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Haque E, Mushtaq AH, Alkhatib R, Alhusaini H, Suleman K. An Unexpected Diagnosis of Second Primary Malignancy in a Breast Cancer Survivor: A Case Report. Cureus 2023; 15:e42819. [PMID: 37664269 PMCID: PMC10471315 DOI: 10.7759/cureus.42819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Breast cancer survival rates are increasing more than ever with the development of better diagnostic and therapeutic techniques. Survivors of breast cancer have an increased risk of developing second primary malignancies, which may be mistaken for breast cancer recurrence and lead to delayed diagnosis and poor prognosis. CASE REPORT We report a case of a 62-year-old female who presented with shortness of breath and bone pain. She had a history of left triple-positive invasive ductal carcinoma (T1N0M0) treated with bilateral skin-sparing mastectomy, adjuvant Taxotere, and trastuzumab-based therapy and then continued on trastuzumab and letrozole. She underwent imaging to explore the source of her symptoms at which new pulmonary nodules were discovered. During workup, she was found to have elevated tumor markers. They were initially suspected to be breast cancer recurrence metastases based on elevated tumor markers; however, further investigations confirmed that the nodules were a second primary lung adenocarcinoma with a different molecular profile. The patient had disease progression despite chemotherapy and eventually succumbed to her disease. CONCLUSION This case highlights the importance of considering second primary malignancies in breast cancer survivors and utilizing advanced diagnostic modalities to efficiently diagnose such cases.
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Affiliation(s)
- Emaan Haque
- Department of Medicine, Alfaisal University, Riyadh, SAU
| | - Ali H Mushtaq
- Department of Medicine, Cleveland Clinic, Cleveland, USA
- Department of Medicine, Alfaisal University, Riyadh, SAU
| | | | - Hamed Alhusaini
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Kausar Suleman
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
- Department of Medicine, Alfaisal University, Riyadh, SAU
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Chen RY, Goh RY, Leung HT, Cheng S, Tan VKM, Chia CLK, Goo JTT, Ong MW. Clinical Significance of Radiologically Detected Small Indeterminate Extra-Mammary Lesions in Breast Cancer Patients. Eur J Breast Health 2022; 18:252-257. [DOI: 10.4274/ejbh.galenos.2022.2022-1-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/30/2022] [Indexed: 12/01/2022]
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The identification of abnormalities on radiotherapy CT planning scans: a retrospective audit. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396922000036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Introduction:
Therapeutic radiographers are an essential part of a cancer patient’s journey and play a vital and changing role in the delivery of radiotherapy services. This retrospective audit highlights the number of incidental abnormalities found by a Breast Advanced Practitioner on radiotherapy computed tomography (CT) planning scans and their subsequent management.
Methods:
This retrospective audit investigated the incidental abnormalities found by the Breast Advanced Practitioner on routine CT planning scans for breast cancer patients 2016–2021. Any breast cancer patient found to have an abnormality had their planning scan uploaded to the national picture archiving and communication systems (PACS) system for radiology review. Further formal CT imaging was requested or direct referral to an appropriate multi-disciplinary team meeting.
Results:
Sixty-three significant abnormalities were found over the five-year period, of these thirty seven were malignant and the majority of these were lung lesions. Seven patients went on to have surgery alone, surgery plus chemoradiation or stereotactic ablative radiotherapy for their newly diagnosed lung primaries. Five patients were found to have liver metastases that unfortunately changed their treatment plan to palliative.
Conclusion:
This retrospective audit has demonstrated that CT planning for radiotherapy offers an opportunity to identify malignant abnormalities at a potentially early stage, thereby improving prognosis and survival. Radiographers have a duty of care to appraise these CT scans to ensure any abnormalities can be addressed in a timely manner.
