The availability of pre- and intraoperative evaluation of a solitary pulmonary nodule in breast cancer patients.
OBJECTIVE
It is clinically difficult to differentiate between primary lung cancer (PLC) and metastasis from breast cancer (MBC) in the diagnosis of a solitary pulmonary nodule (SPN) observed in a patient with past history of breast cancer. We evaluated several clinical, radiological and pathological variables in patients with SPN in an attempt to identify reliable markers to differentiate them.


METHODS
Retrospectively we reviewed the clinical, radiological and pathological characteristics of 64 patients with a history of breast cancer resection who subsequently underwent surgical resection of an indeterminate SPN in our institute.


RESULTS
The patients with MBC were significantly younger (p = 0.01). Among CT findings, presence of a solid opacity (p <0.01), well-defined tumor (p <0.01) and absence of an air bronchogram (p <0.01) were significantly associated with MBC. Among the intraoperative frozen section pathologic findings, the absence of lepidic or papillary patterns (p <0.01) and the presence of strong fibrosis in the tumor (p <0.01) were significantly correlated with MBC.


CONCLUSIONS
Although some cases are difficult to confirm the definitive diagnoses of SPN, combining CT and intraoperative pathological findings might enable us to distinguish SPN between MBC and PLC prior to postoperative examinations.
Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Division of General Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Tomonari
T
Kinoshita
Junji
J
Yoshida
Genichiro
G
Ishii
Tomoyuki
T
Hishida
Masahiro
M
Wada
Keiju
K
Aokage
Kanji
K
Nagai
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007564:Japan; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D019990:Perioperative Care; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D014057:Tomography, X-Ray Computed