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Charles D, Fitzgerald J, Landowski T, Cooper B, Yong R, Everett R, See W, Jacobsohn K, Johnson S, Langenstroer P. Is chest imaging needed as part of pT1a renal cell carcinoma surveillance after surgical resection? Urol Oncol 2024; 42:23.e1-23.e4. [PMID: 38040536 DOI: 10.1016/j.urolonc.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/07/2023] [Accepted: 10/16/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Following surgical excision of pT1a renal cell carcinoma (RCC), 2% to 5% will recur, with 50% to 60% being lung metastases. The ideal surveillance strategy to identify recurrences is unclear. Guidelines are mixed, with NCCN and AUA recommending surveillance via chest x-ray (CXR) at least annually for 5 years, while EAU guidelines do not specifically recommend the use of CXR. In an effort to clarify the utility of surveillance CXR, we retrospectively evaluated pT1a patients following surgical treatment at a single institution. METHODS We performed retrospective analysis of unique patients who underwent surgical excision of pT1 RCC between January 2000 and January 2020. In addition to demographic information, we collected RCC pathology, recurrence details, and most recent chest imaging. We excluded non-RCC pathology, and patients with pulmonary nodules on baseline imaging. RESULTS We identified 463 unique patients (mean age 58.3 years, range 23-87) that underwent surgical excision of pT1a RCC with mean follow-up of 47.6 months (range 1-201). On the most recent pulmonary surveillance imaging, 72.4% (335/463) had CXR while 27.6% (128/463) had chest CT performed. Regardless of modality, pulmonary recurrence was not detected on any surveillance imaging (0/463). CONCLUSION In patients without baseline preoperative lung pathology, we found that there is questionable clinical value in surveillance for pulmonary recurrence after resection of pT1a RCC.
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Affiliation(s)
- David Charles
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI.
| | - John Fitzgerald
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Truman Landowski
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Brennen Cooper
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Raymond Yong
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Ross Everett
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - William See
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Scott Johnson
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
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Liu C, Meng Q, Zeng Q, Chen H, Shen Y, Li B, Cen R, Huang J, Li G, Liao Y, Wu T. An Exploratory Study on the Stable Radiomics Features of Metastatic Small Pulmonary Nodules in Colorectal Cancer Patients. Front Oncol 2021; 11:661763. [PMID: 34336657 PMCID: PMC8322948 DOI: 10.3389/fonc.2021.661763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/17/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives To identify the relatively invariable radiomics features as essential characteristics during the growth process of metastatic pulmonary nodules with a diameter of 1 cm or smaller from colorectal cancer (CRC). Methods Three hundred and twenty lung nodules were enrolled in this study (200 CRC metastatic nodules in the training cohort, 60 benign nodules in the verification cohort 1, 60 CRC metastatic nodules in the verification cohort 2). All the nodules were divided into four groups according to the maximum diameter: 0 to 0.25 cm, 0.26 to 0.50 cm, 0.51 to 0.75 cm, 0.76 to 1.0 cm. These pulmonary nodules were manually outlined in computed tomography (CT) images with ITK-SNAP software, and 1724 radiomics features were extracted. Kruskal-Wallis test was performed to compare the four different levels of nodules. Cross-validation was used to verify the results. The Spearman rank correlation coefficient is calculated to evaluate the correlation between features. Results In training cohort, 90 features remained stable during the growth process of metastasis nodules. In verification cohort 1, 293 features remained stable during the growth process of benign nodules. In verification cohort 2, 118 features remained stable during the growth process of metastasis nodules. It is concluded that 20 features remained stable in metastatic nodules (training cohort and verification cohort 2) but not stable in benign nodules (verification cohort 1). Through the cross-validation (n=100), 11 features remained stable more than 90 times. Conclusions This study suggests that a small number of radiomics features from CRC metastatic pulmonary nodules remain relatively stable from small to large, and they do not remain stable in benign nodules. These stable features may reflect the essential characteristics of metastatic nodules and become a valuable point for identifying metastatic pulmonary nodules from benign nodules.
