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

M. Beth McCarville, Henrique M. Lederman, Victor M. Santana, Najat C. Daw, Stephen J. Shochat, Chin-Shang Li, Robert A. Kaufman

Research output: Contribution to journalArticle

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Abstract

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 (κ ≤ 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.

Original languageEnglish (US)
Pages (from-to)514-520
Number of pages7
JournalRadiology
Volume239
Issue number2
DOIs
StatePublished - May 2006
Externally publishedYes

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Thorax
Lung
Neoplasms
Parental Consent
Pediatrics
Health Insurance Portability and Accountability Act
Biopsy
Research Ethics Committees
Thoracotomy
Compliance
Incidence
Growth

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

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McCarville, M. B., Lederman, H. M., Santana, V. M., Daw, N. C., Shochat, S. J., Li, C-S., & Kaufman, R. A. (2006). Distinguishing benign from malignant pulmonary nodules with helical chest CT in children with malignant solid tumors. Radiology, 239(2), 514-520. https://doi.org/10.1148/radiol.2392050631

Distinguishing benign from malignant pulmonary nodules with helical chest CT in children with malignant solid tumors. / McCarville, M. Beth; Lederman, Henrique M.; Santana, Victor M.; Daw, Najat C.; Shochat, Stephen J.; Li, Chin-Shang; Kaufman, Robert A.

In: Radiology, Vol. 239, No. 2, 05.2006, p. 514-520.

Research output: Contribution to journalArticle

McCarville, MB, Lederman, HM, Santana, VM, Daw, NC, Shochat, SJ, Li, C-S & Kaufman, RA 2006, 'Distinguishing benign from malignant pulmonary nodules with helical chest CT in children with malignant solid tumors', Radiology, vol. 239, no. 2, pp. 514-520. https://doi.org/10.1148/radiol.2392050631
McCarville, M. Beth ; Lederman, Henrique M. ; Santana, Victor M. ; Daw, Najat C. ; Shochat, Stephen J. ; Li, Chin-Shang ; Kaufman, Robert A. / Distinguishing benign from malignant pulmonary nodules with helical chest CT in children with malignant solid tumors. In: Radiology. 2006 ; Vol. 239, No. 2. pp. 514-520.
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abstract = "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 (κ ≤ 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.",
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AB - 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 (κ ≤ 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.

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