nodules in the setting of an extrapulmonary tumor
Leite1, Tiago Nogueira1, Joo Bernando1, Luis
Eugnio1 and Manuel Antunes1 1Cardiothoracic
Surgery, Centro Hospitalar e Universitrio de Coimbra,
In a patient with a known previous extrapulmonary tumor and a new
pulmonary lesion, the hypothesis of a metastasis is put forth, often
accepted and a wedge resection is performed. Still this remains
analyze patients with known previous tumors submitted to resection
surgery due to pulmonary nodules. To establish a relation between the
type of tumor, size, location, number and histology of the nodules.
Methods: Search the
center's records for patients with the
diagnosis of pulmonary lesion/nodule, from January 1st 2008 to December
31st 2012, excluding cases with no previous tumor.
279 patients (163 male / 116 female). 150 had an history of colorectal
cancer, 23 breast, 23 ORL, 23 soft tissue, 20 renovesical, 7 prostatic
and 5 uterine cancer. 232 patients presented with a single nodule
(82%), 37 with 2 (13%) and 10 with 3 (4%). The average size was 22.2mm
(SD 16.03). 171 patients had preoperative PET scan, 99 with PET
positive nodules and 13 PET negative nodules. 218 wedge resections were
performed, 27 lobectomies, 2 pneumonectomies and 18 enucleations.
Comparing the preoperative hypothesis of the nodules being metastasis
with the pathological diagnosis there was concordance in 199 cases
(70%). In patients with a history of colorectal cancer the relative
risk (RR) of the nodule being a primary lung cancer was 2.02
(1.365-2.99) (p<0.0001). No other significant relations where
In patients with a history of colorectal cancer a new pulmonary nodule
presented a significant risk of being primary lung cancer. Still the
surgical approach remains dependent on the ability to distinguish
between them in an extemporaneous examination.