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Affiliation(s)
- Caiyin Liu
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiuhua Meng
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qingsi Zeng
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huai Chen
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yilian Shen
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Biaoda Li
- Department of Radiology, Shenzhen Hospital, University of Hong Kong, Shenzhen, China
| | - Renli Cen
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiongqiang Huang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guangqiu Li
- Department of Pathology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuting Liao
- Department of Pharmaceutical Diagnostics, GE Healthcare (China), Shanghai, China
| | - Tingfan Wu
- Department of Pharmaceutical Diagnostics, GE Healthcare (China), Shanghai, China
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Robertson V, Neal CP, Jones M, Dennison AR, Garcea G. Indeterminate Pulmonary Nodules in Resected Liver Metastases from Colorectal Cancer: A Comparison of Patient Outcomes. World J Surg 2017; 41:1834-9. [DOI: 10.1007/s00268-017-3930-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Lohinai Z, Klikovits T, Moldvay J, Ostoros G, Raso E, Timar J, Fabian K, Kovalszky I, Kenessey I, Aigner C, Renyi-Vamos F, Klepetko W, Dome B, Hegedus B. KRAS-mutation incidence and prognostic value are metastatic site-specific in lung adenocarcinoma: poor prognosis in patients with KRAS mutation and bone metastasis. Sci Rep 2017; 7:39721. [PMID: 28051122 PMCID: PMC5209707 DOI: 10.1038/srep39721] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 11/21/2016] [Indexed: 01/08/2023] Open
Abstract
Current guidelines lack comprehensive information on the metastatic site-specific role of KRAS mutation in lung adenocarcinoma (LADC). We investigated the effect of KRAS mutation on overall survival (OS) in this setting. In our retrospective study, 500 consecutive Caucasian metastatic LADC patients with known KRAS mutational status were analyzed after excluding 32 patients with EGFR mutations. KRAS mutation incidence was 28.6%. The most frequent metastatic sites were lung (45.6%), bone (26.2%), adrenal gland (17.4%), brain (16.8%), pleura (15.6%) and liver (11%). Patients with intrapulmonary metastasis had significantly increased KRAS mutation frequency compared to those with extrapulmonary metastases (35% vs 26.5%, p = 0.0125). In contrast, pleural dissemination and liver involvement were associated with significantly decreased KRAS mutation incidence (vs all other metastatic sites; 17% (p < 0.001) and 16% (p = 0.02) vs 33%, respectively). Strikingly, we found a significant prognostic effect of KRAS status only in the bone metastatic subcohort (KRAS-wild-type vs KRAS-mutant; median OS 9.7 v 3.7 months; HR, 0.49; 95% CI, 0.31 to 0.79; p = 0.003). Our study suggests that KRAS mutation frequency in LADC patients shows a metastatic site dependent variation and, moreover, that the presence of KRAS mutation is associated with significantly worse outcome in bone metastatic cases.
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Affiliation(s)
- Zoltan Lohinai
- National Koranyi Institute of Pulmonology, Budapest, Hungary
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Thomas Klikovits
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Judit Moldvay
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Gyula Ostoros
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Erzsebet Raso
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Jozsef Timar
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
- Molecular Oncology Research Group, Hungarian Academy of Sciences-Semmelweis University, Budapest, Hungary
| | - Katalin Fabian
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Ilona Kovalszky
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - István Kenessey
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Clemens Aigner
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
- Department of Thoracic Surgery, Ruhrlandklinik Essen, University Hospital of University Duisburg-Essen, Essen, Germany
| | - Ferenc Renyi-Vamos
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary
| | - Walter Klepetko
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Balazs Dome
- National Koranyi Institute of Pulmonology, Budapest, Hungary
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Budapest, Hungary
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Balazs Hegedus
- Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
- Molecular Oncology Research Group, Hungarian Academy of Sciences-Semmelweis University, Budapest, Hungary
