Johnson H, Fantone J, Flye M W
J Surg Oncol. 1982 Sep;21(1):1-4. doi: 10.1002/jso.2930210102.
During an 18 month period, 41 patients who had previously had a primary tumor removed, underwent 60 operations for resection of newly detected radiographic pulmonary nodules. Primary tumors included 16 osteogenic sarcomas, 9 malignant melanomas, 12 soft tissue sarcomas, 1 Ewing's sarcoma, 2 adenocarcinomas of the rectum, and 1 testicular teratocarcinoma. One hundred and eight-one pulmonary specimens were submitted for pathologic examination and 149 discrete nodules were found in these specimens by the pathologist (83%). Metastases represented 76-100% of nodules removed in 68% of the operations, 51-75% of nodules in 12%, 26-50% of nodules in 14%, and less than 25% of nodules in 6% of the cases. Metastatic disease was found in 90% of cases where nodules were greater than or equal of 0.5 cm in diameter, while metastases were found in on 33% of cases where the largest nodules removed were less than 0.5 cm. In only two cases did the histology of the pulmonary metastases differ from that of the primary tumor. We conclude that although benign lesions cannot be distinguished from metastases except by resection, nodules less than 0.5 cm in diameter probably should be observed for a further increase in size prior to operation.
在18个月的时间里，41例先前已切除原发性肿瘤的患者接受了60次手术，以切除新发现的影像学肺部结节。原发性肿瘤包括16例骨肉瘤、9例恶性黑色素瘤、12例软组织肉瘤、1例尤因肉瘤、2例直肠腺癌和1例睾丸畸胎癌。181份肺部标本被送去做病理检查，病理学家在这些标本中发现了149个离散结节（83%）。在68%的手术中，转移瘤占切除结节的76 - 100%，在12%的手术中占51 - 75%，在14%的手术中占26 - 50%，在6%的病例中占不到25%。在直径大于或等于0.5 cm的结节病例中，90%发现有转移疾病，而在切除的最大结节小于0.5 cm的病例中，只有33%发现有转移。只有两例肺转移瘤的组织学与原发性肿瘤不同。我们得出结论，虽然除了切除外无法将良性病变与转移瘤区分开来，但直径小于0.5 cm的结节在手术前可能应观察其大小是否进一步增大。
