Medscape and Radiopedia

8/16/2019 Medscape and Radiopedia

1/21

EDITION: ENGLISH DEUTSCH ESPAÑOL FRANÇAIS PORTUGUÊS

News & Perspective

Dr!s & Dise"sesC#E & E$c"ti%

L%! IRe!ister

• Prit

Secondary Lung Tumors• At'%r: D"ie( S Sc'w"rt)* #D* FACS+ C'ie, E$it%r: -%' Gei.e(* #D* DSc*

#Sc* #A /%re000Up$"te$: Dec 12* 3145

• Overview

• C'"r"cteristics %, #et"st"tic Pri/"r6 C"cers• P"t'%p'6si%(%!6• Eti%(%!6• Pr%!%sis• Hist%r6 "$ P'6sic"( E7"/i"ti%• Di,,ereti"( Di"!%sis• L".%r"t%r6 St$ies• C'est R"$i%!r"p'6• CT Sc"i!• #"!etic Res%"ce I/"!i!• PET Sc"i!• 8'%(e9%$6 PET Sc"i! ;Oc%(%!ic PET9CT Sc"<• I//%'ist%c'e/istr6 "$ Gee E7pressi%• #e$i"sti%sc%p6• Aspir"ti% "$ i%ps6• TNA "$ PET sc"i!• I$ic"ti%s ,%r Sr!er6• C'e/%t'er"p6 "$ Ot'er Tre"t/ets• S'%w A((

Re,ereces

OverviewSec%$"r6 (! t/%rs "re e%p("s/s t'"t spre"$ ,r%/ " pri/"r6 (esi%0 T'e

pri/"r6 t/%r c" "rise wit'i t'e (! %r %tsi$e t'e (!* wit' t'e /et"st"sestr"ve(i! t'r%!' t'e .(%%$stre"/ %r (6/p'"tic s6ste/ %r .6 $irect e7tesi% t%

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2/21

re"c' t'eir $esti"ti%0 T'e sec%$"r6 t/%rs /%st t6pic"((6 "ppe"r "s we((9circ/scri.e$* %c"(ci,ie$ %$(es0=4>

T'ese sec%$"r6 c"cers "re i$eti,ie$ .6 t'eir site %, %ri!i0 T's* " c%(%c"cer t'"t /et"st"si)es t% t'e (! is sti(( ?%w "s " c%(% c"cer0 I c'i($re*

/%st (! c"cers "re sec%$"r60=3>

#et"st"tic /"(i!"t e%p("s/s "re t'e /%st c%//% ,%r/ %, sec%$"r6 (!t/%rs0 L! /et"st"ses "re i$eti,ie$ i @19B %, "(( c"cer p"tiets* t'%!'prev"(ece v"ries ."se$ % t'e t6pe %, pri/"r6 c"cer0 ei! e%p("s/s ;e!*.ei! /et"st"si)i! (ei%/6%/"s< "re c%//% e7cepti%s0

I t'is "rtic(e* t'e "ppr%"c' t% sec%$"r6 (! t/%rs is $iscsse$* wit' "e/p'"sis % c(iic"( $ecisi%9/"?i! t% $eter/ie w'et'er tisse $i"!%sisw%($ "(ter c(iic"( /""!e/et0 A(s% $iscsse$ is t'e /(ti$iscip(i"r6 "ppr%"c't% $eter/ie w'e t'e c%tie$ s6ste/ic tre"t/et wit' c'e/%t'er"p6 ,%r

/et"st"tic $ise"se s'%($ .e "cc%/p"ie$ .6 r"$i"ti%* sr!er6* %r .%t'0 A(/%st "6 c"cer '"s t'e ".i(it6 t% spre"$ t% t'e (!s* .t t'e t/%rs t'"t /%stc%//%(6 $% s% ic($e .("$$er c"cer * c%(% c"cer * .re"st c"cer * pr%st"tec"cer * s"rc%/"* 8i(/s t/%r * "$ er%.("st%/"0 ;Pri/"r6 (! c"cers /%stc%//%(6 /et"st"si)e t% t'e "$re"( !("$s* (iver* .r"i* "$ .%e0

Sec%$"r6 (! t/%r is " ter/ t'"t is "(s% se$ ,%r t'e /"(i!"cies t'"t "rise it'e (!s "s " c%seece %, t'er"p6 ,%r c"cer ;e!* c'e/%t'er"p6*r"$i%t'er"p6* .%e /"rr%w tr"sp("t T'is "rtic(e is %t ite$e$ t% c%ver t'e$escripti% %, sc' t/%rs0

Spre"$ t% t'e (!s is s"((6 t'e /"r?er %, " "$v"ce$ /"(i!"t $ise"se* .tspre"$ c" %ccr "s " is%("te$ e"r(6 evet0 I cert"i circ/st"ces* sr!ic"(resecti% wit' cr"tive itet c" .e per,%r/e$* wit' " rep%rte$ 96e"r srviv"(r"te %, "s 'i!' "s @1951B* $epe$i! p% t'e $er(6i! pri/"r6 /"(i!"c6"$ t'e se(ecti% criteri" ,%r sr!er60

