Clinical Characteristics and Etiologies of Miliary Nodules in the US: A Single-Center Study

Salahuddin, Mohammad; Karanth, Siddharth; Ocazionez, Daniel; Estrada‐Y‐Martin, Rosa M.; Cherian, Sujith V.

doi:10.1016/j.amjmed.2018.12.030

Cited by 18 publications

(18 citation statements)

References 9 publications

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“…Miliary nodular pattern of disease has distinct radiologic features characterized by diffuse, bilateral infiltration of the lungs by tiny, typically 1–4 mm in size, nodules likened to millet seeds [24]. This finding is seen in numerous infectious and inflammatory etiologies, including tuberculosis, histoplasmosis, silicosis, and sarcoidosis [25,26,27,28,29,30]. Miliary nodular patterns have also been in the setting of metastatic disease, most notably with primary thyroid cancer, renal cell carcinoma, and melanoma [24,25].…”

Section: Discussionmentioning

confidence: 99%

“…This finding is seen in numerous infectious and inflammatory etiologies, including tuberculosis, histoplasmosis, silicosis, and sarcoidosis [25,26,27,28,29,30]. Miliary nodular patterns have also been in the setting of metastatic disease, most notably with primary thyroid cancer, renal cell carcinoma, and melanoma [24,25]. While the imaging features of diffuse lung metastases in EGFR -mutant NSCLC may overlap with the other pathologies that present with miliary nodules, EGFR -mutant NSCLC with diffuse lung metastases can by distinguished by the presence of a dominant primary lung mass or nodule (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

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Diffuse Lung Metastases in EGFR-Mutant Non-Small Cell Lung Cancer

Digumarthy

Mendoza

Padole

et al. 2019

Cancers

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Diffuse lung metastases have been reported in non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations. The purpose of our study was to compare the incidence of diffuse lung metastases in EGFR-mutant NSCLC and EGFR-wild type NSCLC and to assess other imaging features that may be associated with diffuse lung metastases in EGFR-mutant NSCLC. Two radiologists retrospectively reviewed pre-treatment imaging of metastatic NSCLC cases with known EGFR mutation status. We assessed the imaging features of the primary tumor and patterns of metastases. The cohort consisted of 217 patients (117 EGFR-mutant, 100 EGFR wild-type). Diffuse lung metastasis was significantly more common in EGFR-mutant NSCLC compared with wild-type (18% vs. 3%, p < 0.01). Among the EGFR-mutant group, diffuse lung metastases were inversely correlated with the presence of a nodule greater than 6 mm other than the primary lung lesion (OR: 0.13, 95% CI: 0.04–0.41, p < 0.01). EGFR mutations in NSCLC are associated with increased frequency of diffuse lung metastases. The presence of diffuse lung metastases in EGFR-mutant NSCLC is also associated with a decreased presence of other larger discrete lung metastases. EGFR mutations in NSCLC should be suspected in the setting of a dominant primary lung mass associated with diffuse lung metastases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diffuse Lung Metastases in EGFR-Mutant Non-Small Cell Lung Cancer

Digumarthy

Mendoza

Padole

et al. 2019

Cancers

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“…Once it is clear the patient is unresponsive to treatment and the lesion is huge, i.e., >3 cm, the clinician will favor further tissue proof if no contraindications. Second, the miliary pattern can exist in both TB and lung cancer [29,30]. However, the miliary pattern in lung cancer usually shows bigger, multiple nodules and indicates terminal cancer with metastasis, which hints to physicians to think of cancer instead of TB.…”

Section: Discussionmentioning

confidence: 99%

Factors for the Early Revision of Misdiagnosed Tuberculosis to Lung Cancer: A Multicenter Study in A Tuberculosis-Prevalent Area

Chang

Lai

Chang

et al. 2019

JCM

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Background: Lung cancer misdiagnosed as tuberculosis (TB) is not rare, but the factors associated with early diagnosis revision remain unclear. Methods: We screened the cases with TB notification from 2007 to 2018 and reviewed those with misdiagnosis with a revised diagnosis to lung cancer. We analyzed the factors associated with early diagnosis revision (≤1 months) and early obtained pathology (≤1 months) using multivariable Cox regression. Results: During the study period, 45 (0.7%) of 6683 patients were initially notified as having TB, but later diagnosed with lung cancer. The reasons for the original impression of TB were mostly due to image suspicion (51%) and positive sputum acid-fast stain (AFS) (27%). Using multivariable Cox proportional regression, early diagnosis revision was associated with obtaining the pathology early, lack of anti-TB treatment, and negative sputum AFS. Furthermore, the predictors for early obtained pathology included large lesion size (>3 cm), presence of a miliary radiological pattern, no anti-TB treatment, and a culture-negative result when testing for nontuberculous mycobacteria (NTM) using multivariable Cox regression. Conclusion: In patients who are suspected to have TB but no mycobacterial evidence is present, lung cancer should be kept in mind and pathology needs to be obtained early, especially for those with small lesions, radiological findings other than the miliary pattern, and a culture positive for NTM.

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“…Although rarely observed, physicians should be aware that sarcoidosis can present itself as a pseudo tumoral condition such as miliary nodules, peritoneal involvement, and symptomatic osteolytic or osteoblastic lesions (102)(103)(104).…”

Section: When Should We Look For Neoplasia In Patients With Sarcoidosis?mentioning

confidence: 99%

Sarcoidosis and Cancer: A Complex Relationship

et al. 2020

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Sarcoidosis is a systemic disease of unknown etiology, characterized by the presence of non-caseating granulomas in various organs, mainly the lungs, and the lymphatic system. Since the individualization of sarcoidosis-lymphoma association by Brincker et al., the relationship between sarcoidosis or granulomatous syndromes and malignancies has been clarified through observational studies worldwide. Two recent meta-analyses showed an increased risk of neoplasia in sarcoidosis. The granulomatosis can also reveal malignancy, either solid or hematological, defining paraneoplastic sarcoidosis. Recent cancer immunotherapies, including immune checkpoint inhibitors (targeting PD-1, PD-L1, or CTLA-4) and BRAF or MEK inhibitors were also reported as possible inducers of sarcoidosis-like reactions. Sarcoidosis and neoplasia, especially lymphoma, can show overlapping presentations, thus making the diagnosis and treatment harder to deal with. There are currently no formal recommendations to guide the differential diagnosis workup between the evolution of lymphoma or a solid cancer and a granulomatous reaction associated with neoplasia. Thus, in atypical presentations (e.g., deeply impaired condition, compressive lymphadenopathy, atypical localization, unexplained worsening lymphadenopathy, or splenomegaly), and treatment-resistant disease, targeted biopsies on suspect localizations with histological examination could help the clinician to differentiate neoplasia from sarcoidosis. Pathological diagnosis could sometimes be challenging since very few tumor cells may be surrounded by massive granulomatous reaction. The sensitization of currently available diagnostic tools should improve the diagnostic accuracy, such as the use of more “cancer-specific” radioactive tracers coupled with Positron Emission Tomography scan.

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Clinical Characteristics and Etiologies of Miliary Nodules in the US: A Single-Center Study

Cited by 18 publications

References 9 publications

Diffuse Lung Metastases in EGFR-Mutant Non-Small Cell Lung Cancer

Diffuse Lung Metastases in EGFR-Mutant Non-Small Cell Lung Cancer

Factors for the Early Revision of Misdiagnosed Tuberculosis to Lung Cancer: A Multicenter Study in A Tuberculosis-Prevalent Area

Sarcoidosis and Cancer: A Complex Relationship

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