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Erschienen in:
31.10.2016 | Chest
Predictive factors for malignancy in incidental pulmonary nodules detected in breast cancer patients at baseline CT
Erschienen in: European Radiology | Ausgabe 7/2017
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Objectives
Pulmonary nodules are commonly encountered at staging CTs in patients with extrathoracic malignancies, but their significance on a per-patient basis remains uncertain.
Methods
We undertook a retrospective analysis of pulmonary nodules identified in patients with a diagnosis of breast cancer from 2010 – 2015, evaluating nodules present at a baseline CT (i.e. prevalent nodules). We reviewed 211 patients with 248 individual nodules.
Results
The rate of malignancy in prevalent nodules is low, approximately 13 %. Variables associated with metastasis include pleural studding, hilar lymphadenopathy and the presence of extrapulmonary metastasis, as well as number of nodules, nodule size and nodule shape. Using a combination of these factors, we have developed an evidence-based multivariate decision tree to predict which nodules are malignant in these patients, which is 91 % accurate and 100 % sensitive for metastasis.
Conclusions
We propose a simplified clinical prediction algorithm to guide radiologists and oncologists in managing patients with breast cancer and incidental pulmonary nodules.
Key points
• Incidental pulmonary nodules are common on computed tomography in breast cancer patients.
• Nodules present at baseline have a lower malignancy risk than incident nodules.
• We present an evidence-based decision algorithm predicting which nodules are likely malignant.
• This algorithm can help direct patient management.