Diagnosis

Sec%$"r6 (! t/%rs /"6 .e i$eti,ie$ w'e p"tiets "re ev"("te$ ,%rs6/pt%/s sc' "s c'est p"i* $6spe"* c%!'* %r 'e/%pt6sis %r w'e p"tietswit' ?%w pri/"r6 t/%rs "re .ei! st"!e$ ,%r /et"st"ses0

A c(iic"( sce"ri% t'"t is %t i,reet(6 ec%tere$ is " ici$et"( ,i$i! %,sec%$"r6 (! c"cer %, ?%w %ri!i* ?%w "s "$e%c"rci%/" %, ?%wpri/"r6 ;ACUP

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3/21

Di"!%stic str"te!ies ,%r ACUP ",ter t'e iiti"( c(iic"( "$ r"$i%(%!ic stepwiseev"("ti% ic($e e7tesive i//%'ist%c'e/istr6* w'ic' /"6 6ie($ " ,i"(c("ssi,6i! $i"!%sis i p t% 1B %, p"tiets* ,%((%we$ .6 !ee e7pressi% ;%rreverse tr"scripti%p%(6/er"se c'"i re"cti% =RT9PCR>


4/21

Direct e7tesi% c" "(s% %ccr t'r%!' " v"sc("r r%te* sc' "s t'e spre"$ %,re"( ce(( c"cer %r testic("r !er/ ce(( c"cer "s " t/%r t'r%/.s t% t'e (!vi" t'e i,eri%r ve" c"v" "$ t'e ri!'t si$e %, t'e 'e"rt0

Metastatic spread

Tre /et"st"ses %ccr vi" t'e p(/%"r6 "rteries %r .r%c'i"( "rteries* vi" t'ep(/%"r6 (6/p'"tics* "cr%ss t'e p(er"( c"vit6* %r* i,reet(6* vi" t'e "irw"6s0

Arterial

T'e p(/%"r6 "rteries "re t'e /%st c%//% r%te ,%r /et"st"ses0 C"cers/%st (i?e(6 t% /et"st"si)e t% t'e (!s ic($e t'%se wit' " ric' v"sc("r spp(6$r"ii! $irect(6 it% t'e s6ste/ic ve%s s6ste/0 Spre"$ vi" .r%c'i"( "rteries/"6 .e resp%si.(e ,%r s%/e e$%.r%c'i"( /et"st"ses0 ;Ot'er pr%p%se$ /%$es%, e$%.r%c'i"( spre"$ ic($e .r%c'i"( iv"si% ,r%/ p"rec'6/"( (esi%s*spre"$ vi" iv%(ve$ /e$i"sti"( %r 'i("r (6/p' %$es* "$ e7tesi% "(%! t'e

pr%7i/"( .r%c's0<

Lymphatic

L6/p'"!itic spre"$ c" %ccr i "ss%ci"ti% wit' 'e/"t%!e%s $isse/i"ti%*w'ic' is s.seet(6 ,%((%we$ .6 iv"si% %, t'e "$"cet iterstiti/ "$(6/p'"tics* wit' s.seet t/%r spre"$ t%w"r$ t'e 'i(" %r t%w"r$ t'e perip'er6%, t'e (!0

L6/p'"!itic spre"$ c" "(s% %ccr vi" retr%!r"$e spre"$ %, " t/%r ,r%/ t'e%ri!i"((6 ",,ecte$ /e$i"sti"( %r 'i("r (6/p' %$es* wit' c%seet %.strcti%

%, (6/p'"tic ,(%w0Pleural

P(er"( spre"$ /%st ,reet(6 res(ts i p(er"( /et"st"ses i t'e c"$"( "$p%steri%r p"rts %, t'e p(er"( c"vities0

Airway

Spre"$ vi" "irw"6s is r"re "$ $i,,ic(t t% pr%ve* e7cept i t'e c"se %,.r%c'%"(ve%("r c"rci%/"0

Eti%(%!6 A(t'%!' "6 c"cer c" /et"st"si)e t% t'e (!s* t'e ,%((%wi! e%p("s/s "re/%st (i?e(6 t% $% s%:

• #e("%/"• T'6r%i$ c"cer • re"st c"cer • C%(%rect"( c"cer • He"$ "$ ec? c"cer • Re"( ce(( c"cer • C'%ri%c"rci%/"

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5/21

• Testic("r c"cer • Oste%s"rc%/"• Ewi! s"rc%/"• 8i(/s t/%r •

R'".$%/6%s"rc%/"• Pr%st"te c"cer

Pr%!%sisL! /et"st"ses c%//%(6 c"se % s6/pt%/s* .t i s%/e c"ses t'e6 c" .et'e /"%r c"se %, /%r.i$it60 S6/pt%/s ic($e '6p%7e/i"* $6spe"* c%!'*"$ 'e/%pt6sis0 H6p%7e/i" "$ $6spe" "re /%st c%//%(6 %.serve$ ip"tiets wit' (6/p'"!itic spre"$* "$ c%!' "$ 'e/%pt6sis "re "ss%ci"te$ wit'e$%.r%c'i"( /et"st"ses0 P"((i"tive c"re t% "$$ress s6/pt%/s %r (%c"(tre"t/et wit' cr"tive %r p"((i"tive itet /"6 .e i$ic"te$0

T'e presece %, '6p%7e/i" c"%t .e e7p("ie$ .6 " c"cer%s pr%cess i t'e".sece %, (6/p'"!itic spre"$* /"%r (! c%(("pse* %r /"ssive p(er"( e,,si%0T's* it is s"((6 " ,i$i! i p"tiets wit' "$v"ce$ $ise"se0 T'e presece %,'6p%7e/i" i t'e ".sece %, t'ese c%$iti%s s'%($ pr%/pt t'e se"rc' ,%rc"ses sc' "s t'e ,%((%wi!:

• Pe/%i"• P(/%"r6 t'r%/.%e/.%(is/• T/%r e/.%(i s6$r%/e• P(/%"r6 ve%%cc(sive $ise"se "ss%ci"te$ wit' cert"i c"cers %r

c'e/%t'er"pies• Iterstiti"( ,i.r%sis sec%$"r6 t% c'e/%t'er"p6 %r r"$i"ti%• A i,ecti%s eti%(%!6

Mortality

T'e presece %, /et"st"sis i$ic"tes " "$v"ce$ st"!e %, t'e /"(i!"tpr%cess0 I cert"i circ/st"ces* '%wever* $epe$i! % t'e $er(6i! pri/"r6/"(i!"c6 "$ t'e se(ecti% criteri" ,%r sr!er6* sr!ic"( resecti% wit' cr"tiveitet c" .e per,%r/e$* wit' " e7pecte$ 96e"r srviv"( r"te %, @1951B0

T'e ,%((%wi! 96e"r srviv"( r"tes '"ve .ee rep%rte$ ",ter resecti% %, si!(e

p(/%"r6 /et"st"sis %, t'e /et"st"tic c"cers ?%w t% resp%$ ,"v%r".(6 t%sr!ic"( tre"t/et:

• A$e%i$ c6stic c"rci%/" 9 @B• Testic("r c"cer 9 1B• S"/%s ce(( c"rci%/" %, t'e 'e"$ "$ ec? 9 5191B• C%(% c"cer 9 51B• re"st c"cer 9 @191B• S%,t tisse s"rc%/"s 9 @2B• Re"( ce(( c"cer 9 @19@B

• Oste%!eic s"rc%/" 9 319B

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6/21

S%(it"r6 (! /et"st"sis '"s " si!i,ic"t(6 .etter pr%!%sis t'" $%es /et"st"sis"t "6 %t'er viscer"( site i /et"st"tic /"(i!"t /e("%/"* wit' " /e$i"srviv"( %, 20@ /%t's "$ " 96e"r srviv"( r"te %, 5B0 T'e %t'er i/p%rt"ti$epe$et %tc%/e pre$ict%r i /et"st"tic /"(i!"t /e("%/" is t'e $ise"se9,ree iterv"( pri%r t% t'e i$eti,ic"ti% %, /et"st"tic $ise"se ;J 43 /% vs K43 /%


7/21

$er"!e/ets sc' "s "e/i" %r e(ectr%(6te ".%r/"(ities ;e!* '6p%?"(e/i"< t'"tc%($ i/p"ct "est'esi"0

Cancer-specific tumor markers

F%((%w9p %, c"cer9speci,ic t/%r /"r?ers i ser/ is r"re(6 c(iic"((6 se,( ,%r$i"!%sis %r pr%!%sis0 E7"/p(es %, t/%rs i w'ic' ser/ /"r?ers c" 'e(p t%icre"se t'e speci,icit6 %, i/"!i! st$ies ,%r est".(is'i! t'e $i"!%sis %,p(/%"r6 /et"st"ses ic($e t'e ,%((%wi!:

• N%se/i%/"t%s testic("r !er/ ce(( t/%rs 9 I w'ic' t'e e(ev"te$(eve(s %, "(p'" ,et%pr%tei "$%r t'e .et" s.it %, '/" c'%ri%ic!%"$%tr%pi c" 'e(p t% pre$ict t/%r recrrece

• 8e((9$i,,ereti"te$ p"pi(("r6 %r ,%((ic("r t'6r%i$ c"cer 9 6 i$eti,ic"ti% %,e(ev"te$ t'6r%!(%.(i (eve(s

• Pr%st"te c"cer 9 I w'ic' "6 $etect".(e pr%st"te9speci,ic "ti!e i t'e

ser/ ",ter iiti"( tre"t/et s!!ests persistet $ise"se %r recrreceC'est R"$i%!r"p'6C'est r"$i%!r"p'6 si! 'i!'9"(it6 p%ster%"teri%r "$ ("ter"( r"$i%!r"p's*re/"is t'e /%st c%//% i/"!i! st$6 i t'e iiti"( st"!i! ev"("ti% %, (!c"cer p"tiets0 H%wever* .ec"se %, p%%r 6ie($* it is r"re(6 rec%//e$e$ "s "p"rt %, t'e iiti"( w%r?p ,%r c%//% c"cers ;e!* .re"st c"cer* c%(% c"cer< "t" e"r(6 st"!e0

T'is is re,(ecte$ .6 t'e %.serv"ti% t'"t (! /et"st"ses '"ve .ee $etecte$si! r"$i%!r"p'6 i %(6 104B %, t'e p"tiets wit' st"!e I .re"st c"cer0 C'est

r"$i%!r"p's "re (i/ite$ .6 t'e p%teti"( t% %ver(%%? (esi%s (%c"te$ i t'e (!"pices %r p%steri%r s(ci %r "!"ist t'e 'e"rt %r /e$i"sti/ "$ .6 t'eir %ver"((p%%r sesitivit6 ,%r (! %$(es %, (ess t'" 40c/ i $i"/eter ;w'ic' is ,"r (esssesitive t'" CT sc"i!* respective(6

H%wever* %t'er st$ies* si! c'est CT sc"s "s t'e criteri% st"$"r$* ,"i(e$ t%c%,ir/ t'"t t'ese tec'ies '"$ " si!i,ic"t "$v"t"!e %ver st"$"r$ c'estr"$i%!r"p's0=41>

CT Sc"i!


8/21

8it' t'e itr%$cti% %, CT sc"i! i t'e 41s* re/"r?".(e "$v"ces '"ve.ee /"$e %t %(6 i c(iici"sM ".i(it6 t% $i"!%se (! c"cer .t* /%rei/p%rt"t(6* i c(iic"((6 st"!i! it0 CT sc"s c" $e,ie t'e (%c"ti%* si)e* "$""t%/ic c'"r"cteristics %, " t/%r ,"r .etter "$ /%re precise(6 t'" c'estr"$i%!r"p's c"=41> * "$ t'e6 "re se$ t% $e(ie"te t'e (%c%re!i%"( e7tet "$

$ist"( spre"$ %, " (! t/%r0

T'e /"%r "$v"t"!es %, CT "re re("te$ t% its "7i"( ,%r/"t* 'i!'er9$esit6res%(ti%* "$ wi$er $6"/ic r"!e0 C%ti%s tec'ic"( i/pr%ve/ets "$ t'e$eve(%p/et %, /%re p%wer,( "$ ,"ster c%/pters "re resp%si.(e ,%r t'e ,"ctt'"t t%$"6Ms CT9sc" e7"/i"ti%s %, t'e c'est pr%$ce " ("r!e "/%t %,$et"i(e$ i/"!i! i,%r/"ti% i " ver6 s'%rt ti/e0 ec"se %, t'is ev%(ti% itec'ie* t'e $eve(%p/et %, ew t'er"petic str"te!ies ,%r (! c"cer* "$ t'eitr%$cti% %, PET sc"i!* t'e c%tri.ti% %, CT sc"i! t% t'e st"!i! %,p"tiets wit' (! c"cer is ,(i$0 =44>

Usi! CT sc"i!* t'e i$eti,ic"ti% %, s/"((er (esi%s %,,ers t'e %pp%rtit6 ,%ri/pr%ve$ $i"!%sis "$ e"r(ier tre"t/et %, /et"st"tic $ise"se* w'ic' "re (i?e(6t% .e .ee,ici"(0 H%wever* t'e /"!it$e %, .ee,it '"s %t .ee c(e"r(6$%c/ete$ .6 t'e (iter"tre0 T'e icre"se$ sesitivit6 %, CT sc"i! '"s "(s%res(te$ i " icre"se$ ,reec6 %, i$eti,ic"ti% %, %/"(i!"t (esi%s*w'ic' /st .e $isti!is'e$ ,r%/ tre /"(i!"cies0

Sensitivity and specificity

C%veti%"( CT sc"i! %, t'e c'est ,r%/ t'e (eve( %, t'e speri%r t'%r"cic"pertre t% t'e "$re"( !("$s is speri%r t% p("i c'est r"$i%!r"p'6 ,%r t'e

$etecti% %, p(/%"r6 %$(es "$ /e$i"sti"( (6/p' %$e iv%(ve/et0 Spir"(CT sc"i! ,rt'er icre"ses t'e %$$s %, $etecti! p(/%"r6 %$(es0

Icre"se$ sesitivit6 c%/es "t t'e c%st %, s%/ew'"t $ecre"se$ speci,icit6c%/p"re$ wit' st"$"r$ c'est r"$i%!r"p'6 ;p%ster%"teri%r "$ ("ter"(< "$c%veti%"( CT sc"i!0 H%wever* t'e speci,icit6 %, " test is str%!(6 i,(ece$.6 c(iic"( circ/st"ces0 T's* i 'i!'(6 se(ecte$ p"tiets ;e!* t'%se wit'%ste%!eic s"rc%/" %r s%,t9tisse s"rc%/"* w'ic' "re t/%rs t'"t '"ve " 'i!'pr%pesit6 ,%r /et"st"si)i! t% t'e (!s


9/21

8it' " 'ist%r6 %, s"rc%/" %r /e("%/"* t'e p(/%"r6 %$(e is /%re (i?e(6 t%.e " /et"st"sis0 I t'e c"se %, $er(6i! 'e"$ "$ ec? c"cer %r .re"stc"cer* " sec%$ pri/"r6 c"cer i t'e (! is /%re (i?e(60 8it' %t'er/"(i!"cies* t'e %$(e is e"((6 (i?e(6 t% .e " pri/"r6 (! c"cer %r/et"st"tic $ise"se0

#"(i!"t (esi%s "cc%t ,%r @941B %, CT sc"$etecte$ p(/%"r6 %$(es0 I" %($er p"tiet* " s%(it"r6 %$(e is /%re (i?e(6 t% .e /"(i!"t ;(! c"cer* ip"rtic("r


10/21

Hi!'9res%(ti% CT sc"i! is t'e i/"!i! pr%ce$re %, c'%ice ,%r (6/p'"!iticc"rci%/"t%sis0 C'"r"cteristic ,i$i!s ic($e t'ic?ee$ sept"( (ies* pr%/ietretic("r p"tters* %$("r t'ic?ei! %, .r%c'%v"sc("r .$(es* p%(6!%"( (ies*"$ .e"$e$ sept"0 Hi("r %r /e$i"sti"( (6/p'"$e%p"t'6* (! /"sses* "$ (!%$(es "re "(s% c%//%(6 i$eti,ie$0

C%/p"re$ wit' s"rc%i$%sis ;" /%$e( %, .ei! iterstiti"( (! $ise"se T'is /%$"(it6'"s " 'i!' (i?e(i'%%$ %, "ssessi! t'e /"(i!"t p%teti"( i " p(/%"r6 %$(e*p"rtic("r(6 i, t'e %$(e is s%(i$ "$ ("r!er t'" 4c/ i $i"/eter0 A st"$"r$pt"?e v"(e %, !re"ter t'" @ is sesitive "$ speci,ic ,%r c"cer0=4>

Li/it"ti%s %, PET sc"i! ic($e " i".i(it6 t% $etect .r"i /et"st"ses* ,"(se9e!"tive res(ts i $i".etic p"tiets "$ i p"tiets wit' /"(i!"t (! %$(es(ess t'" 4c/ i $i"/eter ;si)e '"s %t .ee s'%w t% p("6 " r%(e i t'e $etecti%%, /e$i"sti"( (6/p' %$e /et"st"ses


11/21

H%wever* t'ese ewer i/"!i! /%$"(ities p("6 " icre"si!(6 i/p%rt"t r%(e ic(iic"( $ecisi%9/"?i! "(!%rit'/s* rese"rc'* "$ $r! $eve(%p/et0=45* 4* 4>

!ccuracy

I " st$6 %, 4@2 p"tiets wit' 'ep"t%ce((("r c"rci%/"* Lee et "( ,%$ t'"tFDG942 PET "$ CT sc"i! t%!et'er were e7tre/e(6 se,( i $etecti! (!/et"st"ses ("r!er t'" 4c/* "s we(( "s .%e /et"st"ses0 PET sc"i! '"$ "30@B $etecti% r"te ,%r sec%$"r6 p(/%"r6 %$(es %, 4c/ %r !re"ter* .t%(6 " 31B $etecti% r"te ,%r (! /et"st"ses %, (ess t'" 4c/0 =4>

T'e ivesti!"t%rs "(s% ,%$ t'"t c'est CT sc"i! w"s si!i,ic"t(6 /%re"ccr"te t'" PET sc"i! i $etecti! (! /et"st"ses "$ t'"t PET sc"i!w"s si!i,ic"t(6 /%re "ccr"te t'" .%e sc"i! i $etecti! .%e/et"st"ses0

8'%(e9%$6 PET Sc"i! ;Oc%(%!ic PET9CT Sc"

8it' ,si% s%,tw"re* t'e CT "$ PET sc"s /"6 .e %.t"ie$ % $i,,eret $"tes+'%wever* t'is icre"ses t'e "rti,"ct* .ec"se t'ere is $i,,eret p%siti%i!*respir"ti%* "$ %t'er /%ve/et .etwee sc"s0 T'e ,si% s%,tw"re c" "(s% .ese$ wit' #RI0

8it' vis"((6 c%rre("te$ PET9CT sc"i!* t'e r"$i%(%!ist vis"((6 "$ /""((6c%/p"res CT "$ PET sc"s si$e .6 si$e0 T'e e7"/i"ti%s c" .e per,%r/e$% $i,,eret $"tes %r "t $i,,eret ,"ci(ities+ '%wever* t'is /%$"(it6 '"s .ee s'%wi sever"( st$ies t% .e ,"r (ess "ccr"te0=4* 31>

#alse positives$negatives

http://emedicine.medscape.com/article/279960-overviewhttp://emedicine.medscape.com/article/279960-overview