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Metin Y, Metin NO, Özdemir O, Taşçı F, Kul S. The role of low keV virtual monochromatic imaging in increasing the conspicuity of primary breast cancer in dual-energy spectral thoracic CT examination for staging purposes. Acta Radiol 2020; 61:168-174. [PMID: 31237772 DOI: 10.1177/0284185119858040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The additive value of dual-energy spectral computerized tomography (DESCT) in breast cancer imaging is still unknown. Purpose To investigate the role of DESCT in improving the conspicuity of primary breast cancer. Material and Methods Twenty-nine patients who were histopathologically diagnosed with breast cancer and underwent DESCT for staging of lung metastasis were evaluated retrospectively. The visual conspicuity of breast cancer was scored by two readers separately in reconstructed virtual monochromatic images obtained at 40, 60, 80, and 100 keV. A circular region of interest slightly smaller than the maximum contrasted portion of the primary breast cancer was manually placed. Iodine enhancement (HU) and iodine content (mg/mL) values of tumor, normal breast tissue and pectoral muscle, and contrast-to-noise values of images at four different energy levels were calculated. Results The lesion conspicuity score peaked at 40-keV series for both readers and was significantly higher than those at other energy levels (all P < 0.001). Lesion iodine enhancement was highest at 40-keV virtual monochromatic image reconstructions ( P < 0.001). The iodine content was significantly higher in tumor than normal breast tissue, and pectoral muscle ( P < 0.001). The highest contrast-to-noise value was obtained at 60 keV (4.0 ± 2.5), followed by 40 keV (3.9 ± 2.2), without a significant difference ( P = 0.33). Conclusion The conspicuity of primary breast cancer was significantly higher in low keV virtual monochromatic images obtained by DESCT. This gives us hope that DESCT may play an effective role in detecting incidental breast lesions. It also raises the question of whether quantitative values obtained by DESCT can be used for characterization of primary breast lesion.
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Affiliation(s)
- Yavuz Metin
- Department of Radiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Nurgül Orhan Metin
- Department of Radiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Oğuzhan Özdemir
- Department of Radiology, Medical Park Hospital, Bursa, Turkey
| | - Filiz Taşçı
- Department of Radiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Sibel Kul
- Department of Radiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Du C, Wan C, Ding J, Zhang G, Zhang Y, Hu C, Ying H. Management of indeterminate pulmonary nodules (<1 cm) newly detected during the follow-up of nasopharyngeal carcinoma patients. Asia Pac J Clin Oncol 2017; 14:e15-e20. [PMID: 28792116 DOI: 10.1111/ajco.12752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 06/11/2017] [Indexed: 12/01/2022]
Abstract
AIM To investigate the management for the indeterminate pulmonary nodules newly detected during the follow-up for nasopharyngeal carcinoma (NPC) patients. METHODS Indeterminate pulmonary lesions were identified by searching medical records of NPC patients, who were followed-up with thoracic CT between April 2008 and February 2014. Indeterminate pulmonary nodules were defined as opacities that may be solitary or multiple, which were <1 cm in size and not calcified. Nodules which were followed-up for at least two years, were included into analysis. The nodules with growth were considered as metastatic lesions and those which remained stable or regressed were defined as benign. The relations between the risk of the nodules to develop into metastatic lesions and clinical features and characteristics of nodules were analyzed. RESULTS Through a median follow-up of 50 months, the majority (81 of 102, 79.4%) had no change in the size of nodules. The nodules have regressed in 11 patients. There were 10 (9.8%) cases with progression at the follow-up. The 10 patients were considered to have lung metastases, for whom continuous increases of lesions were revealed. The volume doubling time of the increasing nodules ranged from 34 to 105 days. The nodules emerging within two years after primary therapies were more likely to develop into metastatic lesions (P = 0.043). CONCLUSION Ten percent of the indeterminate pulmonary nodules represent metastatic diseases. A short-interval follow-up is recommended and if the nodules remain stable after six months follow-up, it may be proper to prolong the interval of follow-up.
