title: Pulmonary nodules discovered during the initial evaluation of pediatric patients with bone and soft-tissue sarcoma.
abstract: BACKGROUND
  Recent technical advances in CT imaging and data processing have improved the ability to detect small pulmonary nodules in children with bone and soft-tissue sarcoma undergoing radiologic imaging of the chest.
  
  
  METHODS
  We retrospectively studied medical records and CT chest scans at initial diagnosis of 210 children and young adults presenting to a single pediatric tertiary care hospital specialized in oncology for evaluation of bone or soft-tissue sarcoma. We correlated clinical features and CT scan findings with patient outcome and histologic results, when available.
  
  
  RESULTS
  Pulmonary nodules (diameter </=3 cm) were identified in 66 patients (31.4%). The median size of the largest nodule in each patient was 5 mm (range, 1-20 mm). Of patients who underwent biopsy or resection of a nodule, 41.7% had metastatic pulmonary disease. Having more than three nodules and a bilateral distribution were associated with histology-proven metastasis (P = 0.002 and P = 0.011, respectively) and an increased frequency of recurrent or progressive metastatic disease in the lung (P < 0.001 and P = 0.023, respectively). Greater size of the largest nodule present showed a trend towards biopsy-proven lung metastasis, but did not reach statistical significance (P = 0.06). When biopsy or resection was not performed, increased size was significantly associated with nodules being presumed as malignant (median, 16.8 mm compared to 4.0 mm for biopsied nodules, P < 0.001).
  
  
  CONCLUSIONS
  Pulmonary nodules were commonly detected during the initial evaluation of pediatric cases of sarcoma. Number and distribution of nodules were significantly associated with metastatic disease and outcome.
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Absalon
authors.forename: M Beth
authors.initials: MB
authors.lastname: McCarville
authors.forename: Tiebin
authors.initials: T
authors.lastname: Liu
authors.forename: Victor M
authors.initials: VM
authors.lastname: Santana
authors.forename: Najat C
authors.initials: NC
authors.lastname: Daw
authors.forename: Fariba
authors.initials: F
authors.lastname: Navid
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D008297:Male; D013902:Radiography, Thoracic; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000473:pathology*; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed