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Stepwise examination for differential diagnosis of primary lung cancer and breast cancer relapse presenting as a solitary pulmonary nodule in patients after mastectomy
Author(s) -
Okasaka Toshiki,
Usami Noriyasu,
Mitsudomi Tetsuya,
Yatabe Yasushi,
Matsuo Keitaro,
Yokoi Kohei
Publication year - 2008
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21149
Subject(s) - medicine , differential diagnosis , solitary pulmonary nodule , lung cancer , breast cancer , radiology , nodule (geology) , biopsy , mastectomy , cancer , lung , pathology , paleontology , biology
Background and Objectives The distinction of primary lung from metastatic breast cancer is crucial in patients presenting with a solitary pulmonary nodule after mastectomy, because treatment strategies are completely different. Definitive diagnosis of these nodules, however, is often difficult. We assessed the feasibility of our diagnostic approach for these nodules and estimated the frequency of primary lung cancer occurrence in patients after mastectomy. Methods We evaluated solitary pulmonary nodules appearing in 48 patients after mastectomy. For histological examination, CT‐guided needle aspiration biopsy (CT‐NAB) or trans‐bronchial lung biopsy (TBLB) was performed. Besides conventional morphopathological examination, differential diagnosis was performed by immunohistochemical examination and evaluation using a molecular marker (mammaglobin 1). Results Biopsy specimens were obtained using minimally invasive methods, namely CT‐NAB and TBLB, in 91.7% of patients. From 48 patients, differential diagnosis was obtained by morphopathological methods alone in 32, and by immunohistochemical and molecular marker examination in the remaining 16. Final diagnosis was metastatic breast and primary lung cancer in 40 (83.3%) and 8 patients (16.7%), respectively. Conclusions Our results show the clinical feasibility of our stepwise approach to the differential diagnosis of primary lung cancer and breast cancer relapse presenting as a solitary nodule in patients after mastectomy. J. Surg. Oncol. 2008;98:510–514. © 2008 Wiley‐Liss, Inc.