Indeterminate pulmonary nodules in breast cancer: Clinical significance and management

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617 Background: Increasing numbers of patients with early breast cancer undergo routine staging using computerized tomography (CT). Those in whom indeterminate pulmonary nodules are visualized without the presence of other potentially metastatic lesions represent a clinical dilemma of whether they should be managed as early breast cancer or metastatic disease. This study sought to investigate the incidence, clinical characteristics and outcomes of patients with indeterminate pulmonary nodules in breast cancer, which has important implications for their management and also entry into clinical trials. Methods: Medical records of individual breast cancer patients who underwent thoracic CT scans between the years 2002 to 2007 were analyzed and those with obvious metastatic disease were excluded. Patients were identified via the radiology database by searching for the following terms: suspicious lung metastases, and/ or indeterminate nodules. Results: Out of 2,578 patients scans, we identified 34 cases (1.3%) with indeterminate pulmonary nodules without evidence of disease elsewhere on CT scanning. We categorized these cases to the size of the nodules. At a median follow-up of 13.5 months, there were no changes in lesion size in 86% of the patients with a solitary nodule smaller than 1cm, and 89% with multiple sub-centimeter nodules. In contrast, 100% of cases with pulmonary nodules larger than 1cm had progressed at follow up (χ2, p=0.004). Conclusions: Breast cancer cases with sub-centimeter indeterminate pulmonary lesions and no evidence of metastases elsewhere are unlikely to represent metastatic disease. Treatment with curative intent or entry into clinical trials should not be excluded. No significant financial relationships to disclose.