title: Pulmonary Nodule Size <5 mm Still Warrants Investigation in Patients With Osteosarcoma and Ewing Sarcoma.
abstract: Osteosarcoma (OS) and Ewing sarcoma (ES) have a high propensity to develop pulmonary metastases. Lung lesions with calcification, peripheral location, and size >5 mm are more likely to represent malignant metastases. We evaluated the incidence of malignancy in nodules 5 mm or less to potentially guide decisions between biopsy and observation.
  
  
  
  A retrospective review of patients <25 years of age with metastatic OS and ES treated at our institution between 2001 and 2014 who had undergone pulmonary nodule biopsy was performed. Computed tomographic scans were reviewed to evaluate nodule size and change over time.
  
  
  
  Thirty-five patients (27 OS, 8 ES) met inclusion criteria. One hundred sixteen nodules were biopsied (97 OS, 19 ES). Nodule size at biopsy was not significantly different between the malignant (median, 6 mm, range, 1 to 79 mm) and benign (median, 3 mm, range, 1 to 21 mm) lesions (P=0.063). Size of pulmonary nodules <5 mm was not entirely predictive of benign status, with sensitivity estimate of 0.709 (95% confidence interval, 0.465-0.872; P=0.091) and specificity estimate of 0.776 (95% confidence interval, 0.324-0.962; P=0.219) for all nodules biopsied.
  
  
  
  Pulmonary nodules in patients with OS and ES <5 mm cannot be excluded from biopsy considerations.
authors.affiliation: Departments of *Surgery, Division of Pediatric Surgery †Radiology §Pediatrics, Division of Hematology, Oncology, and Bone Marrow Transplantation, Nationwide Children's Hospital, The Ohio State University College of Medicine ‡Department of Biostatistics, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Jared
authors.initials: J
authors.lastname: Kusma
authors.forename: Cody
authors.initials: C
authors.lastname: Young
authors.forename: Han
authors.initials: H
authors.lastname: Yin
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Stanek
authors.forename: Nicholas
authors.initials: N
authors.lastname: Yeager
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Aldrink
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary*; D008297:Male; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging*; D012516:Osteosarcoma / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000473:pathology*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult