Caparica Rafael, Mak Milena Perez, Rocha Claudio Henrique, Velho Pedro Henrique Isaacsson, Viana Publio, Moura Mauricio R L, Menezes Marcos Roberto, Amato Marcelo B P, Feher Olavo
, Universidade de São Paulo; and , Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
J Glob Oncol. 2016 Feb 3;2(3):138-144. doi: 10.1200/JGO.2015.002089. eCollection 2016 Jun.
The differential diagnosis of pulmonary nodules (PNs) includes metastases, lung cancers, infectious diseases, and scar tissue, among others. Because data regarding whether and when to perform a PN biopsy in patients with cancer are scarce, clinicians tend to assume that PNs are metastatic disease based solely on imaging. The current study evaluated the findings of PN biopsies in a population of patients with cancer and sought to determine the variables that correlated with higher odds of metastatic disease.
We conducted a retrospective, single-institution study that included consecutive patients with nonpulmonary solid malignancies who underwent PN biopsy from January 2011 to December 2013. Imaging and clinical variables were analyzed by logistic regression to determine the correlation between such variables and the odds of metastatic disease. Patients with previously known metastatic disease or primary hematologic malignancies were excluded.
Two hundred twenty-eight patients were included in the study. Metastatic disease was found in 146 patients (64%), 60 patients (26.3%) were diagnosed with a second primary lung tumor, and 22 patients (9.6%) had no cancer on biopsy. On multivariate analysis, the presence of multiple PNs (> 5 mm) and cavitation/necrosis were the only variables associated with higher odds ( < .05) of metastatic disease. We registered six (2.6%) procedure complications demanding active interventions, and no procedure-related death occurred.
Multiple PNs (> 5 mm) and cavitation were the two characteristics associated with the highest chances of metastatic disease. Our findings demonstrate that PNs should not be assumed to be metastases without performing a biopsy. This assumption may lead to high rates of misdiagnosis. Tissue sampling is fundamental for accurately diagnosing patients with cancer.
肺结节（PNs）的鉴别诊断包括转移瘤、肺癌、传染病和瘢痕组织等。由于关于癌症患者是否以及何时进行PN活检的数据稀缺，临床医生往往仅根据影像学就认定PNs为转移性疾病。本研究评估了癌症患者群体中PN活检的结果，并试图确定与转移性疾病较高几率相关的变量。
我们进行了一项回顾性单机构研究，纳入了2011年1月至2013年12月期间接受PN活检的非肺实体恶性肿瘤连续患者。通过逻辑回归分析影像学和临床变量，以确定这些变量与转移性疾病几率之间的相关性。排除先前已知有转移性疾病或原发性血液系统恶性肿瘤的患者。
228名患者纳入研究。146名患者（64%）发现有转移性疾病，60名患者（26.3%）被诊断为第二原发性肺癌，22名患者（9.6%）活检未发现癌症。多因素分析显示，多个PNs（>5mm）和空洞/坏死是与转移性疾病较高几率（<0.05）相关的仅有的变量。我们记录了6例（2.6%）需要积极干预的手术并发症，未发生与手术相关的死亡。
多个PNs（>5mm）和空洞是与转移性疾病最高几率相关的两个特征。我们的研究结果表明，在未进行活检的情况下，不应认定PNs为转移瘤。这种认定可能导致高误诊率。组织取样对于准确诊断癌症患者至关重要。