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Affiliation(s)
- Chengrun Du
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Caifeng Wan
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
| | - Jianhui Ding
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Guangyuan Zhang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Youwang Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Hongmei Ying
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
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Hammer MM, Mortani Barbosa EJ. Predictive factors for malignancy in incidental pulmonary nodules detected in breast cancer patients at baseline CT. Eur Radiol 2016; 27:2802-2809. [PMID: 27798753 DOI: 10.1007/s00330-016-4627-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 09/02/2016] [Accepted: 09/29/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Pulmonary nodules are commonly encountered at staging CTs in patients with extrathoracic malignancies, but their significance on a per-patient basis remains uncertain. METHODS We undertook a retrospective analysis of pulmonary nodules identified in patients with a diagnosis of breast cancer from 2010 - 2015, evaluating nodules present at a baseline CT (i.e. prevalent nodules). We reviewed 211 patients with 248 individual nodules. RESULTS The rate of malignancy in prevalent nodules is low, approximately 13 %. Variables associated with metastasis include pleural studding, hilar lymphadenopathy and the presence of extrapulmonary metastasis, as well as number of nodules, nodule size and nodule shape. Using a combination of these factors, we have developed an evidence-based multivariate decision tree to predict which nodules are malignant in these patients, which is 91 % accurate and 100 % sensitive for metastasis. CONCLUSIONS We propose a simplified clinical prediction algorithm to guide radiologists and oncologists in managing patients with breast cancer and incidental pulmonary nodules. KEY POINTS • Incidental pulmonary nodules are common on computed tomography in breast cancer patients. • Nodules present at baseline have a lower malignancy risk than incident nodules. • We present an evidence-based decision algorithm predicting which nodules are likely malignant. • This algorithm can help direct patient management.
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Affiliation(s)
- Mark M Hammer
- Division of Cardiothoracic Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Ground Floor Founders Bldg., Philadelphia, PA, 19104, USA
| | - Eduardo J Mortani Barbosa
- Division of Cardiothoracic Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Ground Floor Founders Bldg., Philadelphia, PA, 19104, USA.
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Natural progression and clinical significance of incidentally detected pulmonary nodules in radiotherapy planning CT scans of breast cancer patients: a retrospective cohort. JOURNAL OF RADIOTHERAPY IN PRACTICE 2016. [DOI: 10.1017/s1460396916000376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AbstractAimIndeterminate pulmonary nodules incidentally detected during radiological imaging completed for radiotherapy planning always creates dilemma for the oncologist. The purpose of this study is to evaluate the clinical significance of pulmonary nodules incidentally detected in patients undergoing locoregional radiotherapy for breast cancer and present a retrospective analysis of the natural progression of such nodules.MethodsA retrospective review of computed tomography scans of breast cancer patients who underwent radiotherapy over a period of 3 years to screen out patients with indeterminate lung nodules was undertaken. This was correlated with the patient and tumour characteristics and the status of the disease at last follow-up.ResultsOf the 132 patients reviewed 28 had indeterminate lung nodules. Of the 28 patients, four had progressive lung nodules on follow-up. Subgroup analyses did not show any significant correlation.Discussion and conclusionOne fifth of patients may present with incidentally detected lung nodules. Multiple nodules, ER negative status and locally advanced breast cancer may point to a higher risk of these nodules progressing to metastatic cancer. There is no indication to stop locoregional therapy in the presence of indeterminate nodules, but close follow-up of high-risk group is recommended.
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Li F, Armato SG, Giger ML, MacMahon H. Clinical significance of noncalcified lung nodules in patients with breast cancer. Breast Cancer Res Treat 2016; 159:265-71. [PMID: 27503305 DOI: 10.1007/s10549-016-3937-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/03/2016] [Indexed: 12/21/2022]
Abstract
Patients with breast cancer are increasingly likely to have chest computed tomography (CT) performed. In many cases, small lung nodules will be detected, raising concern for metastases and causing considerable patient anxiety. The majority of these nodules, however, are benign, though the specific probability of malignancy is uncertain in any given case. Therefore, we analyzed the results of chest CT scans of a large number of patients with breast cancer, to determine characteristics and clinical significance of noncalcified lung nodules. 3313 patients were investigated, and 4889 CT scans from 1325 patients were retrospectively reviewed. Among the 1325 patients, 812 (59 %) had at least one noncalcified lung nodule, of which 330 (41 %) had malignant nodules, 197 (24 %) had large (≥10 mm) nodules, and 586 (72 %) had multiple nodules. Large nodules were more often malignant than benign (P < 0.001). In patients with multiple large nodules, the rate of malignancy rate was 83 %, and most of these were metastases. In the case of very small (2-4 mm) nodules, the malignancy rates for solitary and multiple nodules were 8 and 20 %, respectively. Lung metastases were more likely with breast cancer cell grade 3 (22 %) than grade 1-2 (10 %) (P < 0.001) and when patients were clinical stage 2-3 (14 %) than stage 0-1 (7.9 %) (P = 0.03). Lung metastases are highly likely in patients with multiple nodules greater than 10 mm. Higher cancer cell grades and clinical stage are also related to an increased likelihood of lung metastases. The great majority of small lung nodules in breast cancer patients are benign.
