Brendon M Stiles1, Michael Schulster2, Abu Nasar2, Subroto Paul2, Paul C Lee2, Jeffrey L Port2, Nasser K Altorki2. 1. Division of Thoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY. Electronic address: brs9035@med.cornell.edu. 2. Division of Thoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
Abstract
OBJECTIVE: We sought to define the prevalence, malignancy rate, and outcome of secondary nodules (SNs) detected on computed tomography (CT) scan for patients undergoing resection for primary non-small cell lung cancer (NSCLC). METHODS: In consecutive patients with NSCLC, we reviewed all CT scan reports obtained at diagnosis of the dominant tumor for description of SNs. When resected, pathology was reviewed. Serial CT reports for 2 years postoperatively were evaluated to follow SNs not resected. RESULTS: Among 155 patients, 88 (57%) were found to have SNs. A total of 137 SNs were evaluated (median size, 0.5 cm). Thirty-two nodules were resected at primary resection. Nineteen (61%) resected nodules were benign, whereas 13 (39%) were malignant (8 synchronous primary tumors and 5 lobar metastases). A total of 105 unresected nodules were followed by CT. Of these, 32 (30%) resolved completely, 20 (19%) shrunk, and 28 (27%) were stable, whereas 11 (11%) were lost to follow-up. Fourteen SNs (13%) grew, of which 5 were found to be malignant, each a new primary. Overall 5-year survival was not different between patients with or without SNs (67% vs 64%; P = .88). DISCUSSION: The prevalence of SNs on CT scan in patients undergoing resection for primary NSCLC is high. Only a low proportion of SNs are ever found to be malignant, predominantly those on the ipsilateral side as the dominant tumor. The presence of SNs has no effect on survival. Patients with SNs, if otherwise appropriately staged, should not be denied surgical therapy.
OBJECTIVE: We sought to define the prevalence, malignancy rate, and outcome of secondary nodules (SNs) detected on computed tomography (CT) scan for patients undergoing resection for primary non-small cell lung cancer (NSCLC). METHODS: In consecutive patients with NSCLC, we reviewed all CT scan reports obtained at diagnosis of the dominant tumor for description of SNs. When resected, pathology was reviewed. Serial CT reports for 2 years postoperatively were evaluated to follow SNs not resected. RESULTS: Among 155 patients, 88 (57%) were found to have SNs. A total of 137 SNs were evaluated (median size, 0.5 cm). Thirty-two nodules were resected at primary resection. Nineteen (61%) resected nodules were benign, whereas 13 (39%) were malignant (8 synchronous primary tumors and 5 lobar metastases). A total of 105 unresected nodules were followed by CT. Of these, 32 (30%) resolved completely, 20 (19%) shrunk, and 28 (27%) were stable, whereas 11 (11%) were lost to follow-up. Fourteen SNs (13%) grew, of which 5 were found to be malignant, each a new primary. Overall 5-year survival was not different between patients with or without SNs (67% vs 64%; P = .88). DISCUSSION: The prevalence of SNs on CT scan in patients undergoing resection for primary NSCLC is high. Only a low proportion of SNs are ever found to be malignant, predominantly those on the ipsilateral side as the dominant tumor. The presence of SNs has no effect on survival. Patients with SNs, if otherwise appropriately staged, should not be denied surgical therapy.
Authors: Leslie J Kohman; Lin Gu; Nasser Altorki; Ernest Scalzetti; Linda J Veit; Jason M Wallen; Xiaofei Wang Journal: J Thorac Cardiovasc Surg Date: 2017-02-07 Impact factor: 5.209
Authors: Massimo Castiglioni; Brian E Louie; Candice L Wilshire; Alexander S Farivar; Ralph W Aye; Jed Gorden; Matthew P Horton; Eric Vallières Journal: Front Surg Date: 2015-01-12
Authors: Mitchell D Ross; Sreeja Biswas Roy; Pradnya D Patil; Jasmine L Huang; Nitika Thawani; Ralph Drosten; Tanmay S Panchabhai Journal: Case Rep Pulmonol Date: 2018-02-20