Kusma Jared, Young Cody, Yin Han, Stanek Joseph R, Yeager Nicholas, Aldrink Jennifer H
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.
J Pediatr Hematol Oncol. 2017 Apr;39(3):184-187. doi: 10.1097/MPH.0000000000000753.
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.
骨肉瘤（OS）和尤因肉瘤（ES）极易发生肺转移。伴有钙化、位于周边且大小>5 mm的肺部病变更有可能为恶性转移灶。我们评估了5 mm及以下结节的恶性发生率，以指导活检与观察之间的决策。
对2001年至2014年在我院接受治疗的年龄<25岁的转移性OS和ES患者进行回顾性研究，这些患者均接受了肺结节活检。回顾计算机断层扫描以评估结节大小及随时间的变化。
35例患者（27例OS，8例ES）符合纳入标准。共对116个结节进行了活检（97个OS结节，19个ES结节）。恶性病变（中位数6 mm，范围1至79 mm）和良性病变（中位数3 mm，范围1至21 mm）活检时的结节大小无显著差异（P = 0.063）。对于所有活检的结节，<5 mm的肺结节大小并不能完全预测其为良性，敏感性估计值为0.709（95%置信区间，0.465 - 0.872；P = 0.091），特异性估计值为0.776（95%置信区间，0.324 - 0.962；P = 0.219）。
不能将OS和ES患者中<5 mm的肺结节排除在活检考虑范围之外。
