Significance of lung biopsy for the definitive diagnosis of lung nodules in breast cancer patients

Abstract

The aim of the present study was to evaluate the significance of lung biopsy for the modification of the treatment strategy in breast cancer patients who develop lung nodules during follow-up after breast surgery. Of 53 consecutive patients who underwent lung biopsies in two institutions (Hiroshima University Hospital and Hiroshima Prefectural Hospital, Hiroshima, Japan) between 1997 and 2014, 45 underwent lung surgery and 8 underwent percutaneous or transbronchial tumor biopsy for lung nodules developing after curative surgery for breast cancer. The indications for lung biopsy included lung nodules for which a definitive diagnosis was difficult to achieve, and those for which the treatment strategy depended on the pathological diagnosis. The lung nodules were pathologically diagnosed as primary breast cancer metastases to the lungs in 25 (47%), primary malignant lung tumors in 21 (40%) and benign disease in 7 (13%) patients. Among the 25 metastatic patients confirmed by lung biopsy, phenotype discordance was observed in 6 patients (24%). A total of 3 patients with lung metastasis proven to have estrogen or progesterone receptor upregulation by lung biopsy received endocrine therapy. Univariate analysis revealed that patients with metastatic breast cancer confirmed by lung biopsy were significantly younger and had more locally advanced primary cancers diagnosed via clinical and pathological assessment compared with patients with other diseases. Therefore, mastectomy and axillary lymph node dissection were performed more frequently in the metastasis group compared with the others group. Multivariate analysis revealed that mastectomy (P<0.001) and axillary dissection (P<0.001) were independent factors predicting that the lung nodules would be metastases from breast cancer. Lung biopsy in breast cancer patients who developed lung nodules during the follow-up period after breast cancer surgery was crucial for making a definitive diagnosis and modifying the treatment strategy, which may improve the prognosis of breast cancer patients.

Linear mixed-effects models for estimation of pulmonary metastasis growth rate: implications for CT surveillance in patients with sarcoma

“…Matsuura et al showed in a sample of 53 patients with breast cancer and suspected pulmonary metastases that 47% had confirmed pulmonary metastases, 40% had a second primary (primary malignant lung cancer), and 13% had benign disease. 30 Caparica et al, evaluated biopsies of pulmonary nodules in 228 patients with non-pulmonary cancer and showed that metastases were found in 64%, a secondary primary malignancy (lung cancer) in 26.3%, and 9.6% had benign disease. 31 The data suggest that assuming a pulmonary nodule is actionable at 8 mm, and assuming the previous CT had a nodule at least 2 mm in size (approximately the lower limits of detection by CT), then in 252 days (approximately 8.4 months; 95% CI (4.9, 10.2) months), an untreated nodule is expected to grow by 6 mm, from 2 to 8 mm.…”

Etiología de nódulos pulmonares en pacientes con cáncer mamario

“…El pulmón es uno de los principales sitios de metástasis de cáncer de mama, especialmente en los tumores triple negativos, a diferencia de los tumores luminales donde el sitio más común son los huesos (3). La presencia de nódulos pulmonares en imágenes diagnósticas de estadificación o seguimiento son muy frecuentes en pacientes con cáncer y de ahí la importancia de su confirmación histopatológica por la posibilidad de encontrar otras etiologías como: segundos tumores primarios pulmonares, metástasis de otros órganos, tumores pulmonares benignos, infecciones, vasculitis o secundarios a enfermedades exposicionales (4)(5)(6)(7).…”

“…Es importante aclarar la etiología de los nódulos pulmonares en las pacientes con cáncer de mama ya que su etiología determina el abordaje terapéutico (8). El diagnóstico de enfermedad metastásica por cáncer de mama implica el uso de tratamientos sistémicos agresivos, con un impacto significativo en la supervivencia global que puede llegar a 12 o 24 meses en algunas series (6,9,10). A diferencia del diagnóstico de segundos tumores primarios pulmonares que requieren una estadificación y un manejo diferente dado que el tratamiento administrado con intención curativa puede lograr supervivencias por encima del 90% (11).…”