12/21

8it' "6 PET9CT sc" /%$"(it6* t'e c(iic"( st"!e %,te $i,,ers ,r%/ t'ep"t'%(%!ic st"!e* /e"i! t'"t si!i,ic"t ,"(se p%sitives "$ e!"tives re/"i0T'e v"(e %, PET9CT sc"s is t'"t t'e6 'e(p t% $irect t'e sr!e% t%w"r$ t"r!ets,%r .i%psies t% r(e %t %$"( %r s6ste/ic $ise"se0 A(( sspici%s "re"s s'%($ .e.i%psie$* .t t'e pr"ctice %, si! " p%sitive PET %r PET9CT sc" "s $e,iitive

evi$ece %, c"cer is ".s%(te(6 wr%!0

Staging

PET9CT sc"i! '"s e'"ce$ t'e ".i(it6 t% sp"ti"((6 i$eti,6 strctres t'"tc%($ /%re "ccr"te(6 ev"("te t'e st"!e* "s we(( "s t'e i$ivi$"( T* N* "$ #st"ts* i p"tiets wit' NSCLC0=4@* 34>

O(6 FDG942 is crret(6 se$ i PET9CT sc"s* .t ew r"$i%p'"r/"cetic"(s"$ t'e pr%spects ,%r $eve(%pi! %t'er ew r"$i%tr"cers ,%r i/"!i! see/ t% .epr%/isi!0=33> As .e,%re* "6 ew r"$i%tr"cer /st .e c"re,((6 "ssesse$ t%

$eter/ie its "ccr"c6 "t e"c' %$"( st"ti% "$ "t e"c' /et"st"sis site0I " retr%spective st$6 %, 1 p"tiets wit' (! (esi%s sspici%s ,%r c"cer*ite!r"te$ CT9PET sc"i! c%rrect(6 pre$icte$ T st"ts i 2B %, p"tiets* Nst"ts i 21B %, p"tiets* # st"ts i 2B %, p"tiets* "$ TN# st"ts i 1B %,p"tiets0

I c%/p"ris%* c%rrect pre$icti% r"tes wit' CT sc"i! "(%e were (%wer*re"c'i! 2B* B* 22B* "$ 5B* respective(60 8it' PET sc"i! "(%e* t'ec%rrect pre$icti% r"tes were 5B* 1B* B* "$ @1B* respective(6* "$ wit'CT9 "$ PET9sc" vis"( c%rre("ti%* t'e c%rrect pre$icti% r"tes were 3B* 2B*B* "$ 5B* respective(60

I//%'ist%c'e/istr6 "$ Gee E7pressi%%mmunohistochemistry

T'e c%/.i"ti% %, " stepwise "ppr%"c'* wit' iiti"( c(iic"( "$ r"$i%(%!icev"("ti% "$ " .i%ps6 pr%ce$re* ,%((%we$ .6 'ist%(%!ic ev"("ti% wit'e7tesive i//%'ist%c'e/istr6* /"6 6ie($ " ,i"( c("ssi,6i! $i"!%sis i p t%1B %, p"tiets w'% '"ve %t .ee %t'erwise $i"!%se$0=>

&ene expression

I t'e re/"ii! p"tiets w'% '"ve %t .ee %t'erwise $i"!%se$* ,rt'erc("ssi,ic"ti% ."se$ % !ee e7pressi% /"6 .e e7pecte$ t% pr%vi$e "$$iti%"(c("ssi,6i! i,%r/"ti%0=3@* 35* 3>

T'e %t'er "ppr%"c' w%($ .e " r"t'er si/(t"e%s /et'%$ i w'ic' t'e !eee7pressi% pr%,i(e is $eter/ie$ p ,r%t0 C%/p(ete rep("ce/et %, 'ist%(%!ic "$i//%'ist%c'e/ic"( ev"("ti% .6 t'ese /et'%$s '"s .ee s!!este$0 %t'str"te!ies /"6 '"ve pr%s "$ c%s i ter/s %, "ccr"c6* ti/e ,r"/es* "$ c%sts0T'ese $i,,eret "spects "re crret(6 .ei! ivesti!"te$ i " $i"!%stic tri"( .6 "c%((".%r"tive !r%p wit'i t'e Er%pe" Or!"i)"ti% ,%r Rese"rc' "$Tre"t/et ,%r C"cer ;EORTC CU11@CR


13/21

#e$i"sti%sc%p6 is t'e criteri% st"$"r$ ,%r t'e $i"!%sis %, /e$i"sti"( (6/p'%$e /et"st"tic $ise"se0 Rep%rte$ speci,icit6 %, t'e pr%ce$re is "s 'i!' "s411B* wit' " sesitivit6 %, "ppr%7i/"te(6 1B0

Cervic"( /e$i"sti%sc%p6 .6 t'e C"r(es /et'%$ is se$ ,%r t'e $i"!%sis %,

ri!'t9si$e$ p"r"tr"c'e"(* prec"ri"(* "$ s.c"ri"( (6/p'"$e%p"t'60 Le,t9si$e$p"r"ster"( /e$i"sti%sc%p6 is se$ ,%r t'e $i"!%sis %, "teri%r /e$i"sti"( "$"%rt%p(/%"r6 wi$%w (6/p' %$e /et"st"ses0

