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Abstract
Background: This study sought to determine the rate and patterns of malignancy in patients with extrapulmonary 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 the results of a diagnostic biopsy, and were considered benign if their appearance remained stable 2 years after the initial study, if they resolved, or if a biopsy showed a non-malignant condition.
Results: Sixty four of 151 patients (42%) were diagnosed with malignant nodules; 32 had newly diagnosed lung cancers, 28 had metastatic spread of their primary cancers, and four had lesions that were either new cancers or of undetermined aetiology. On univariate analysis the 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 which patients should undergo diagnostic biopsy.
Conclusion: Nearly half the 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 in patients with extrapulmonary cancers and non-calcified pulmonary nodules. In smokers, such lesions should raise concern for lung cancer.
- CT, computed tomographic scanning
- ELCAP, Early Lung Cancer Action Project
- FNA, fine needle aspiration
- NCPN, non-calcified pulmonary nodule
- PET, positron emission tomographic scanning
- VATS, video assisted thoracoscopic surgery
- lung cancer
- pulmonary nodule
- metastasis
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Footnotes
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Published Online First 7 February 2006
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Dr Feinstein is the sponsor of this study and supervised all steps of this research project. He developed the hypothesis and study design in consultation with the other authors and is responsible for assessing data quality and disseminating these results through publications and national meetings.
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The studies described in this manuscript were supported by internal funding only and not by external sources, with the exception of Dr Vickers whose contribution was funded by a P50-CA92629 SPORE from the National Cancer Institute.
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Competing interests: None of the authors has any competing interest to the material covered by this manuscript.
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Ethics approval: This study was approved by the institutional privacy board of the Memorial Sloan-Kettering Cancer Center in New York City. This board is designed to oversee retrospective studies, such as this one, to ensure that they maintain compliance with institutional and governmental guidelines of medical ethics and patient confidentiality. Given the study design, no informed consent was required.