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Affiliation(s)
- Feng Li
- Department of Radiology, The University of Chicago, 5841 S. Maryland Avenue, MC 2026, Chicago, IL, 60637, USA.
| | - Samuel G Armato
- Department of Radiology, The University of Chicago, 5841 S. Maryland Avenue, MC 2026, Chicago, IL, 60637, USA
| | - Maryellen L Giger
- Department of Radiology, The University of Chicago, 5841 S. Maryland Avenue, MC 2026, Chicago, IL, 60637, USA
| | - Heber MacMahon
- Department of Radiology, The University of Chicago, 5841 S. Maryland Avenue, MC 2026, Chicago, IL, 60637, USA
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Brothers JM, Kidwell KM, Brown RKJ, Henry NL. Incidental radiologic findings at breast cancer diagnosis and likelihood of disease recurrence. Breast Cancer Res Treat 2016; 155:395-403. [PMID: 26797222 DOI: 10.1007/s10549-016-3687-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/13/2016] [Indexed: 12/19/2022]
Abstract
Despite guidelines recommending against its routine use, perioperative imaging for distant metastases is frequently performed in newly diagnosed breast cancer patients, uncovering incidental findings of uncertain significance. We assessed the clinical significance of incidental findings by determining if their presence is associated with disease recurrence. A retrospective review of staging imaging was performed in patients with stage II or III invasive breast cancer diagnosed during 2008-2009 at a large academic medical center. Data related to perioperative imaging and disease recurrence were abstracted from the medical record. Kaplan-Meier curves and Cox proportional hazards models were used to assess the association between incidental findings and time to disease recurrence. A total of 169 of 340 patients (49.7 %) underwent staging evaluation for distant metastases (CT chest, abdomen, pelvis, bone scan, and/or PET-CT). Of these, 146 (86.4 %) had at least one suspicious or indeterminate finding. Follow-up studies were performed in 73 (43.2 %) patients. Nineteen patients were diagnosed with metastatic disease at diagnosis, 18 of whom had stage III disease. In patients without metastatic disease at diagnosis, 32 later developed recurrence. Non-calcified pulmonary nodules were associated with shorter time to disease recurrence (hazard ratio 2.51, 95 % CI 1.13-5.57, p = 0.02). Imaging for distant metastases frequently reveals indeterminate findings, most of which are not associated with disease recurrence. The association between pulmonary nodules and recurrence warrants validation in an independent cohort. Overall, these findings support current guidelines recommending against routine extent of disease evaluation in patients with newly diagnosed stage II breast cancer.
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Affiliation(s)
- Joel M Brothers
- Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Med Inn Bldg C450, Ann Arbor, MI, 48109-5843, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Richard K J Brown
- Department of Radiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, USA
| | - N Lynn Henry
- Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Med Inn Bldg C450, Ann Arbor, MI, 48109-5843, USA.
