title: The clinical significance of radiologically detected silent pulmonary nodules in early breast cancer.
abstract: BACKGROUND
  Increasing numbers of patients with early cancer undergo routine staging using computerized tomography (CT). Those in whom indeterminate pulmonary nodules are visualized without the presence of other metastatic lesions represent a clinical dilemma regarding their management as early breast cancer or metastatic disease.
  
  
  METHODS
  Medical records of breast cancer patients who underwent thoracic CT scans between the years 2002 and 2008 were analyzed. Those with obvious metastatic disease were excluded. Patients were identified via the radiology database by searching for the terms: 'suspicious lung metastases' and 'indeterminate nodules'.
  
  
  RESULTS
  Out of 1578 new patients assessed from 2002 to 2008, we carried out 802 staging CT scans. Thirty-four cases (4.2%) with indeterminate pulmonary nodules were identified. We categorized cases by size and number of nodules. At a median follow-up of 18 months, there were no changes in lesion size in 86% of patients with a solitary nodule <1 cm and 89% with multiple subcentimeter nodules. In contrast, in 100% of cases with pulmonary nodules >1 cm, the nodules had progressed at follow-up (chi(2), P = 0.004).
  
  
  CONCLUSIONS
  Breast cancer cases with subcentimeter indeterminate pulmonary lesions and no evidence of metastases elsewhere are unlikely to represent metastatic disease. Treatment with curative intent or entry into clinical trials should not be excluded.
authors.affiliation: Department of Medical Oncology, Imperial College, The Hammersmith Hospitals NHS Trust, Charing Cross Hospital, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Lee
authors.forename: A
authors.initials: A
authors.lastname: Lim
authors.forename: A
authors.initials: A
authors.lastname: Lalvani
authors.forename: M J L
authors.initials: MJ
authors.lastname: Descamps
authors.forename: R
authors.initials: R
authors.lastname: Leonard
authors.forename: S
authors.initials: S
authors.lastname: Nallamala
authors.forename: J S
authors.initials: JS
authors.lastname: Lewis
authors.forename: R C
authors.initials: RC
authors.lastname: Coombes
authors.forename: J
authors.initials: J
authors.lastname: Stebbing
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000473:pathology*; D014057:Tomography, X-Ray Computed