Chapter 52 • Few lung metastases are symptomatic; only 15% to 20% of patients report having a cough or pain. All patients with isolated pulmonary metastasis from an extrathoracic malignancy should be evaluated for the possibility of resection. • Initial imaging studies should consist of a computed tomographic (CT) examination to predict resectability. Integrated fluorine-18 fluorodeoxyglucose positron emission tomography–CT may be substituted for CT alone. Magnetic resonance imaging has a limited role. • CT is unable to distinguish reliably between malignant and benign lesions. • CT differs from the final pathology report in 42% of cases. • CT underestimates the number of malignant lesions in 25% to 35% of cases. • The accuracy of radiologic imaging is only 37%, underestimating the number of lesions by 39% and overestimating them by 25%, for patients undergoing bilateral exploration. • Prognostic factors include number of metastases, disease-free interval, and histology/organ site of the primary tumor. • From 10% to 25% of patients with primary colorectal tumors have detectable metastases at the time of primary tumor diagnosis. • Metastatic disease develops in 25% to 70% of patients with localized bone and soft tissue sarcoma; 10% will present with metastasis at the time of primary tumor diagnosis. • Patients with metastatic melanoma have an especially poor prognosis, with isolated lung metastasis occurring in 2% to 11% of patients. • In 50% of patients who have a radical nephroureterectomy, pulmonary metastases later develop; however, only 16% have metastatic disease confined to the lung.
Lung Metastases
Summary of Key Points
Evaluation
Pulmonary Metastasis for Specific Tumor Types
Isolated lung metastases occur in up to 20% of patients with sarcoma during the course of their disease, with the lung being the sole site of failure after treatment in up to 90% of cases.
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Lung Metastases