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Natural History of Preoperative Subcentimeter Pulmonary Nodules in Patients With Resectable Pancreatic Adenocarcinoma. Ann Surg 2015; 261:970-5. [DOI: 10.1097/sla.0000000000000719] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Mano R, Vertosick E, Sankin AI, Chevinsky MS, Larish Y, Jakubowski CD, Hötker AM, Hakimi AA, Sjoberg DD, Akin O, Russo P. Subcentimeter pulmonary nodules are not associated with disease progression in patients with renal cell carcinoma. J Urol 2014; 193:776-82. [PMID: 25241004 DOI: 10.1016/j.juro.2014.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE Renal cell carcinoma most commonly metastasizes to the lung. Indeterminate pulmonary nodules develop preoperatively in half of the patients with localized renal cell carcinoma but clinical significance remains poorly defined. We determined whether the presence of indeterminate pulmonary nodules, or nodule size or number is associated with renal cell carcinoma outcomes. MATERIALS AND METHODS We reviewed data on 1,102 patients with renal cell carcinoma in whom chest computerized tomography was done within 6 months before nephrectomy from 2002 to 2012. Patients with metastatic disease at presentation, benign tumors, pulmonary nodules greater than 2 cm or concurrent pulmonary disease were excluded, leaving 748 available for analysis. Study outcomes included lung metastasis, any distant metastasis or death from renal cell carcinoma. Cox proportional hazards models were used to assess whether the presence of indeterminate pulmonary nodules, or nodule size or number was associated with outcomes. Models were evaluated by comparing discrimination using the Harrell c-index. RESULTS Indeterminate pulmonary nodules were present in 382 of 748 patients (51%). Median followup was 4.1 years (IQR 2.2-6.1). The presence of indeterminate pulmonary nodules was not associated with distant metastasis or death from kidney cancer. However, compared to subcm indeterminate pulmonary nodules the nodules greater than 1 cm were associated with metastatic disease after adjusting for tumor histology, stage and size (HR 2.48, 95% CI 1.08-5.68, p = 0.031). The outcome c-index increased slightly after adding nodule size to a predictive model adjusted for tumor characteristics. CONCLUSIONS No evidence in the current study suggested that indeterminate pulmonary nodules less than 1 cm are associated with renal cell carcinoma progression, although large nodules significantly predicted metastatic disease. Patients with subcm indeterminate pulmonary nodules would be unlikely to benefit from extensive postoperative chest imaging surveillance, which should be reserved for patients with nodules greater than 1 cm.
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Affiliation(s)
- Roy Mano
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emily Vertosick
- Departments of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alexander I Sankin
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael S Chevinsky
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yaniv Larish
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher D Jakubowski
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andreas M Hötker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - A Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel D Sjoberg
- Departments of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
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Anvari K, Fanipakdel A, Davoudi Y. The effect of surveillance on the outcome of breast cancer patients. IRANIAN JOURNAL OF CANCER PREVENTION 2013; 6:17-24. [PMID: 25250105 PMCID: PMC4142908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 10/15/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND The beginning of metastasis poorly affects the prognosis of breastcancer patients. Lung is the most frequent site of visceral metastasis, and the rate of recurrence is 10-30%. We have tried to find out if the routine Chest X Ray (CXR) could play a role for early detection of lung metastasis, during the prognosis of these patients. METHODS The files of the breast cancer patients between 1996 to 2006 (1739 patients) have reviewed. Clinical characteristics of patients with pulmonary metastasis have recorded. Patients, who lacked imaging files or lacked an appropriate follow-up, have excluded. Data have analyzed by SPSS 11.5. The survival analyses have performed by using the Kaplan-Meier method. RESULTS Fifty-six patients, median age 46, have entered into this retrospective study. Median tumor size was 4cm; median number of Lymphadenopathy (LAP) was 4. The intermediate grade has detected in 74% of patients. All patients have received adjuvant treatment. Median time from cancer diagnosis to pulmonary metastasis was 22 months. Pulmonary metastasis has detected by control CXR in77.4% and patients' symptoms in 22.6%. Forty eight patients have received chemotherapy in metastatic phase. In 28 patients (50%), other sites of metastasis (bone, liver, and brain) have discovered.The most frequent pattern of lung recurrence was pulmonary nodule (44.6%), followed by pleural effusion (28.6%). Median survival was 27.5; median survival from pulmonary metastasis was 8 m. CONCLUSION Early detection of pulmonary metastasis by CXR did not affect patients' endpoints. None of the probable prognostic factors have shown a significant effect on patients' outcome. Despite systemic treatment, survival after metastasis is low.
