title: Distinguishing benign from malignant pulmonary nodules with helical chest CT in children with malignant solid tumors.
abstract: OBJECTIVE
  To retrospectively assess whether computed tomographic (CT) findings can indicate the benign or malignant nature of pulmonary nodules in pediatric patients with malignant solid primary tumors.
  
  
  METHODS
  With institutional review board approval, waived parental and patient consent, and HIPAA compliance, the authors determined the incidence of malignancy among 81 pulmonary nodules that were sampled at biopsy within 3 weeks after chest CT (January 1999 to September 2003) in 41 young patients with malignant solid tumors. Three radiologists independently and retrospectively reviewed these scans and the available previously obtained scans, classifying nodules as benign, malignant, or indeterminate on the basis of their number, unilateral versus bilateral distribution, size, margins (indistinct vs distinct), calcification, growth, and associated adenopathy. These classifications were compared with nodule histologic type, and interreviewer agreement was assessed.
  
  
  RESULTS
  The median patient age was 14.8 years (mean, 13.7 years; range, 5-21 years). Twenty-four of the 41 patients (58%) had at least one biopsy-proved malignant nodule. Four (10%) patients had both benign and malignant nodules; 17 (42%) had only benign nodules. Reviewer 1 classified 65% (39 of 60) of nodules correctly; reviewer 2, 57% (37 of 65); and reviewer 3, 67% (43 of 64). Interreviewer agreement was slight to moderate (kappa </= 0.43, P </= .03). In contrast to findings in adults, sharply defined nodules in younger individuals were more likely to be malignant (P = .03) and nodule size was not associated with malignancy (P >/= .32).
  
  
  CONCLUSIONS
  The frequency of benign nodules and the inconsistency of predictions based on CT features suggest the need for better predictors of pulmonary nodules being malignant or benign, so as to reduce unnecessary thoracotomy in pediatric patients with solid malignancy. .
authors.affiliation: Department of Radiological Sciences, St Jude Children's Research Hospital, 332 N Lauderdale St, Memphis, TN 38105-2794, USA. beth.mccarville@stjude.org
authors.forename: M Beth
authors.initials: MB
authors.lastname: McCarville
authors.forename: Henrique M
authors.initials: HM
authors.lastname: Lederman
authors.forename: Victor M
authors.initials: VM
authors.lastname: Santana
authors.forename: Najat C
authors.initials: NC
authors.lastname: Daw
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Shochat
authors.forename: Chin-Shang
authors.initials: CS
authors.lastname: Li
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kaufman
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed