title: What is the Significance of Indeterminate Pulmonary Nodules in Patients Undergoing Resection for Pancreatic Adenocarcinoma?
abstract: OBJECTIVE
  The significance of indeterminate pulmonary nodules (IPNs) in patients undergoing resection of pancreatic ductal adenocarcinoma (PDAC) is unknown. We sought to define the prevalence and impact of IPN in such patients.
  
  
  METHODS
  We studied all patients who underwent surgical resection of PDAC between 1980 and 2013. IPN was defined as ≥1 well-defined lung nodule(s) less than 3 cm in diameter. Survival was assessed using univariate and multivariate Cox models.
  
  
  RESULTS
  Of the 2306 resected patients, 374 (16.2 %) had a preoperative chest computed tomography (CT) scan. Of these patients, 183 (49 %) had ≥1 IPN. Demographic and clinicopathological characteristics were similar among patients with or without IPN (all P>0.05). Median survival was comparable among patients who did (15.6 months) or did not (18.0 months) have IPN (P=0.66). Of the 183 patients with IPN, 29 (16 %) progressed to clinically recognizable metastatic lung disease compared to 13 % without IPN (P=0.38). The presence of >1 IPN was associated with the development of lung metastasis (relative risk 1.58, 95 % CI 1.03-2.4; P=0.05). However, lung metastasis was not associated with survival (P=0.24).
  
  
  CONCLUSIONS
  An IPN proved to be a lung metastasis in only one of six patients with PDAC undergoing surgical resection in this study. Survival was not impacted, even among patients who developed lung metastasis. Patients with PDAC who have IPN should not be precluded from surgical consideration.
authors.affiliation: Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Halsted 608, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Poruk
authors.forename: Yuhree
authors.initials: Y
authors.lastname: Kim
authors.forename: John L
authors.initials: JL
authors.lastname: Cameron
authors.forename: Jin
authors.initials: J
authors.lastname: He
authors.forename: Frederic E
authors.initials: FE
authors.lastname: Eckhauser
authors.forename: Neda
authors.initials: N
authors.lastname: Rezaee
authors.forename: Joseph
authors.initials: J
authors.lastname: Herman
authors.forename: Daniel
authors.initials: D
authors.lastname: Laheru
authors.forename: Lei
authors.initials: L
authors.lastname: Zheng
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hruban
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Weiss
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000150:complications* / Q000175:diagnosis; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016016:Proportional Hazards Models; D014057:Tomography, X-Ray Computed