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Journal of Clinical Oncology, 2004 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 22, No 14S (July 15 Supplement), 2004: 8549
© 2004 American Society of Clinical Oncology
Pulmonary nodules in the initial evaluation of pediatric patients with bone and soft-tissue sarcoma
M. J. Absalon,
M. B. McCarville,
T. Liu,
A. Cain and
F. Navid
St. Jude Children's Research Hospital, Memphis, TN
8549
Background: The radiographic detection of the small pulmonary nodule during the initial metastatic workup of the pediatric oncology patient presents a significant clinical dilemma. The outcome of the decision of whether the nodule is malignant or benign often affects decisions regarding treatment, protocol enrollment, and assessment of prognosis. The incidence of this clinical situation in the era of helical computed tomography (CT) is unknown and practice guidelines pertaining to the pretherapy evaluation of the small pulmonary nodule are lacking. Methods: We performed a retrospective review of initial lung CT reports of 181 consecutive pediatric patients referred to our hospital for the primary treatment of bone or soft-tissue sarcomas from 1999–2003. The frequency, number, size, location and characteristics of nodules were documented. These lung CT findings were correlated with the histologic conclusions from lung biopsy and/or clinical outcome. Results: : Pulmonary nodules were found on CT evaluation in 57 (31%) of patients. In approximately half of these patients, the largest nodule was less than or equal to 10 mm diameter. Twenty-two patients were coded as having pulmonary metastatic disease by the primary oncologist. Four of these patients underwent a lung biopsy to histologically confirm pulmonary metastasis. The remaining 18 patients were determined to have pulmonary metastasis without further intervention. Of the 35 patients who were coded as not having pulmonary metastasis, 12 had lung biopsies showing normal lung or granulomatous disease. Patients with osteosarcoma were more likely to have an invasive procedure (p=0.010), but size, number of nodules, and presence of calcifications were not predicative (p>0.36) of those going to biopsy. Conclusions: Our findings confirm that the finding of a small pulmonary nodule during the initial workup of pediatric patients with sarcoma presents a common clinical scenario and highlights the need for a systematic approach to its evaluation. A proposal to study this problem will be offered.
No significant financial relationships to disclose.
Abstract presentation from the 2004 ASCO Annual Meeting
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