Cancer Res Treat.  2014 Jul;46(3):280-287.

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

• Kim TY
• Lee KH
• Han SW
• Oh DY
• Im SA
• Kim TY
• Han W
• Kim K
• Chie EK
• Park IA
• Kim YT
• Noh DY
• Ha SW
• Bang YJ

Abstract

PURPOSE
A newly isolated mediastinal lymph node (LN) or a small pulmonary nodule, which appears during breast cancer surveillance, may pose a diagnostic dilemma with regard to malignancy. We conducted this study to determine which clinical factors were useful for the differentiation of malignant lesions from benign lesions under these circumstances.
MATERIALS AND METHODS
We enrolled breast cancer patients who were presented with a new isolated mediastinal LN or small pulmonary nodule that arose during surveillance, and whose lesions were pathologically confirmed. Tissue diagnosis was made by mediastinoscopy, video-assisted thoracic surgery or thoracotomy.
RESULTS
A total of 43 patients were enrolled (mediastinal LN, 13 patients; pulmonary nodule, 30 patients). 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 (malignant group). 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 than in the benign group (20.8 mm vs. 14.4 mm, p=0.024). Metastatic lesions had a significantly higher value of maximal standardized uptake (mSUV) than that of benign lesions (6.4 vs. 3.4, p=0.021).
CONCLUSION
Hormone receptor status, lesion size, and mSUV on positron emission tomography are helpful in the differentiation of malignant lesions from benign lesions in breast cancer patients who were presented with a new isolated mediastinal LN or small pulmonary nodule during surveillance.

Keyword

Breast neoplasms; Pulmonary nodule; Mediastinal lymph node; Neoplasm metastasis; Benign

MeSH Terms

Breast Neoplasms*
Diagnosis
Humans
Lymph Nodes*
Mediastinoscopy
Neoplasm Metastasis
Positron-Emission Tomography
Thoracic Surgery, Video-Assisted
Thoracotomy

Reference

References

1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005; 55:74–108.

2. Sanuki-Fujimoto N, Takeda A, Amemiya A, Ofuchi T, Ono M, Yamagami R, et al. Pattern of tumor recurrence in initially nonmetastatic breast cancer patients: distribution and frequency of metastases at unusual sites. Cancer. 2008; 113:677–82.

3. Kamby C, Andersen J, Ejlertsen B, Birkler NE, Rytter L, Zedeler K, et al. Pattern of spread and progression in relation to the characteristics of the primary tumour in human breast cancer. Acta Oncol. 1991; 30:301–8.

4. Hodgson NC, Gulenchyn KY. Is there a role for positron emission tomography in breast cancer staging? J Clin Oncol. 2008; 26:712–20.

5. Hoh CK, Schiepers C, Seltzer MA, Gambhir SS, Silverman DH, Czernin J, et al. PET in oncology: will it replace the other modalities? Semin Nucl Med. 1997; 27:94–106.

6. Juweid ME, Cheson BD. Positron-emission tomography and assessment of cancer therapy. N Engl J Med. 2006; 354:496–507.

7. Lavayssiere R, Cabee AE, Filmont JE. Positron emission tomography (PET) and breast cancer in clinical practice. Eur J Radiol. 2009; 69:50–8.

8. Das CJ, Kumar R, Balakrishnan VB, Chawla M, Malhotra A. Disseminated tuberculosis masquerading as metastatic breast carcinoma on PET-CT. Clin Nucl Med. 2008; 33:359–61.

9. Hunt BM, Vallieres E, Buduhan G, Aye R, Louie B. Sarcoidosis as a benign cause of lymphadenopathy in cancer patients. Am J Surg. 2009; 197:629–32.

10. Hammoud ZT, Anderson RC, Meyers BF, Guthrie TJ, Roper CL, Cooper JD, et al. The current role of mediastinoscopy in the evaluation of thoracic disease. J Thorac Cardiovasc Surg. 1999; 118:894–9.

11. Sobel JM, Lai R, Mallery S, Levy MJ, Wiersema MJ, Greenwald BD, et al. The utility of EUS-guided FNA in the diagnosis of metastatic breast cancer to the esophagus and the mediastinum. Gastrointest Endosc. 2005; 61:416–20.

12. Isasi CR, Moadel RM, Blaufox MD. A meta-analysis of FDGPET for the evaluation of breast cancer recurrence and metastases. Breast Cancer Res Treat. 2005; 90:105–12.

13. Pennant M, Takwoingi Y, Pennant L, Davenport C, Fry-Smith A, Eisinga A, et al. A systematic review of positron emission tomography (PET) and positron emission tomography/computed tomography (PET/CT) for the diagnosis of breast cancer recurrence. Health Technol Assess. 2010; 14:1–103.

14. Bender H, Kirst J, Palmedo H, Schomburg A, Wagner U, Ruhlmann J, et al. Value of 18fluoro-deoxyglucose positron emission tomography in the staging of recurrent breast carcinoma. Anticancer Res. 1997; 17:1687–92.

15. Lin WY, Tsai SC, Cheng KY, Yen RF, Kao CH. Fluorine-18 FDG-PET in detecting local recurrence and distant metastases in breast cancer: Taiwanese experiences. Cancer Invest. 2002; 20:725–9.

16. Neri A, Marrelli D, Rossi S, De Stefano A, Mariani F, De Marco G, et al. Breast cancer local recurrence: risk factors and prognostic relevance of early time to recurrence. World J Surg. 2007; 31:36–45.

17. Brewster AM, Do KA, Thompson PA, Hahn KM, Sahin AA, Cao Y, et al. Relationship between epidemiologic risk factors and breast cancer recurrence. J Clin Oncol. 2007; 25:4438–44.

18. Gao D, Du J, Cong L, Liu Q. Risk factors for initial lung metastasis from breast invasive ductal carcinoma in stages I-III of operable patients. Jpn J Clin Oncol. 2009; 39:97–104.

19. Dent R, Hanna WM, Trudeau M, Rawlinson E, Sun P, Narod SA. Pattern of metastatic spread in triple-negative breast cancer. Breast Cancer Res Treat. 2009; 115:423–8.

20. Dent R, Trudeau M, Pritchard KI, Hanna WM, Kahn HK, Sawka CA, et al. Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res. 2007; 13(15 Pt 1):4429–34.

21. Voogd AC, Nielsen M, Peterse JL, Blichert-Toft M, Bartelink H, Overgaard M, et al. Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials. J Clin Oncol. 2001; 19:1688–97.

22. Elston CW, Ellis IO, Pinder SE. Pathological prognostic factors in breast cancer. Crit Rev Oncol Hematol. 1999; 31:209–23.

23. Rampaul RS, Pinder SE, Elston CW, Ellis IO; Nottingham Breast Team. Prognostic and predictive factors in primary breast cancer and their role in patient management: The Nottingham Breast Team. Eur J Surg Oncol. 2001; 27:229–38.

24. Eubank WB, Mankoff DA, Takasugi J, Vesselle H, Eary JF, Shanley TJ, et al. 18fluorodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancer. J Clin Oncol. 2001; 19:3516–23.