and a pulmonary metastasis, and the appropriate surgical management. Methods: We divided 55 cases into two groups: patients with new lung cancer (NLC, n = 32) and patients with pulmonary metastases (PM, n = 23). Based on the primary organ, the previous malignancy was classified into four categories: head and neck, colorectal, genitourinary, and breast cancer. The parameters included in the study were age, sex, smoking history, a family history of cancer, disease-free interval, primary organ, treatments for previous malignancies, size, and SUV max of the lung lesion on 18F-fluorodeoxyglucose positron emission tomography scan and high-resolution computed tomography findings of the lung lesion. Results: A predisposition for larger lesions was found in the NLC group. In addition, in the NLC group, disease-free interval was noted to be longer, patients were significantly older and SUV-max values of solitary pulmonary lesions were significantly higher than in the PM group. Pulmonary lesions in patients with prior head and neck cancers were more likely to develop NLC. No significant difference in statistical analysis was observed between the groups in terms of sex, smoking, a family history of cancer, a history of adjuvant therapy, radiological pulmonary lesions signs, and localization. Conclusion: PL monitoring on CT surveillance is essential, particularly in patients with previous head and neck cancers, who appear to have a higher risk for NLC. If pathological MLN accompanies PL in a patient with previous extrapulmonary malignancy, cervical mediastinoscopy may help acquire a possible PL diagnosis besides mediastinal staging. Intraoperative frozen section may have difficulty in distinguishing between PM and NLC when the lesion is of the same histological type as the previous malignancy. When precise distinction cannot be achieved by frozen section, we speculate that DFI, age, and radiological findings of the PL may help thoracic surgeons take initiative peroperatively while designating the subsequent surgical intervention. Lastly, pulmonary segmentectomy is also better be considered along with lobectomy in NLC cases.

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“…28 Nonetheless, there are several articles that state the opposite. 24,29 We did not find any family history of cancer or adjuvant therapy as a factor of NLC in our study.…”

Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical and surgical approaches for malignant pulmonary lesions after a previous extrapulmonary malignancy

Seyrek¹,

Cansever

Bedirhan

2021

ANZ Journal of Surgery

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“…Solitary pulmonary lesions (SPLs) can be categorized into various types [1][2][3], such as tumors and inflammatory or tuberculous granulomas. Early identification and differentiation of benign and malignant lesions, especially in lung cancer are of great significance to guiding clinical treatment protocols and improving prognoses [4].…”

Section: Introductionmentioning

confidence: 99%

Value of dynamic metabolic curves and artificial neural network prediction models based on 18F-FDG PET/CT multiphase imaging in differentiating nonspecific solitary pulmonary lesions: a pilot study

Luo

Huang

et al. 2022

Nuclear Medicine Communications

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Objective To investigate the value of dynamic metabolic curves and artificial neural network prediction models based on 18F-FDG PET multiphase imaging in differentiating nonspecific solitary pulmonary lesions. Methods This study enrolled 71 patients with solitary pulmonary lesions (48 malignant and 23 benign lesions) who underwent multiphase 18F-fluorodeoxyglucose (18F-FDG)-PET/CT imaging. We recorded information on age, sex and uniformity of FDG uptake, measured standardized uptake value, metabolic tumor volume and total lesion glycolysis at various time points, and calculated individual standardized uptake values, retention index (RI) and slope of metabolic curve. Variables with high diagnostic efficiency were selected to fit dynamic metabolic curves for various lesions and establish different artificial neural network prediction models. Results There were no significant differences in the retention index, metabolic tumor volume, total lesion glycolysis or sex between benign and malignant lesions; standardized uptake values, the slopes of five metabolic curves, uniformity of FDG uptake, and age showed significant differences. Dynamic metabolic curves for various solitary pulmonary lesions exhibited characteristic findings. Model-1 was established using metabolic parameters with high diagnostic efficacy (area under the curve, 83.3%). Model-2 was constructed as Model-1 + age (area under the curve, 86.7%), whereas Model-3 was established by optimizing Model-2 (area under the curve, 86.0%). Conclusions Dynamic metabolic curves showed varying characteristics for different lesions. Referring to these findings in clinical work may facilitate the differential diagnosis of nonspecific solitary pulmonary lesions. Establishing an artificial neural network prediction model would further improve diagnostic efficiency.

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“…Another issue is the lack of histological proof in one patient. However, radiographic evidence such as peripheral sites, lack of spiculation and the absence of nodal lung or mediastinal extension can be helpful tools to determine whether an isolated nodule is a primary or a secondary disease [30].…”

Section: Discussionmentioning

confidence: 99%

Distinct Outcomes of Oropharyngeal Squamous Cell Carcinoma Patients after Distant Failure According to p16 Status: Implication in Therapeutic Options

et al. 2021

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Introduction: Recent modifications in the epidemiology of oropharyngeal squamous cell carcinoma (OSCC) have led to the increase of Human papillomavirus (HPV) related metastatic head and neck cancer patients with high life expectancy even at advanced stage, low comorbidity and still restricted systemic therapy opportunities. In the recent era of ablative therapies’ development, oligometastatic HPV OSCC patients are indubitably good candidates for intensified treatment. However, data related to outcomes after optimised management of metastatic sites are dramatically missing. Materials and patients: In our cohort of 186 unselected consecutive OSCC patients treated with curative intent at our institution between 2009 and 2013, we analysed the incidence, treatment and outcomes of distant metastatic (DM) failure according to p16 status. Results: After a median follow-up of 4.2 years (95% CI: 3.8–4.4) from primary diagnosis of OSCC, 21/95 p16− patients (22.1%) vs. 8/91 (8.8%) p16+ patients presented DM failure with a median interval of 11 (range 0–46) and 28 months (range 0–71), respectively (p = 0.10). Overall survival (OS) after DM failure was significantly higher in p16+ patients with a two-year OS rate of 75% and 15% for p16+ and p16−, respectively (p = 0.002). In eight HPV-related metastatic patients, three underwent ablative lung metastasis treatment and are still complete responders four to five years later. Conclusion: This study highlights distinct outcomes of metastatic HPV-related OSCC patients emphasised by three long-term complete responders after lung ablative treatment. In patients with high life expectancy and limited tumour burden, the question of ablative treatment such as metastasectomy or stereotactic ablative radiotherapy (SBRT) should be addressed.

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Solitary Pulmonary Lesion in Patients with History of Malignancy: Primary Lung Cancer or Metastatic Cancer?

Cited by 8 publications

References 36 publications

Clinical and surgical approaches for malignant pulmonary lesions after a previous extrapulmonary malignancy

Clinical and surgical approaches for malignant pulmonary lesions after a previous extrapulmonary malignancy

Value of dynamic metabolic curves and artificial neural network prediction models based on 18F-FDG PET/CT multiphase imaging in differentiating nonspecific solitary pulmonary lesions: a pilot study

Distinct Outcomes of Oropharyngeal Squamous Cell Carcinoma Patients after Distant Failure According to p16 Status: Implication in Therapeutic Options

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