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Affiliation(s)
- Kazem Anvari
- Cancer Research Center, Omid Hospital ,Faculty of Medicine, Mashad University of Medical Sciences, Mashad, Iran
| | - Azar Fanipakdel
- Cancer Research Center, Omid Hospital ,Faculty of Medicine, Mashad University of Medical Sciences, Mashad, Iran,Corresponding Author:
Azar Fanipakdel, MD;
Assistant Professor of Radiation Oncology
Tel: (+98) 511 842 60 82
| | - Yasmin Davoudi
- Dept. of Radiology, Imam Reza Hospital, Mashad University of Medical Sciences, Mashad, Iran
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Baek SJ, Kim SH, Kwak JM, Cho JS, Shin JW, Amar AHY, Kim J. Indeterminate pulmonary nodules in rectal cancer: a recommendation for follow-up guidelines. J Surg Oncol 2012; 106:481-5. [PMID: 22457192 DOI: 10.1002/jso.23106] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 02/27/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Incidental visualization of indeterminate pulmonary nodules is considered a clinical dilemma. METHODS We identified patients for inclusion in this study by searching for the term "indeterminate nodules" in the radiology database of rectal cancer patients who underwent surgery. Patients with definite metastatic disease were excluded. RESULTS In total, 224 patients underwent chest computerized tomography (CT) and 59 of these patients had indeterminate pulmonary nodules detected more than twice by CT scan. Six patients (10.2%) were confirmed to have metastatic lesions on follow-up evaluation. Pulmonary nodule size (P=0.028), pathologic N status (P=0.049), positive nodal status (P=0.036) and the number of positive lymph nodes (P=0.033) were significant risk factors for pulmonary metastasis. In the pulmonary metastasis group, the patients who had received adjuvant oxaliplatin-based (FOLFOX4) chemotherapy had longer intervals to developing metastasis compared to patients who had not received it. CONCLUSIONS It is not necessary to perform excessive surveillance routinely for all rectal cancer patients who have indeterminate pulmonary lesions. Intensive follow-up chest CT or other invasive diagnostic modalities should be considered only in patients with pulmonary nodules larger than 5.7 mm or positive nodal status. In addition, patients receiving adjuvant FOLFOX4 chemotherapy should be followed-up for longer periods.
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Affiliation(s)
- Se-Jin Baek
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
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Shai A, Leitzin L, Steiner M, Peer A, Srour S, Shalom RB. FDG PET/CT differentiating two malignant tumors in the same patient. Acta Oncol 2012; 51:142-4. [PMID: 21851187 DOI: 10.3109/0284186x.2011.604348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Varol Y, Varol U, Karaca B, Karabulut B, Sezgin C, Uslu R. The frequency and significance of radiologically detected indeterminate pulmonary nodules in patients with colorectal cancer. Med Princ Pract 2012; 21:457-61. [PMID: 22572176 DOI: 10.1159/000337426] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 02/13/2012] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To investigate the frequency and significance of pulmonary nodules in patients with colorectal cancer (CRC). SUBJECTS AND METHODS Medical records of 1,344 patients with CRC who underwent thoracic computerized tomography scans between January 2003 and December 2009 were reviewed. Those with any distant metastatic disease or who were already known to have pulmonary malignancies were excluded. Number, size, shape and location of the nodules were evaluated. A multivariate analysis was performed to determine the predictive factors for evidence of metastases. RESULTS Of the 1,344 patients, 55 (4.09%) had nodules that met the criteria of an indeterminate pulmonary nodule. The mean follow-up time was 25 ± 17.9 months and the mean time to develop pulmonary metastasis was 15.5 ± 6.4 months. The nodules of 17 (30.9%) patients showed progression at follow-up; 8 had metastasized. Multivariate analysis showed multiple indeterminate pulmonary nodules (p = 0.006) of parenchymal localization (p = 0.016) with an irregular border (p = 0.002), which is predictive of metastatic disease. CONCLUSION Our study has shown that multiple indeterminate pulmonary nodules with an irregular border in a parenchymal location were more likely to represent metastatic disease. However, the frequency of the occurrence of indeterminate pulmonary metastases of CRC was low.
