Annals of Surgical Oncology

, Volume 25, Issue 5, pp 1237–1244 | Cite as

Solitary Pulmonary Lesion in Patients with History of Malignancy: Primary Lung Cancer or Metastatic Cancer?

  • Ke Jin
  • Kexi Wang
  • Huizhong Zhang
  • Yuejiang Pan
  • Dexiong Cao
  • Minghui Wang
  • Ju Chen
  • Duoguang Wu
  • Boshen Chen
  • Xuan XieEmail author
Thoracic Oncology



Defining the status of solitary pulmonary lesion (SPL) in patients with history of malignancy is important because primary lung cancer (PLC) or intrapulmonary metastasis might indicate different surgical strategies. The aim of this study is to identify factors related to the status of these lesions and construct a clinical model to estimate the pretest probability of PLC.


From January 2005 to January 2016, 104 patients with previous malignancy and suitable for surgery were retrospectively studied. Univariate and multivariate analyses were performed to identify possible factors related to SPLs. A nomogram was constructed to differentiate PLC from intrapulmonary metastasis.


Ninety-seven (93.3%) patients were diagnosed as malignant postoperatively, including 61 patients with intrapulmonary metastasis and 36 patients with PLC. Multivariate analysis showed that site of primary tumor [head and neck squamous cell cancer: odds ratio (OR) = 28.509, P = 0.006; genitourinary cancer: OR = 23.928, P = 0.012], negative lymph node status of primary tumor (OR = 3.154, P = 0.038), spiculation of SPL (OR = 3.972, P = 0.022), and central location of SPL (OR = 4.679, P = 0.026) were four independent factors differentiating PLC from intrapulmonary metastasis. All of these were included in the nomogram. The C-index of the nomogram for predicting probability was 0.82.


Incidence of malignant SPLs was fairly high in patients with history of malignancy. A nomogram including site and lymph node status of primary tumor, and spiculation and location of SPL might be a good tool for differentiating PLC from intrapulmonary metastasis preoperatively and guiding treatment.



This study was supported by the National Natural Science Foundation of China (Grant No. 81602105) and Natural Science Foundation of Guangdong Province (Grant No. 2014A030310011). The authors appreciate the contribution of all participants.



Supplementary material

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Supplementary material 1 (DOCX 15 kb)
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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Ke Jin
    • 1
    • 2
  • Kexi Wang
    • 1
    • 2
  • Huizhong Zhang
    • 1
    • 2
  • Yuejiang Pan
    • 1
    • 2
  • Dexiong Cao
    • 1
    • 3
  • Minghui Wang
    • 1
    • 2
  • Ju Chen
    • 1
    • 2
  • Duoguang Wu
    • 1
    • 2
  • Boshen Chen
    • 1
    • 2
  • Xuan Xie
    • 1
    • 2
    Email author
  1. 1.Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouPeople’s Republic of China
  2. 2.Department of Thoracic Surgery, Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouPeople’s Republic of China
  3. 3.Department of Anesthesiology, Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouPeople’s Republic of China

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