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Pulmonary nodules in the setting of an extrapulmonary tumor

penyakit paru

Filipe Leite1, Tiago Nogueira1, Joo Bernando1, Luis Eugnio1 and Manuel Antunes1
1Cardiothoracic Surgery, Centro Hospitalar e Universitrio de Coimbra, Coimbra, Portugal

Introduction: 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 empirical.

Objectives: To 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.

Material and 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.

Results: 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 observed.

Conclusion: 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.

PP-PDPI. 20/07/17.

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