Solitary Pulmonary Lesion in Patients with History of Malignancy: Primary Lung Cancer or Metastatic Cancer?

• Published in: Annals of surgical oncology Vol. 25; no. 5; pp. 1237 - 1244
• Main Authors: Jin, Ke, Wang, Kexi, Zhang, Huizhong, Pan, Yuejiang, Cao, Dexiong, Wang, Minghui, Chen, Ju, Wu, Duoguang, Chen, Boshen, Xie, Xuan
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.05.2018; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Carcinoma, Squamous Cell - secondary; Female; Head & neck cancer; Head and Neck Neoplasms - pathology; Humans; Lung cancer; Lung Neoplasms - diagnosis; Lung Neoplasms - pathology; Lung Neoplasms - secondary; Lymph; Lymph nodes; Lymph Nodes - pathology; Lymphatic system; Male; Malignancy; Medicine; Medicine & Public Health; Metastases; Metastasis; Middle Aged; Multivariate analysis; Nomograms; Oncology; Pulmonary lesions; Retrospective Studies; Solitary Pulmonary Nodule - diagnosis; Solitary Pulmonary Nodule - pathology; Surgery; Surgical Oncology; Thoracic Oncology; Urogenital Neoplasms - pathology; Young Adult; Intrapulmonary Metastases; Previous Malignancy; Solitary Pulmonary Lesions (SPLs); Head And Neck Squamous Cell Cancer (HNSCC); Negative Lymph Node Status
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-018-6360-6

Background Defining the status of solitary pulmonary lesion (SPL) in patients with history of malignancy is important because primary lung cancer (PLC) or intrapulmonary metastasis might indicate different surgical strategies. The aim of this study is to identify factors related to the status of these lesions and construct a clinical model to estimate the pretest probability of PLC. Methods From January 2005 to January 2016, 104 patients with previous malignancy and suitable for surgery were retrospectively studied. Univariate and multivariate analyses were performed to identify possible factors related to SPLs. A nomogram was constructed to differentiate PLC from intrapulmonary metastasis. Results Ninety-seven (93.3%) patients were diagnosed as malignant postoperatively, including 61 patients with intrapulmonary metastasis and 36 patients with PLC. Multivariate analysis showed that site of primary tumor [head and neck squamous cell cancer: odds ratio (OR) = 28.509, P  = 0.006; genitourinary cancer: OR = 23.928, P  = 0.012], negative lymph node status of primary tumor (OR = 3.154, P  = 0.038), spiculation of SPL (OR = 3.972, P  = 0.022), and central location of SPL (OR = 4.679, P  = 0.026) were four independent factors differentiating PLC from intrapulmonary metastasis. All of these were included in the nomogram. The C -index of the nomogram for predicting probability was 0.82. Conclusions Incidence of malignant SPLs was fairly high in patients with history of malignancy. A nomogram including site and lymph node status of primary tumor, and spiculation and location of SPL might be a good tool for differentiating PLC from intrapulmonary metastasis preoperatively and guiding treatment.