Pulmonary Nodules Discovered During the Initial Evaluation of Pediatric Patients With Bone and Soft-Tissue Sarcoma

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Abstract

Background

Recent technical advances in CT imaging and data processing have improved the ability to detect small pulmonary nodules in children with bone and soft-tissue sarcoma undergoing radiologic imaging of the chest.

Procedure

We retrospectively studied medical records and CT chest scans at initial diagnosis of 210 children and young adults presenting to a single pediatric tertiary care hospital specialized in oncology for evaluation of bone or soft-tissue sarcoma. We correlated clinical features and CT scan findings with patient outcome and histologic results, when available.

Results

Pulmonary nodules (diameter ≤3 cm) were identified in 66 patients (31.4%). The median size of the largest nodule in each patient was 5 mm (range, 1–20 mm). Of patients who underwent biopsy or resection of a nodule, 41.7% had metastatic pulmonary disease. Having more than three nodules and a bilateral distribution were associated with histology-proven metastasis (P = 0.002 and P = 0.011, respectively) and an increased frequency of recurrent or progressive metastatic disease in the lung (P < 0.001 and P = 0.023, respectively). Greater size of the largest nodule present showed a trend towards biopsy-proven lung metastasis, but did not reach statistical significance (P = 0.06). When biopsy or resection was not performed, increased size was significantly associated with nodules being presumed as malignant (median, 16.8 mm compared to 4.0 mm for biopsied nodules, P < 0.001).

Conclusions

Pulmonary nodules were commonly detected during the initial evaluation of pediatric cases of sarcoma. Number and distribution of nodules were significantly associated with metastatic disease and outcome. Pediatr Blood Cancer 2008;50:1147–1153. © 2008 Wiley-Liss, Inc.

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