Distinguishing benign from malignant pulmonary nodules with helical chest CT in children with malignant solid tumors

Distinguishing benign from malignant pulmonary nodules with helical chest CT in children with malignant solid tumors

Autor McCarville, M. Beth Google Scholar
Lederman, Henrique Manoel Autor UNIFESP Google Scholar
Santana, Victor M. Google Scholar
Daw, Najat C. Google Scholar
Shochat, Stephen J. Google Scholar
Li, Chin Shang Google Scholar
Kaufman, Robert A. Google Scholar
Instituição St Jude Childrens Hosp
Universidade Federal de São Paulo (UNIFESP)
Univ Tennessee
Resumo Purpose: To retrospectively assess whether computed tomographic (CT) findings can indicate the benign or malignant nature of pulmonary nodules in pediatric patients with malignant solid primary tumors.Materials and Methods: With institutional review board approval, waived parental and patient consent, and HIPAA compliance, the authors determined the incidence of malignancy among 81 pulmonary nodules that were sampled at biopsy within 3 weeks after chest CT (January 1999 to September 2003) in 41 young patients with malignant solid tumors. Three radiologists independently and retrospectively reviewed these scans and the available previously obtained scans, classifying nodules as benign, malignant, or indeterminate on the basis of their number, unilateral versus bilateral distribution, size, margins (indistinct vs distinct), calcification, growth, and associated adenopathy. These classifications were compared with nodule histologic type, and interreviewer agreement was assessed.Results: the median patient age was 14.8 years (mean, 13.7 years; range, 5-21 years). Twenty- four of the 41 patients (58%)had at least one biopsy-proved malignant nodule. Four (10%) patients had both benign and malignant nodules; 17 (42%) had only benign nodules. Reviewer 1 classified 65% (39 of 60) of nodules correctly; reviewer 2, 57% (37 of 65); and reviewer 3, 67% (43 of 64). Interreviewer agreement was slight to moderate (kappa <= 0.43, P <= .03). in contrast to findings in adults, sharply defined nodules in younger individuals were more likely to be malignant (P = .03) and nodule size was not associated with malignancy (P >= .32).Conclusion: the frequency of benign nodules and the inconsistency of predictions based on CT features suggest the need for better predictors of pulmonary nodules being malignant or benign, so as to reduce unnecessary thoracotomy in pediatric patients with solid malignancy. (c) RSNA, 2006.
Idioma Inglês
Data 2006-05-01
Publicado em Radiology. Oak Brook: Radiological Soc North America, v. 239, n. 2, p. 514-520, 2006.
ISSN 0033-8419 (Sherpa/Romeo, fator de impacto)
Editor Radiological Soc North America
Extensão 514-520
Fonte http://dx.doi.org/10.1148/radiol.2392050631
Direito de acesso Acesso aberto Open Access
Tipo Artigo
Web of Science WOS:000237090800025
URI http://repositorio.unifesp.br/handle/11600/28862

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