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Reddy SK, Al-sukhni E. Surgical Management of the Colorectal Cancer Patient with Simultaneous Liver and Lung Metastases. Curr Colorectal Cancer Rep 2016; 12:201-207. [DOI: 10.1007/s11888-016-0325-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Adibi M, Kenney PA, Thomas AZ, Borregales LD, Nogueras-gonzález GM, Wang X, Devine CE, Karam JA, Wood CG. Prediction of Pulmonary Metastasis in Renal Cell Carcinoma Patients with Indeterminate Pulmonary Nodules. Eur Urol 2016; 69:352-60. [DOI: 10.1016/j.eururo.2015.08.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/29/2015] [Indexed: 12/21/2022]
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Kim CH, Huh JW, Kim HR, Kim YJ. Indeterminate Pulmonary Nodules in Colorectal Cancer: Follow-up Guidelines Based on a Risk Predictive Model. Ann Surg 2015; 261:1145-52. [DOI: 10.1097/sla.0000000000000853] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Poruk KE, Kim Y, Cameron JL, He J, Eckhauser FE, Rezaee N, Herman J, Laheru D, Zheng L, Fishman EK, Hruban RH, Pawlik TM, Wolfgang CL, Weiss MJ. What is the Significance of Indeterminate Pulmonary Nodules in Patients Undergoing Resection for Pancreatic Adenocarcinoma? J Gastrointest Surg 2015; 19:841-7. [PMID: 25595307 DOI: 10.1007/s11605-014-2740-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/27/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The significance of indeterminate pulmonary nodules (IPNs) in patients undergoing resection of pancreatic ductal adenocarcinoma (PDAC) is unknown. We sought to define the prevalence and impact of IPN in such patients. METHODS We studied all patients who underwent surgical resection of PDAC between 1980 and 2013. IPN was defined as ≥1 well-defined lung nodule(s) less than 3 cm in diameter. Survival was assessed using univariate and multivariate Cox models. RESULTS Of the 2306 resected patients, 374 (16.2 %) had a preoperative chest computed tomography (CT) scan. Of these patients, 183 (49 %) had ≥1 IPN. Demographic and clinicopathological characteristics were similar among patients with or without IPN (all P>0.05). Median survival was comparable among patients who did (15.6 months) or did not (18.0 months) have IPN (P=0.66). Of the 183 patients with IPN, 29 (16 %) progressed to clinically recognizable metastatic lung disease compared to 13 % without IPN (P=0.38). The presence of >1 IPN was associated with the development of lung metastasis (relative risk 1.58, 95 % CI 1.03-2.4; P=0.05). However, lung metastasis was not associated with survival (P=0.24). CONCLUSIONS An IPN proved to be a lung metastasis in only one of six patients with PDAC undergoing surgical resection in this study. Survival was not impacted, even among patients who developed lung metastasis. Patients with PDAC who have IPN should not be precluded from surgical consideration.
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Nordholm-Carstensen A, Jorgensen LN, Wille-Jørgensen PA, Hansen H, Harling H. Indeterminate Pulmonary Nodules in Colorectal-Cancer: Do Radiologists Agree? Ann Surg Oncol 2014; 22:543-9. [DOI: 10.1245/s10434-014-4063-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Indexed: 12/21/2022]
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Nordholm-Carstensen A, Wille-Jørgensen PA, Jorgensen LN, Harling H. Indeterminate pulmonary nodules at colorectal cancer staging: a systematic review of predictive parameters for malignancy. Ann Surg Oncol 2013; 20:4022-30. [PMID: 23812771 DOI: 10.1245/s10434-013-3062-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aimed to estimate the prevalence of indeterminate pulmonary nodules and specific radiological and clinical characteristics that predict malignancy of these at initial staging chest computed tomography (CT) in patients with colorectal cancer. A considerable number of indeterminate pulmonary nodules, which cannot readily be classified as either benign or malignant, are detected at initial staging chest CT in colorectal cancer patients. METHODS A systematic review based on a search in EMBASE, Medline, the Cochrane library and science citation index, PubMed databases, Google scholar, and relevant conference proceedings was performed in cooperation with the Cochrane Colorectal Cancer Group. RESULTS A total of 2,799 studies were identified, of which 12 studies met the inclusion criteria. The studies primarily consisted of case series and included a total of 5,873 patients. Of these patients, 9% (95% confidence interval [95% CI] 8.9-9.2%) had indeterminate pulmonary nodules at chest CT, of which 10.8% (95% CI 10.3-11.2%) turned out to be colorectal cancer metastases at follow-up. Generally, regional lymph node metastasis, and multiple numbers of indeterminate pulmonary nodules were reported to predict malignancy, whereas calcification of the nodules indicated benign lesions. CONCLUSION It was found that 1 in 100 colorectal cancer patients subjected to preoperative staging chest CT will have an indeterminate pulmonary nodule that proves to be metastatic disease. Such a low risk suggests that indeterminate pulmonary nodules should not cause further preoperative diagnostic workup or follow-up besides routine regimens.
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