Therapeutic strategy in patients with non-small cell lung cancer associated to satellite pulmonary nodules.
OBJECTIVE
In patients with non-small cell lung cancer (NSCLC) the presence of satellite metastatic nodules may be considered a contraindication to surgical treatment. The use of spiral computed tomography (CT) scan has improved the accuracy of the diagnostic assessment of pulmonary diseases, but has also led to the detection of a consistent number of indeterminate satellite lesions. Obtaining a differential diagnosis of these lesions is extremely important in defining the therapeutic strategy. The aim of the study was to assess the characteristics of satellite nodules in patients with NSCLC and to examine the diagnostic and therapeutic approach used in the presence of indeterminate satellite lesions.


METHODS
From November 1995 to February 2001, 29 patients (mean age 64 years) who underwent surgery for NSCLC had indeterminate satellite pulmonary lesions at the preoperative spiral CT scan. A differential diagnosis of the nodules was obtained by histological examination in 27 patients and by follow-up (62 and 64 months, respectively) in two patients. Positron emission tomography (PET) scan was selectively performed in the preoperative evaluation.


RESULTS
Thirty-two satellite nodules were analyzed in the group of 29 patients. The size of the lesions varied from 2 to 15 mm (mean 8mm). The nodules were ipsilateral to the primary tumor in 25 patients and contralateral in four. They were benign in 22 cases and malignant in ten (metastases from NSCLC in seven patients and second primary lung cancer in three). Nodules with a size equal to or less than 5mm were more frequently benign. Patients with stage III tumors had a higher incidence of malignant satellite nodules in comparison to earlier stages, although the data did not reach statistical significance. PET scan correctly differentiated benign and malignant satellite nodules in six patients.


CONCLUSIONS
Obtaining a differential diagnosis of indeterminate pulmonary nodules associated to NSCLC is of great importance in defining the therapeutic strategy. The results of this study show that indeterminate satellite lesions may be benign or represent a second primary lung cancer, and should not therefore be considered a contraindication to surgical exploration when a preliminary differential diagnosis by other means cannot be obtained.
Carretta
Angelo
A
Department of Thoracic Surgery, Scientific Institute H San Raffaele, Vita-Salute San Raffaele University, Via Olgettina, 60-20132 Milan, Italy. angelo.carretta@hsr.it
Ciriaco
Paola
P
Canneto
Barbara
B
Nicoletti
Roberto
R
Del Maschio
Alessandro
A
Zannini
Piero
P
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis*; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed