Abstract
We test the hypothesis that a model including clinical and computed tomography (CT) features may allow discrimination between benign and malignant lung nodules in patients with soft-tissue sarcoma (STS). Seventy-one patients with STS undergoing their first lung metastasectomy were examined. The performance of multiple logistic regression models including CT features alone, clinical features alone, and combined features, was tested to evaluate the best model in discriminating malignant from benign nodules. The likelihood of malignancy increased by more than 11, 2, 6 and 7 fold, respectively, when histological synovial sarcoma sub-type was associated with the following CT nodule features: size ≥ 5.6 mm, well defined margins, increased size from baseline CT, and new onset at preoperative CT. Likewise, in the case of grade III primary tumor, the odds ratio (OR) increased by more than 17 times when the diameter of pulmonary nodules (PNs) was >5.6 mm, more than 13 times with well-defined margins, more than 7 times with PNs increased from baseline CT, and more than 20 times when there were new-onset nodules. Finally, when CT nodule was ≥5.6 in size, it had well-defined margins, it increased in size from baseline CT, and when new onset nodules at preoperative CT were concomitant to residual primary tumor R2, the risk of malignancy increased by more than 10, 6, 25 and 28 times, respectively. The combination of clinical and CT features has the highest predictive value for detecting the malignancy of pulmonary nodules in patients with soft tissue sarcoma, allowing early detection of nodule malignancy and treatment options.
Highlights
Soft-tissue sarcoma (STS) is a heterogeneous group of rare solid tumors of mesenchymal origin that account for approximately 1% of adult malignancies [1]
The inclusion criteria were as follows: (1) Availability of histological examination for all resected nodules; (2) Availability of clinical data related to the primary tumor; (3) Available images from 8- or 16-detector row computed tomography (CT) scans 3–6 months preoperatively and up to 7 days from the date of the operation; (4) Available images from postoperative CT scan; (5) Uniform CT protocol with examinations performed with a layer thickness
When CT nodule was ≥5.6 in size, it had well-defined margins, it increased in size from baseline CT, and when new onset nodules at preoperative CT were concomitant to residual primary tumor R2, the risk of malignancy increased by more than 10, 6, 25 and 28 times, respectively (Figure 4C)
Summary
Soft-tissue sarcoma (STS) is a heterogeneous group of rare solid tumors of mesenchymal origin that account for approximately 1% of adult malignancies [1]. It includes different types of malignant diseases that can grow in soft tissues such as fat, muscles, nerves, fibrous tissues, blood vessels, or deep skin tissues [2]. As far as we know, only a few attempts have been made to detect malignant lung nodules using computed tomography (CT) characteristics but none by clinical criteria [5,6,7].
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