An algorithm for managing bilateral lung masses

Abstract

7371 Background: Ten percent of patients with NSCLC present with bilateral masses. Often these lesions are considered to be metastatic, but may be benign, or a separate primary. Resection is best for benign lesions or separate primaries, but poor therapy for metastases. We report 36 patients with bilateral lung masses on whom we first performed mediastinoscopy. If mediastinal nodes were benign, we then resected both lesions. The resulting data allow the generation of an algorithm to manage patients with bilateral lung masses. Methods: Seventy patients were gleaned from 115 fifteen patients with bilateral lung masses. The CT reports of these patients were read as highly suspicious for malignancy. After negative mediastinoscopy, 36 patients remained, all of whom underwent bilateral resections. Survival was determined for those with “Same Path” in both lesions, “Different Path”, and “One Benign.” Student's t test was used to compare means, and chi-square to compare proportions. Results: There were no differences in the average age of the patients in the three groups. There were striking differences in the survival between those with one benign lesion and those with the same pathology in both lesions (p=0.004). Those patients with different pathologies in each mass had intermediate survival. Conclusions: Our experience demonstrates that patients with similar pathology in bilateral lung masses have very low survival at 24 months, and should not be treated with resection. Patients with bilateral masses should first undergo staging workup and mediastinoscopy. If those are negative, thoracoscopic wedge resection of the smaller lesion combined with needle aspiration of the larger lesion will identify those patients with identical pathology. The larger mass can then be treated with chemoradiotherapy. Patients who are found to have a benign lesion or different pathology should undergo resection. No significant financial relationships to disclose.