Surgery for pulmonary nodules in breast cancer patients

The nature of pulmonary nodules that appeared in patients who had received surgery for breast cancer, as well as the role of surgery for such pulmonary nodules, remains unclear.

A total of 52 consecutive patients who underwent surgery for pulmonary nodules between 1992 and 2001 after curative operation for breast cancer were reviewed.

The pathologic diagnoses of pulmonary nodules were pulmonary metastases of breast cancer in 39 patients, primary lung cancer in 6, and other diagnoses in 7 (tuberculosis and hamartoma in 2 each; sclerosing hemangioma, organizing pneumonia, and paragohimiasis in 1 each). The incidence of multiple pulmonary nodules was significantly higher in metastatic breast cancer patients (64.1%), but 33.3% of primary lung cancer patients and 28.6% of other histology patients had multiple pulmonary nodules. The average disease-free interval from the initial mastectomy was significantly shorter in metastatic breast cancer patients (66.8 months), but disease-free intervals were longer than 5 years in 41.0% of metastatic breast cancer patients. The 5-year survival rate after pulmonary metastectomy of metastatic breast cancer patients was 30.8%, which was not better than those documented in metastatic breast cancer patients treated with modern chemotherapy. There was no significant difference in postmetastectomy survival according to the number or sites of pulmonary metastases or the disease-free interval.

Pulmonary metastectomy may not be the primary therapeutic option in metastatic breast cancer patients, and patients should be treated principally with chemotherapy. As pulmonary nodules that appear in breast cancer patients are not always pulmonary metastases, the pathologic diagnosis should be confirmed, and surgery is an option for the pathologic confirmation.