Significance of non-calcified pulmonary nodules among patients with extra-pulmonary cancers

Saira Khokhar ¹, Andrew Vickers ¹, Michelle Moore ¹, Svetlana Mironov ¹, Diane E Stover ¹ and Marc Feinstein ^1*

¹ Memorial Sloan-Kettering Cancer Center, United States

^* To whom correspondence should be addressed. E-mail: feinstem{at}mskcc.org.

Accepted 19 January 2006

Abstract

Background: This study sought to determine the rate and patterns of malignancy among patients with extra-pulmonary cancers and non-calcified pulmonary nodules, and to develop a statistical model to guide clinicians regarding choice of patients for diagnostic biopsy.

Method: The medical records of 151 patients evaluated at the Memorial Sloan-Kettering Cancer Center between January 1999 and December 2001 for non-calcified pulmonary nodules were reviewed. Nodules were considered malignant based on results of a diagnostic biopsy. Nodules were considered benign if their appearance remained stable two years from the initial study, if they resolved, or if biopsy demonstrated a non-malignant condition.

Results: Among 151 patients studied, 64 (42%) were diagnosed with malignant nodules. Of these, 32 patients had newly diagnosed lung cancers, 28 had metastatic spread of their primary cancers, and 4 had lesions that were either new cancers or of undetermined etiology. On univariate analysis, likelihood of malignancy increased with nodule size, tobacco exposure, and the finding of a solitary nodule. On multivariable analysis, only nodule size and tobacco exposure were predictive of malignancy. The model had good predictive accuracy (area-under-the-curve 0.751), but had insufficient discrimination for use as a clinical tool to determine biopsy.

Conclusion: Nearly half of non-calcified pulmonary nodules identified in this series were malignant. Lung cancer was more common than metastatic disease. These findings support the need for close interval follow-up and a low threshold for diagnostic biopsy among patients with extra-pulmonary cancers and non-calcified pulmonary nodules. Among smokers, such lesions should raise concern for lung cancer.

Keywords: lung cancer, metastasis, pulmonary nodule

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