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Affiliation(s)
- Yelda Varol
- Department of Chest Diseases, Izmir M Enver Senerdem Torbalı Government Hospital, Izmir, Turkey
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Shaw JA, Brown J, Coombes RC, Jacob J, Payne R, Lee B, Page K, Hava N, Stebbing J. Circulating tumor cells and plasma DNA analysis in patients with indeterminate early or metastatic breast cancer. Biomark Med 2011; 5:87-91. [PMID: 21319970 DOI: 10.2217/bmm.10.118] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Circulating tumor cells (CTCs) and tumor-specific alterations in cell-free plasma DNA can both be used as markers of prognosis in breast cancer. To date, there have been no studies that have compared these as markers for subclinical metastases in the follow-up of early breast cancer. In this study, we measured CTCs and plasma DNA in a published group of patients with multiple pulmonary nodules and indeterminate metastatic disease. PATIENTS & METHODS A single blood sample for CTC and plasma DNA measurement was taken approximately 1.5 years after surgery from 19 women with histologically confirmed primary breast cancer and small pulmonary nodules. The CellSearch system was used to enrich and enumerate CTCs from peripheral blood. DNA was isolated from plasma and was analyzed by quantitative real-time PCR for DNA concentration, integrity and evidence of HER2 amplification. RESULTS Of the 19 individuals with 'indeterminate' early or metastatic breast cancer, 17 demonstrated no evidence of CTCs, one had one CTC and one had three CTCs. The mean plasma DNA concentration was low and within the range detected in healthy female controls, as were the values for DNA integrity. HER2 amplification was detected in the plasma DNA in four of the eight patients with HER2 immunohistochemistry 3+ tumors, but there was no overlap with the two CTC-positive patients. None of the patients have relapsed thus far (median follow-up: 3.5 years). CONCLUSION Both CTC and plasma DNA analyses together suggested that these patients had little evidence of metastatic disease. Future studies will be designed to assess the utility of these biomarkers in the follow-up of a larger number of women with breast cancer.
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Affiliation(s)
- Jacqui A Shaw
- Department of Cancer Studies & Molecular Medicine, University of Leicester, Leicester Royal Infirmary, UK
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The value of preoperative staging chest computed tomography to detect asymptomatic lung and liver metastasis in patients with primary breast carcinoma. Breast Cancer Res Treat 2011; 126:637-41. [DOI: 10.1007/s10549-011-1368-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Accepted: 01/23/2011] [Indexed: 10/18/2022]
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Sharma A, Ngan S, Nandoskar A, Lowdell C, Lewis JS, Hogben K, Charles Coombes R, Stebbing J. Schizophrenia does not adversely affect the treatment of women with breast cancer: A cohort study. Breast 2010; 19:410-2. [DOI: 10.1016/j.breast.2010.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Revised: 03/21/2010] [Accepted: 04/07/2010] [Indexed: 10/19/2022] Open
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Tuthill M, Pell R, Guiliani R, Lim A, Gudi M, Contractor KB, Lewis JS, Coombes RC, Stebbing J. Peritoneal disease in breast cancer: a specific entity with an extremely poor prognosis. Eur J Cancer 2009; 45:2146-9. [PMID: 19464163 DOI: 10.1016/j.ejca.2009.04.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 04/15/2009] [Accepted: 04/24/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Peritoneal metastases are now a significant cause of morbidity and mortality in patients with advanced breast cancer. There are few published data regarding the prognosis, clinical characteristics and management of individuals with peritoneal metastases from breast cancer. METHODS The electronic database at Imperial College Healthcare NHS Trust (Charing Cross Hospital) was searched for the terms 'breast', 'cancer' or 'tumour', 'peritoneal' and 'ascites' from 2000 to 2008. Those with confirmed peritoneal disease from breast cancer, as described on ultrasound or staging CT reports with a clinico-pathologic confirmed diagnosis, were included. RESULTS A total of 1628 patients were screened and initially 168 patients were identified. A subsequent total of 44 individuals (2.7% of the cohort) were defined as having breast cancer with peritoneal secondaries and were included in the analysis. Of these, the majority (77%) had invasive ductal carcinomas (IDCs). While the median survival from the diagnosis of metastatic breast cancer measured 20.5 months (range 0.1-125 months), the median survival of patients with peritoneal disease was 1.56 months (range 0.2-27 months). CONCLUSIONS These data demonstrate that the median survival of patients with peritoneal breast cancer metastasis is surprisingly poor, with only a minority surviving more than 6 months. A specific association with invasive lobular carcinoma (ILC) was not observed. The dismal outcome of these individuals, despite further active therapy, merits their inclusion into clinical trials designed specifically for this group of patients.
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Affiliation(s)
- Mark Tuthill
- Department of Medical Oncology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
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