Clinical significance of indeterminate pulmonary nodule in RT planning CT scans of breast cancer patients

Department of Radio Therapy,CHRISTIAN MEDICAL COLLEGE Abstract : Background- Incidental finding of lung nodules on Planning CT scans in breast cancer patients is common. It causes clinical dilemma regarding the plan of further management. It Is important to study the course of these lung nodules to make proper clinical judgment in future.Patients and Methods - From January 2010 to May 2013, RT planning CT scans done for breast cancer patients were reviewed retrospectively to identify indeterminate pulmonary nodules. Patients with pulmonary nodules were grouped according to number, size, associated benign diseases, stage and were followed up. The nodules which increased in size or number were further evaluated with either biopsy or PET CT scan. The lung nodules which showed progression were correlated with patients characteristics. Results- Out of 134 patients treated with conformal radiation therapy, 28 patients (21) were found to have incidental lung nodules in planning CT scans. Thirteen patients had solitary nodules and 15 had multiple nodules. 20 had nodule less than 5mm and 8 had more than 5 mm. Median follow up period was 13 months (range 6 - 36 months). During follow up, 4 patients (14) progressed to lung metastases. 3 out of 4 patients had multiple nodules and all of them had locally advanced breast carcinoma at presentation. Conclusion - Incidental lung no dules are common finding on routine imaging. Multiple nodules, size 5 mm, advanced stage at presentation are high risk for progression to lung metastases and should be closely followed up. Majority of incidental lung nodules are benign and unnecessary evaluation should be avoided as it delays treatment of the primary.