A 53-year-old woman who had a malignant tumor removed 2 years ago presents with a solitary lung nodule 1.5 cm in diameter. The following is/are true:
- If the primary tumor originated in the breast, the lesion is most likely to represent a new primary lung cancer.
- If the primary tumor was melanoma, the lesion is most likely to be metastatic
- If the remainder of the lung fields are clear, a CT scan is unnecessary
- If the primary tumor was in the GI tract, there is very little chance that the lesion is a new primary lung cancer
- Fine needle aspiration should always be performed prior to resection of the lung lesion
Medicine
a. If the primary tumor originated in the breast, the lesion is most likely to represent a new primary lung cancer.
b. If the primary tumor was melanoma, the lesion is most likely to be metastatic
A new pulmonary lesion in a patient with a history of a previously treated malignancy poses a diagnostic and therapeutic challenge. A CT scan should always be obtained since plain radiographs can detect lesions only 9 mm in diameter or greater. The lesion is most likely to be metastatic if the prior malignancy was sarcoma or melanoma and most likely to be a new primary lung cancer if the prior malignancy originated in the head, neck or breast. When the original lesion was in the GI or GU tract, there is an equal chance that it is metastatic or a new primary. Fine needle aspiration does not usually alter the plan for excision and is done only when the patient is not an operative candidate or desires to know the diagnosis.
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