Abstract
Objective: The use of high-resolution computed tomography (HRCT) has improved the management of non-small cell lung cancer (NSCLC), but has also increased the detection of indeterminate satellite nodules. Obtaining differential diagnosis of nodules less than 10 mm is difficult but essential for choosing optimal therapeutic strategies. Here, we evaluated the characteristics of small satellite nodules in patients with operable NSCLC and examined the optimal diagnostic and therapeutic approach in patients with small satellite nodules. Methods: Using data from a prospective database, all surgically treated patients diagnosed with NSCLC from 2008 to 2011 were retrospectively reviewed. Patients presenting with small pulmonary non-GGO nodule(s) were identified. Results: A total of 1206 patients underwent complete resection for NSCLC, out of which 45 patients presented with 60 nodules less than 10 mm on thoracic CT. Twenty-six nodules (43%) were malignant, 31 (52%) were benign, and 3 (5%) were of undetermined nature. Tumor histology (adenocarcinoma vs. nonadenocarcinoma), TNM stage (advanced stage vs. early stage), and nodule size (6–10 vs. 5 mm) were associated with nodule malignancy. The incidence of metastatic nodules in patients with stage III NSCLC was significantly higher than that in patients with stage I NSCLC. In contrast, the incidence of multiple primary lung cancers in patients with stage I NSCLC was significantly higher than that in patients with stage III NSCLC. Conclusion: Differential diagnosis of indeterminate satellite lesions in patients with operable NSCLC is critical. Surgery should be performed cautiously in patients with stage III NSCLC having nodules larger than 5 mm.
Highlights
Advances in computed tomography (CT) have increased the detection of small pulmonary nodules [1]
Patients who met the following inclusion criteria were included in the study: diagnosed with operable non-small cell lung cancer (NSCLC) received surgical therapy; had not undergone peri-operative radiotherapy or chemotherapy; had pulmonary nodules less than 10 mm in diameter on ipsilateral or contralateral lung neoplasms on CT; the nature of the nodules was not determined by CT, but was identified by pathology, or nodules were followed-up for more than 24 months
Lobectomy was performed in 21 patients, lobectomy plus wedge resection was performed in 20 patients, and wedge resection was performed in 4 patients
Summary
Advances in computed tomography (CT) have increased the detection of small pulmonary nodules [1]. Small coexisting lesions are often encountered on CT before surgery for non-small cell lung cancer (NSCLC) [2]. We defined these coexisting nodules in bilateral lung parenchyma with lung cancer as satellite pulmonary nodules. Most of these nodules cannot be characterized as benign or malignant with CT or other imaging modalities. As prognosis is significantly better in patients with stage I (T1-2N0M0) or synchronous primary lung cancer than those with stage IIIB (T4N0M0) or stage IV (T12N0M1), the existence of malignant pulmonary nodules could be considered a contraindication to surgery [7]. A number of recent studies have supported the role of SPLC resection, which can yield comparable results as those in patients with single lung cancers of similar stages [8, 9]
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