Histology of Newly Detected Lung Lesions in Melanoma
Background: Melanoma frequently metastasizes to the lung. Improved radiologic techniques may decrease the need for biopsy of such lesions. The aim of this study was to examine factors predictive of a positive biopsy of melanoma.
Methods: Using the Memorial Sloan-Kettering Cancer Center melanoma database, all patients with melanoma who had undergone biopsy of a suspicious new lung lesion from 1996 to 2009 were identified. Age, date of diagnosis, histology, and stage were obtained. Chart review was carried out to obtain medical history, smoking status, radiological appearance, and histology of lung lesions biopsied.
Results: Two hundred and twenty-nine patients were identified; median age was 63 years; 48% were never smokers; 27% had a prior nonmelanoma cancer; 88% of lung nodules were malignant: 69% melanoma, 19% other cancers. Among 113 patients undergoing positron emission tomography (PET), proportions of benign, melanoma, and nonmelanoma 2-[fluorine-18]fluoro-2-deoxy-D-glucose-avid nodules did not differ (P = 0.53). On multivariable analysis, >stage I melanoma, negative smoking history, multiple lung nodules, and no prior nonmelanoma cancer were significantly associated with a melanoma biopsy result rather than other cancer.
Conclusions: In this study, 31% of lung lesions were not melanoma. In the subset undergoing PET, this did not differentiate between benign and malignant lesions. Biopsy is mandated in melanoma patients with new lung nodules.
Outcomes for patients with metastatic malignant melanoma are generally poor; median survival ranges from 6 to 15 months. Survival is shortest for those with nonpulmonary visceral disease (M1c) and longest for those with skin and distant lymph node involvement only (M1a). Prognosis for those with lung-only metastases (M1b) is intermediate, and for selected patients, this may be improved by surgical resection. Median survival in patients after pulmonary metastasectomy has been shown to range from 18 to 40 months with 5-year survival ranging from 22% to as high as 39% in those with a solitary pulmonary lesion.
Superior survival following resection of pulmonary metastases is dependent on both careful patient selection and accurate tissue diagnosis. 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG)–positron emission tomography (PET) alone or in combination with computed tomography (CT) is often used to evaluate the extent of disease before planning treatment strategies. In some studies, the use of PET has been associated with increased accuracy in the detection of metastatic lesions when compared with conventional imaging, although this increased accuracy has not been consistent across all studies, in particular when relating to small metastatic lesions. However, the mere presence of a new lung nodule or nodules seen on imaging is insufficient to diagnose recurrent disease, and National Comprehensive Cancer Network guidelines recommend that initial clinical recurrence should be confirmed pathologically by biopsy whenever possible. The aim of this study was to examine the factors predictive of a positive lung biopsy in patients with a history of malignant melanoma presenting with new lung lesions.
Abstract and Introduction
Abstract
Background: Melanoma frequently metastasizes to the lung. Improved radiologic techniques may decrease the need for biopsy of such lesions. The aim of this study was to examine factors predictive of a positive biopsy of melanoma.
Methods: Using the Memorial Sloan-Kettering Cancer Center melanoma database, all patients with melanoma who had undergone biopsy of a suspicious new lung lesion from 1996 to 2009 were identified. Age, date of diagnosis, histology, and stage were obtained. Chart review was carried out to obtain medical history, smoking status, radiological appearance, and histology of lung lesions biopsied.
Results: Two hundred and twenty-nine patients were identified; median age was 63 years; 48% were never smokers; 27% had a prior nonmelanoma cancer; 88% of lung nodules were malignant: 69% melanoma, 19% other cancers. Among 113 patients undergoing positron emission tomography (PET), proportions of benign, melanoma, and nonmelanoma 2-[fluorine-18]fluoro-2-deoxy-D-glucose-avid nodules did not differ (P = 0.53). On multivariable analysis, >stage I melanoma, negative smoking history, multiple lung nodules, and no prior nonmelanoma cancer were significantly associated with a melanoma biopsy result rather than other cancer.
Conclusions: In this study, 31% of lung lesions were not melanoma. In the subset undergoing PET, this did not differentiate between benign and malignant lesions. Biopsy is mandated in melanoma patients with new lung nodules.
Introdution
Outcomes for patients with metastatic malignant melanoma are generally poor; median survival ranges from 6 to 15 months. Survival is shortest for those with nonpulmonary visceral disease (M1c) and longest for those with skin and distant lymph node involvement only (M1a). Prognosis for those with lung-only metastases (M1b) is intermediate, and for selected patients, this may be improved by surgical resection. Median survival in patients after pulmonary metastasectomy has been shown to range from 18 to 40 months with 5-year survival ranging from 22% to as high as 39% in those with a solitary pulmonary lesion.
Superior survival following resection of pulmonary metastases is dependent on both careful patient selection and accurate tissue diagnosis. 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG)–positron emission tomography (PET) alone or in combination with computed tomography (CT) is often used to evaluate the extent of disease before planning treatment strategies. In some studies, the use of PET has been associated with increased accuracy in the detection of metastatic lesions when compared with conventional imaging, although this increased accuracy has not been consistent across all studies, in particular when relating to small metastatic lesions. However, the mere presence of a new lung nodule or nodules seen on imaging is insufficient to diagnose recurrent disease, and National Comprehensive Cancer Network guidelines recommend that initial clinical recurrence should be confirmed pathologically by biopsy whenever possible. The aim of this study was to examine the factors predictive of a positive lung biopsy in patients with a history of malignant melanoma presenting with new lung lesions.
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