#e$i"sti%sc%p6 is " %tp"tiet pr%ce$re wit' " rep%rte$ c%/p(ic"ti% r"te %,3B "$ " pr%ce$re9re("te$ /%rt"(it6 r"te %, 103B0

Aspir"ti% "$ i%ps6Transthoracic needle aspiration iopsy

Tr"st'%r"cic ee$(e "spir"ti% .i%ps6 ;TNA< re/"is t'e iiti"( pr%ce$re ,%r

t'e $i"!%sis %, p(/%"r6 %$(es0 A 4 /et"9""(6sis %, 52 st$ies rep%rte$ " p%%(e$ sesitivit6 ,%r /"(i!"t(esi%s %, 204B ;r"!e* 2@0292205B


14/21

t'e (%wer (%.e ."si("r se!/ets %r i t'e "pic"( se!/ets %, t'e pper (%.es*6ie($ is 2B* c%/p"re$ wit' 2@B ,%r %t'er (%c"ti%s* "$ ,%r (esi%s wit' s'"rp.%r$ers* t'e 6ie($ is 5B* c%/p"re$ wit' 2@B ,%r (esi%s wit' ,))6 .%r$ers0 O(6%e %, t'e s"/p(i! /et'%$s w"s p%sitive i 35B %, .r%c'%sc%pies0

T'e %ver"(( 6ie($ %, iv"sive .r%c'%sc%pic speci/es ,%r $i"!%sis %, perip'er"((esi%s is 3B ,%r .rs'* B ,%r tr"s.r%c'i"( .i%ps6* "$ 4B ,%rtr"s.r%c'i"( ee$(e "spir"ti%0

TNA "$ PET sc"i!C%/.ii! tr"s.r%c'i"( ee$(e "spir"ti% ;TNA< "$ PET sc"i! '"s .ees'%w t% %.vi"te t'e ee$ ,%r /e$i"sti%sc%p6 ,%r /e$i"sti"( st"!i! %, %9s/"(( ce(( (! c"cer wit' /e$i"sti"( (6/p'"$e%p"t'6 i /%st p"tiets0

I " retr%spective st$6 %, p"tiets wit' e("r!e$ /e$i"sti"( (6/p' %$es* t'ec%/.i"ti% %, TNA "$ PET sc"i! $e/%str"te$ 'i!'er sesitivit6*e!"tive pre$ictive v"(e* "$ "ccr"c6 t'" $i$ eit'er /%$"(it6 "(%e0

T'e st$6 se$ 'ist%p"t'%(%!6 .6 sr!ic"( (6/p' %$e $issecti% "s t'e criteri%st"$"r$ "$ ,%$ t'"t t'e c%/.ie$ TNA "$ PET sc" '"$ 411B sesitivit6*5B speci,icit6* B p%sitive pre$ictive v"(e* 411B e!"tive pre$ictive v"(e*"$ B "ccr"c6 i t'e $etecti% %, /"(i!"t (6/p' %$es0 F%r PET "(%e*t'ese r"tes were 2B* 2B* 5B* B* "$ 2B* respective(6+ ,%r TNA "(%e*t'ese r"tes were 5B* 411B* 411B* 4B* "$ 3B* respective(60

'avigation ronchoscopy (ith iopsy

T'is ses tec'%(%!6 t'"t "((%ws t'e %per"t%r t% "ppr%"c' " perip'er"( (! /"sssi! e(ectr%/"!etic "vi!"ti% ."se$ % virt"( .r%c'%sc%p6 "$ re"(9ti/e @9D CT i/"!es0 T'e tec'%(%!6 '"s .ee s'%w t% .e c"p".(e %, re"c'i!perip'er"( (! /"sses .e6%$ t'e re"c' %, t'e st"$"r$ .r%c'%sc%pe i ""i/"( /%$e(0=3>

"ndoronchial ultrasonography (ith iopsy

E$%.r%c'i"( (tr"s%%!r"p'6 ;EUS< '"s .ee wi$e(6 "$%pte$ .6p(/%%(%!ists "$ t'%r"cic sr!e%s "$ is p%ise$ t% rep("ce /e$i"sti%sc%p6i t'e ,tre0 F%r t'%r"cic sr!e%s* t'e tec'ie c" .e e"si(6 (e"re$* "$ it/"6 .e i/p%rt"t t% $% s% t% /"it"i its tr"$iti%"( "$ i/p%rt"t r%(e i t'e$i"!%sis "$ st"!i! %, t'%r"cic /"(i!"cies0

EUS '"s .ee "ss%ci"te$ wit' " (%w r"te %, seri%s "$verse e,,ects ;J 4B


15/21

(6/p' %$es "ccessi.(e ,r%/ t'e es%p'"!s0 It "ppe"rs t% .e c%/p(i/et"r6 t%EUS0

)ideo-assisted thorascopic surgery (ith iopsy

i$e%9"ssiste$ t'%r"c%sc%pic sr!er6 ;ATS< wit' (! .i%ps6 is " ip"tietpr%ce$re wit' " 'i!' $i"!%stic 6ie($ "$ " (%w c%/p(ic"ti% r"te0 It c" "(s% .ese$ ,%r cr"tive resecti%

