title: Stepwise examination for differential diagnosis of primary lung cancer and breast cancer relapse presenting as a solitary pulmonary nodule in patients after mastectomy.
abstract: OBJECTIVE
  The distinction of primary lung from metastatic breast cancer is crucial in patients presenting with a solitary pulmonary nodule after mastectomy, because treatment strategies are completely different. Definitive diagnosis of these nodules, however, is often difficult. We assessed the feasibility of our diagnostic approach for these nodules and estimated the frequency of primary lung cancer occurrence in patients after mastectomy.
  
  
  METHODS
  We evaluated solitary pulmonary nodules appearing in 48 patients after mastectomy. For histological examination, CT-guided needle aspiration biopsy (CT-NAB) or trans-bronchial lung biopsy (TBLB) was performed. Besides conventional morphopathological examination, differential diagnosis was performed by immunohistochemical examination and evaluation using a molecular marker (mammaglobin 1).
  
  
  RESULTS
  Biopsy specimens were obtained using minimally invasive methods, namely CT-NAB and TBLB, in 91.7% of patients. From 48 patients, differential diagnosis was obtained by morphopathological methods alone in 32, and by immunohistochemical and molecular marker examination in the remaining 16. Final diagnosis was metastatic breast and primary lung cancer in 40 (83.3%) and 8 patients (16.7%), respectively.
  
  
  CONCLUSIONS
  Our results show the clinical feasibility of our stepwise approach to the differential diagnosis of primary lung cancer and breast cancer relapse presenting as a solitary nodule in patients after mastectomy.
authors.affiliation: Division of Thoracic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan. okasaka@qj8.so-net.ne.jp
authors.forename: Toshiki
authors.initials: T
authors.lastname: Okasaka
authors.forename: Noriyasu
authors.initials: N
authors.lastname: Usami
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mitsudomi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yatabe
authors.forename: Keitaro
authors.initials: K
authors.lastname: Matsuo
authors.forename: Kohei
authors.initials: K
authors.lastname: Yokoi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000556:secondary*; D060785:Mammaglobin A; D008408:Mastectomy; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000378:metabolism; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009687:Nuclear Proteins / Q000276:immunology; D037701:Pulmonary Surfactant-Associated Protein B / Q000276:immunology; D015641:Radiography, Interventional; D011960:Receptors, Estrogen / Q000276:immunology; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis*; D000074482:Thyroid Nuclear Factor 1; D014057:Tomography, X-Ray Computed; D014157:Transcription Factors / Q000276:immunology; D014598:Uteroglobin / Q000378:metabolism
chemical_list: D000906:Antibodies; D014408:Biomarkers, Tumor; D060785:Mammaglobin A; D009363:Neoplasm Proteins; D009687:Nuclear Proteins; D037701:Pulmonary Surfactant-Associated Protein B; D011960:Receptors, Estrogen; C556448:SCGB2A2 protein, human; D000074482:Thyroid Nuclear Factor 1; D014157:Transcription Factors; D014598:Uteroglobin