title: Characteristics and outcomes of secondary nodules identified on initial computed tomography scan for patients undergoing resection for primary non-small cell lung cancer.
abstract: OBJECTIVE
  We sought to define the prevalence, malignancy rate, and outcome of secondary nodules (SNs) detected on computed tomography (CT) scan for patients undergoing resection for primary non-small cell lung cancer (NSCLC).
  
  
  METHODS
  In consecutive patients with NSCLC, we reviewed all CT scan reports obtained at diagnosis of the dominant tumor for description of SNs. When resected, pathology was reviewed. Serial CT reports for 2 years postoperatively were evaluated to follow SNs not resected.
  
  
  RESULTS
  Among 155 patients, 88 (57%) were found to have SNs. A total of 137 SNs were evaluated (median size, 0.5 cm). Thirty-two nodules were resected at primary resection. Nineteen (61%) resected nodules were benign, whereas 13 (39%) were malignant (8 synchronous primary tumors and 5 lobar metastases). A total of 105 unresected nodules were followed by CT. Of these, 32 (30%) resolved completely, 20 (19%) shrunk, and 28 (27%) were stable, whereas 11 (11%) were lost to follow-up. Fourteen SNs (13%) grew, of which 5 were found to be malignant, each a new primary. Overall 5-year survival was not different between patients with or without SNs (67% vs 64%; P = .88).
  
  
  CONCLUSIONS
  The prevalence of SNs on CT scan in patients undergoing resection for primary NSCLC is high. Only a low proportion of SNs are ever found to be malignant, predominantly those on the ipsilateral side as the dominant tumor. The presence of SNs has no effect on survival. Patients with SNs, if otherwise appropriately staged, should not be denied surgical therapy.
authors.affiliation: Division of Thoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY. Electronic address: brs9035@med.cornell.edu.
authors.forename: Brendon M
authors.initials: BM
authors.lastname: Stiles
authors.affiliation: Division of Thoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Schulster
authors.affiliation: Division of Thoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
authors.forename: Abu
authors.initials: A
authors.lastname: Nasar
authors.affiliation: Division of Thoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
authors.forename: Subroto
authors.initials: S
authors.lastname: Paul
authors.affiliation: Division of Thoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Lee
authors.affiliation: Division of Thoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Port
authors.affiliation: Division of Thoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
authors.forename: Nasser K
authors.initials: NK
authors.lastname: Altorki
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009519:New York City / Q000453:epidemiology; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden