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DOI: 10.1148/radiol.2392050631
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(Radiology 2006;239:514-520.)
© RSNA, 2006

Pediatric Imaging

Distinguishing Benign from Malignant Pulmonary Nodules with Helical Chest CT in Children with Malignant Solid Tumors1

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

1 From the Departments of Radiological Sciences (M.B.M., H.M.L., R.A.K.), Hematology-Oncology (V.M.S., N.C.D.), Surgery (S.J.S.), and Biostatistics (C.S.L.), St Jude Children's Research Hospital, 332 N Lauderdale St, Memphis, TN 38105-2794; Department of Diagnostic Imaging, UNIFESP-Escola Paulista de Medicina, Sao Paulo, Brazil (H.M.L.); and University of Tennessee, College of Medicine, Memphis, Tenn (M.B.M., R.A.K., V.M.S., N.C.D., S.J.S.). Received April 15, 2005; revision requested June 14; revision received July 22; final version accepted August 25. Supported in part by Cancer Center Support grant CA21765 from the U.S. Public Health Service and by the American Lebanese Syrian Associated Charities (ALSAC). Address correspondence to M.B.M. (e-mail: beth.mccarville{at}stjude.org).

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 ({kappa} ≤ 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.

© RSNA, 2006




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Distinguishing Benign from Malignant Pulmonary Nodules in Children and in Adults
Denis TACK, et al.
Radiology Online, 27 May 2008 [Full text]