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Clinical significance of perifissural nodules in the oncologic population

      Highlights

      • Perifissural nodules (PFNs) are common in the general population.
      • In our dedicated cancer population, PFNs were found to be stable or decreased in size over a follow up, similar to the general population and; therefore, can be presumed benign.
      • While a pulmonary or pleural nodule will still necessitate follow up in cancer patients, our results indicate we as radiologists can provide reassurance to our oncologic colleagues and oncologic patients.

      Abstract

      Purpose

      To evaluate for stability of perifissural nodules (PFNs) in a dedicated oncologic population.

      Methods

      A retrospective review of 500 computed tomography (CT) chests from oncologic patients at our tertiary care cancer center with at least a three year follow up yielded 76 patients with PFNs. Patients with metastases on baseline CT chest were excluded (n = 14) as the presence of a PFN would not be clinically relevant, thus our final patient cohort was 62 patients with a total of 112 PFNs. PFN features, clinical features, and ancillary information was recorded from the CT and the electronic medical record for all patients. The two patient cohorts—stable or decreased PFN vs. increased PFN—were then compared.

      Results

      112 PFNs were examined in 62 patients with a median follow up interval of 5.7 years. Of 62 patients, 59 (95.2%, 95% CI: 86.5, 99.0) had decreased/stable PFNs on follow up scan (median follow up 5.6 years) and 3 (4.8%, 95% CI: 1.0, 13.5%) had enlarged PFNs (median follow up 6.3 years). None of the PFN features, clinical features, nor ancillary information from the CT proved to be statistically significant.

      Conclusions

      Despite the lack of statistically significant distinguishing features to predict growth, our results are reassuring, since the majority of PFNs in our oncology patients were decreased or unchanged in size which is comparable to previously published data on PFNs in non-oncologic patients. Thus, we can similarly presume these nodules are most likely benign and can provide reassurance to our oncologic colleagues and our patients. Larger studies are warranted to further evaluate PFNs in the oncologic population which also examines the nodules by cancer type.

      Keywords

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