A New Isolated Mediastinal Lymph Node or Small Pulmonary Nodule Arising during Breast Cancer Surveillance Following Curative Surgery: Clinical Factors That Differentiate Malignant from Benign Lesions
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PurposeA newly isolated mediastinal lymph node (LN) or a small pulmonary nodule, which appearsduring breast cancer surveillance, may pose a diagnostic dilemma with regard to malignancy. We conducted this study to determine which clinical factors were useful for thedifferentiation of malignant lesions from benign lesions under these circumstances. Materials and MethodsWe enrolled breast cancer patients who were presented with a new isolated mediastinalLN or small pulmonary nodule that arose during surveillance, and whose lesions were pathologicallyconfirmed. Tissue diagnosis was made by mediastinoscopy, video-assisted thoracicsurgery or thoracotomy. ResultsA total of 43 patients were enrolled (mediastinal LN, 13 patients; pulmonary nodule, 30patients). Eighteen patients (41.9%) were pathologically confirmed to have a benign lesion(benign group), and 25 patients (58.1%) were confirmed to have malignant lesion (malignantgroup). Between the two groups, the initial tumor size (p=0.096) and N stage (p=0.749)were similar. Hormone receptor negativity was more prevalent in the malignant group(59.1% vs. 40.9%, p=0.048). The mean lesion size was larger in the malignant group thanin the benign group (20.8 mm vs. 14.4 mm, p=0.024). Metastatic lesions had a significantlyhigher value of maximal standardized uptake (mSUV) than that of benign lesions (6.4 vs. 3.4, p=0.021). ConclusionHormone receptor status, lesion size, and mSUV on positron emission tomography are helpfulin the differentiation of malignant lesions from benign lesions in breast cancer patientswho were presented with a new isolated mediastinal LN or small pulmonary nodule duringsurveillance.
Abstract
PurposeA newly isolated mediastinal lymph node (LN) or a small pulmonary nodule, which appearsduring breast cancer surveillance, may pose a diagnostic dilemma with regard to malignancy. We conducted this study to determine which clinical factors were useful for thedifferentiation of malignant lesions from benign lesions under these circumstances. Materials and MethodsWe enrolled breast cancer patients who were presented with a new isolated mediastinalLN or small pulmonary nodule that arose during surveillance, and whose lesions were pathologicallyconfirmed. Tissue diagnosis was made by mediastinoscopy, video-assisted thoracicsurgery or thoracotomy. ResultsA total of 43 patients were enrolled (mediastinal LN, 13 patients; pulmonary nodule, 30patients). Eighteen patients (41.9%) were pathologically confirmed to have a benign lesion(benign group), and 25 patients (58.1%) were confirmed to have malignant lesion (malignantgroup). Between the two groups, the initial tumor size (p=0.096) and N stage (p=0.749)were similar. Hormone receptor negativity was more prevalent in the malignant group(59.1% vs. 40.9%, p=0.048). The mean lesion size was larger in the malignant group thanin the benign group (20.8 mm vs. 14.4 mm, p=0.024). Metastatic lesions had a significantlyhigher value of maximal standardized uptake (mSUV) than that of benign lesions (6.4 vs. 3.4, p=0.021). ConclusionHormone receptor status, lesion size, and mSUV on positron emission tomography are helpfulin the differentiation of malignant lesions from benign lesions in breast cancer patientswho were presented with a new isolated mediastinal LN or small pulmonary nodule duringsurveillance.
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