Endobronchial metastasis of breast cancer 5 years after breast-conserving therapy

Case report: Hilar metastasis of breast cancer: A single-center retrospective case-control study

Purpose

The lungs are a common metastatic organ in breast cancer, mainly due to blood metastasis. On imaging, most metastatic lesions show a peripheral round mass in the lung, occasionally with a hilar mass as the primary manifestation, showing burr and lobulation signs. This study aimed to investigate breast cancer patient's clinical characteristics and prognosis with two different metastatic sites in the lung.

Methods

We retrospectively analyzed patients admitted to the First Hospital of Jilin University between 2016 and 2021 diagnosed with breast cancer lung metastases. Forty breast cancer patients with hilar metastases (HM) and 40 patients with peripheral lung metastases (PLM) were matched 1:1 using a pairing method. To analyze the patient's prognosis, the clinical characteristics of patients with two different metastatic sites were compared using the chi-square test, Kaplan-Meier curve, and Cox proportional hazards model.

Results

The median follow-up time was 38 months (2-91 months). The median age of patients with HM was 56 years (25-75 years), and that of patients with PLM was 59 years (44-82 years). The median overall survival (mOS) was 27 months in the HM group and 42 months in the PLM group (p = 0.001). The results of the Cox proportional hazards model showed that the histological grade (hazard ratio = 2.741, 95% confidence interval 1.442-5.208, p = 0.002) was a prognostic factor in the HM group.

Conclusion

The number of young patients in the HM group was higher than that in the PLM group, with higher Ki-67 indexes and histological grades. Most patients had mediastinal lymph node metastasis, with shorter DFI and OS and poor prognosis.

Endobronchial metastases from extrapulmonary solid tumors

Malignancy detected during endobronchial biopsies is usually regarded as proof of lung cancer. It may, however, represent endobronchial metastases from extrapulmonary primary tumors. The literature was reviewed to describe how frequent extrapulmonary tumors have been reported to metastasize to the endobronchial epithelium. English language literature was searched from 1962 through 2002. Primary lung cancer and lymphomas were excluded. Endobronchial metastases were reported in 204 patients, originating from 20 different extrapulmonary primary tumors, usually cancers of the breast, kidney, colorectal, uterine cervix, sarcoma and skin. The mean time from diagnosis of primary tumor was 50 months (range 0-300 months) and mean survival time from diagnosis of endobronchial metastasis was 15.2 months (range 0-150 months). It is important to make a distinction between endobronchial metastases from primary lung cancer, as treatment possibilities may be different. The possibility of endobronchial metastasis should be considered if the patient has a history of malignancy in other organs.