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Lung Cancer |

Diagnosis of New Parenchymal Lung Findings in Subjects With History of A Nonhematologic Malignancy

Yuan Zhang, MD; Xin Zhang, MD; Mingying Zeng, MD; Rex Yung, MD
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Department of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD


Chest. 2013;144(4_MeetingAbstracts):651A. doi:10.1378/chest.1702521
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Abstract

SESSION TITLE: Decision-Making in Lung Cancer

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 30, 2013 at 07:30 AM - 09:00 AM

PURPOSE: Abnormal chest findings in subjects with cancer histories are worrisome for metastases, however they can be non-malignant conditions (e.g. infections) that requires different treatment. Furthermore patients with prior cancer can develop second malignancies. Finally having accurate tumor diagnosis and adequate sampling is necessary for personalized molecular therapies. We aimed to investigate factors associated with whether new chest lesions are metastatic, primary lung cancer or non-cancers in subjects with history of a non-hematologic malignancy.

METHODS: Review of IRB-approved bronchoscopy database of abnormal lung findings suspicious for thoracic malignancies. Details include patient demographics, prior medical history (especially cancer background), diagnostic procedures and final diagnosis, including follow-up non-bronchoscopic tissue diagnosis.

RESULTS: In a 36 months period,145 patients with prior non-hematologic cancers had new lesions referred for bronchoscopy. 88/145(60.7%) are diagnosed with cancer. Of 53 patients with prior lung-cancers(LC), 66%(35/53) were diagnosed with cancer, 30 LC progression or new second-primary LC(SPLC) and 5 metastatic from new non-lung primary(NLP) sites. Of 92 prior non-lung primaries(NPLs), 57.6%(53/92) had new cancer diagnosis, 22 are NLP mets and 31 are new secondary LCs. Therefore a majority of our cohort have active cancer. Those with prior NLP are more likely to have new LC(31/53=58.5%) than metastases from their NLP(22/53=41.5%). Different cancer types are associated with different risks: 81% are metastases for the group of Renal Cell(5/5), sarcomas(4/4), melanoma(5/6), prostate(3/4), gastrointestinal-colorectal & pancreatic(8/12). On the other hand, 72% are new primary LCs for the group of Head and Neck(7/11), uroepithelial/bladder(3/3) and breasts(3/4). No clear distinction for non-melanoma skin and GYN. For prior LCs, only a minority(5/35=14.3%) has metastases from new NLP. Use of immunohistochemical stains are critical in distinguishing tumor origin.

CONCLUSIONS: Not all new chest lesions represent metastases in patients with prior non-hematologic malignancies.

CLINICAL IMPLICATIONS: New pulmonary findings in patients with prior cancers should be aggressively pursued as cancers may be of a new cell type, and non-cancerous diagnosis warrants specific treatment.

DISCLOSURE: The following authors have nothing to disclose: Yuan Zhang, Xin Zhang, Mingying Zeng, Rex Yung

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