The clinical significance of indeterminate pulmonary nodules in melanoma patients at baseline and during follow-up chest CT

Abstract

ObjectiveThis study aims to determine an appropriate timeline to monitor indeterminate pulmonary nodules (IPN) in melanoma patients to confirm metastatic origin.Materials and Methods588 clinically non-metastatic melanoma patients underwent curative intent surgery during 3 years. Patients with baseline chest CT and at least one follow-up (FU) CT were retrospectively analyzed to assess for IPN. Patients with definitely benign nodules, metastases and non-melanoma malignancies were excluded. Change in volume from first to FU CT, initial diameter (D1) and volume (V1), distance from pleura, peripheral and perifissural location, density and clinical stage were evaluated. Nodules were volumetrically measured on CTs and were considered metastases if they increased in size between two CTs or if increase was accompanied by multiple new nodules or extrapulmonary metastases.Results148 patients were included. Two out of 243 baseline IPN detected in 70 patients, increased significantly in volume in 3 and 5 months and were proven metastases. During FU, 86% of 40 interval IPN detected in 28 patients, were proven metastases. Interval nodule (p < 0.0001, HR:243,CI:[57.32,1033.74]), 3-month volume change (OR:1.023,CI:[1.014,1.033]), V1 (OR:1.006,CI:[1.003,1.009]), D1 (OR:1.424,CI:[1.23,1.648]), distance from pleura (OR:1.03,CI:[1.003,1.059]), and combined stage IIC + III (OR:11.29,CI:[1.514,84.174]), were associated with increased risk for metastasis. 43%, 72% and 94% of patients with IPN were confirmed with metastases in the first FU CT at 3, 6 and 12 months respectively.ConclusionBaseline IPN are most likely benign, while interval IPN are high risk for metastasis. Absence of volume increase of IPN within 6 months excluded metastasis in most patients.

Two synchronous lung metastases from malignant melanoma: the same patient but different morphological patterns

“…Pulmonary metastases from malignant melanoma may exhibit different morphologic patterns [4]. The solid nodular pattern is usually found in pulmonary metastatic disease [3,4]. Conversely, the subsolid nodular pattern is rarely observed [3,4].…”

“…The solid nodular pattern is usually found in pulmonary metastatic disease [3,4]. Conversely, the subsolid nodular pattern is rarely observed [3,4]. However, the literature reports that the subsolid appearance of pulmonary metastases is most commonly found in melanoma patients [5][6][7][8].…”

“…Among the multiple sites of metastatic disease, the lung is one of the most frequently involved sites [2]. The literature reports that approximately 18% of melanoma patients develop lung metastases during follow-up [3]. Typically, pulmonary metastases from malignant melanoma occur as a single or multiple solid nodules on computed tomography (CT) images [3,4].…”

“…The literature reports that approximately 18% of melanoma patients develop lung metastases during follow-up [3]. Typically, pulmonary metastases from malignant melanoma occur as a single or multiple solid nodules on computed tomography (CT) images [3,4]. Rarely, pulmonary involvement in metastatic melanoma occurs as a single or multiple subsolid nodules [3][4][5][6][7][8].…”

Enhanced immunotherapeutic profile of oncolytic virus-based cancer vaccination using cyclophosphamide preconditioning

“…In particular, approximately 60% of patients with pulmonary metastatic melanoma are diagnosed with >3 nodules; a criterion associated with ineligibility to surgical resection in 70% of the cases and with poor prognosis. [18][19][20] This report builds on previous studies revealing Treg depletion and extended survival times when CTX is used in combination with vaccines in murine models. 21 22 Expanding on these findings, we showed that CTX preconditioning enhances specific CD8 + T-cell responses against the TAA targeted by the vaccine and such effects are only observed in the setting of tumor-bearing animals.…”