Therapeutic strategy in patients with non-small cell lung cancer associated to satellite pulmonary nodules

Objectives: In patients with non-small cell lung cancer (NSCLC) the presence of satellite metastatic nodules may he considered a contraindication to surgical treatment. The use of spiral computed tomography (CT) scan has improved the accuracy of the diagnostic assessment of pulmonary diseases. but has also led to the detection of a consistent number of indeterminate satellite lesions. Obtaining a differential diagnosis of these lesions is extremely important in defining the therapeutic strategy. The aim of the study was, to assess the characteristics of satellite nodules in patients with NSCLC and to examine the diagnostic and therapeutic approach used in the presence of indeterminate satellite lesions. Methods: From November 1995 to February, 2001, 29 patients (mean age 64 years) who underwent surgery for NSCLC had indeterminate satellite pulmonary lesions at the preoperative spiral CT scan A differential diagnosis of the nodules was obtained by histological examination in 27 patients and by follow-up (62 and 64 months respectively) in two patients. Positron emission tomography (PET) scan was selectively performed in the preoperative evaluation. Results: Thirty-two satellite nodules were analyzed in the group of 29 patients. The size of the lesions varied from 2 to 15 mm (mean 8 mm). The nodules were ipsilateral to the primary tumor in 25 patients and contralateral in four. They were benign in 22 cases and malignant in ten (metastases from NSCLC in seven patients and second primary lung cancer in three). Nodules with a size equal to or less than 5 mm were more frequently benign. Patients with stage III tumors had a higher incidence of malignant satellite nodules in comparison to earlier stages. although the data did not reach statistical significance, PET scat, correctly differentiated benign and malignant satellite nodules in six patients. Conclusions: Obtaining a differential diagnosis of indeterminate pulmonary nodules associated to NSCLC is of great importance in defining the therapeutic strategy. The results of this study show that indeterminate satellite lesions may be benign or represent a second primary lung cancer, and should not therefore be considered a contraindication to surgical exploration when a preliminary differential diagnosis by other means cannot he obtained. (C) 2002 Elsevier Science B.V. All rights reserved.