I$ic"ti%s ,%r Sr!er6Sr!ic"( tre"t/et %, sec%$"r6 (! t/%rs s'%($ .e c%si$ere$ ,%r "p(/%"r6 /et"st"sis %, pri/"r6 (! c"cer "$* i,reet(6* ,%r /et"st"ses %,%t'er t6pes %, pri/"r6 c"cer0

Sr!ic"( resecti% %, " (! /et"st"sis s'%($ %t .e per,%r/e$ (ess* "si$ic"te$ .6 pre$ictive p%st%per"tive p(/%"r6 ,cti% testi! %r

c"r$i%p(/%"r6 e7ercise testi!* t'e pr%ce$re '"s " si!i,ic"t (i?e(i'%%$ %,.ei! cr"tive "$ %t $is".(i!0

A /et"st"tic %$(e i t'e s"/e (%.e "s " pri/"r6 (! t/%r w"s previ%s(6c%si$ere$ " T5 t/%r* "s $esi!"te$ i t'e 4 TN# c("ssi,ic"ti% sc'e/e0Crret(6* '%wever* "cc%r$i! t% t'e Iter"ti%"( Ass%ci"ti% ,%r t'e St$6 %,L! C"cer* revise$ t' e$iti% TN# st"!i! s6ste/* it is c%si$ere$ " T@(esi%0

Acc%r$i! t% t'e %($ c("ssi,ic"ti%* t'e presece %, 3 /"(i!"t %$(es %, t'es"/e 'ist%(%!ic t6pe i 3 $i,,eret (%.es % t'e ipsi("ter"( si$e %, t'e (!

i$ic"te$ /et"st"tic $ise"se %r st"!e I (! c"cer0 Acc%r$i! t% t'e revise$st"!i! s6ste/* '%wever* t'is is i$ic"tive %, p%teti"((6 resect".(e T5 (esi%s0 =32>

I .%t' c"ses* sr!ic"( /""!e/et t'"t is /%re "!!ressive t'" %t'erwiserec%//e$e$ ,%r t'e s"/e st"!e %, t'e $ise"se '"s .ee "$v%c"te$0 Ever6e,,%rt s'%($ .e /"$e t% $%c/et t'e $i"!%sis %, .%t' i$ivi$"( %$(es i,(%c"te$ i $i,,eret (! (%.es* .ec"se t'e "ppr%"c' is /%re "!!ressive i, 3sep"r"te* s6c'r%%s (! c"cers "re $%c/ete$0 ;S6c'r%%s (!c"cers "re st"!e$ sep"r"te(6* .t t'e %ver"(( pr%!%sis is p%%rer t'" ,%r "si!(e (! c"cer %, " si/i("r st"!e0< T'is .ec%/es p"rtic("r(6 i/p%rt"t i, %,t'e (esi%s pr%ves .ei!0

Primary cancers

Sr!ic"( pr%ce$res %, c'%ice ,%r t'e tre"t/et %, pri/"r6 (! c"cer te$ t% .e(%.ect%/6 %r pe/%ect%/6* $epe$i! % t'e si)e "$ t'e (%c"ti% %, t'et/%r0 Sr!ic"( $ecisi%s "re "(s% $ict"te$ .6 t'e iv%(ve/et %, re!i%"( (6/p'%$es0 #etic(%s pre%per"tive (! ,cti% ev"("ti% wit' p(/%"r6 ,cti%testi! ;PFT


16/21

p"tiet is %t'erwise ".(e t% t%(er"te t'e reire$ (! resecti%0 F"v%r".(e%tc%/es '"ve .ee rep%rte$ i c"ses %, resecti% %, /(tip(e (! %$(es ,%rse(ect t/%rs0

Metastasectomy

T'e pr%ce$re %, c'%ice ,%r t'e tre"t/et %, sec%$"r6 (! t/%rs is/et"st"sect%/6 ;we$!e resecti% %, t'e /"(i!"t %$(e< .6 /e"s %,t'%r"c%t%/6 %r vi$e%9"ssiste$ t'%r"c%sc%pic sr!er6 ;ATS


17/21

• #ec'"ic"( re/%v"( %, t'e %.strcti% wit' ri!i$ .r%c'%sc%p6• E$%(/i"( stet p("ce/et

C'e/%t'er"p6 "$ Ot'er Tre"t/etsC'e/%t'er"p6 re/"is t'e tre"t/et %, c'%ice ,%r "$v"ce$ c"cer0 #et"st"tic

c"cers ?%w t% resp%$ ,"v%r".(6 t% c'e/%t'er"p6 ic($e H%$!?i(6/p'%/"* %9H%$!?i (6/p'%/"* !er/ ce(( t/%rs* "$ t'6r%i$ c"cer0 A ,"irresp%se t% c'e/%t'er"p6 is e7pecte$ ,%r c"rci%/"s %, t'e .re"st* pr%st"te*"$ %v"r60 I//%t'er"p6 is " "$$iti%"( %pti% ,%r t'e tre"t/et %, /et"st"tic/"(i!"t /e("%/"0

+ther therapies

Sever"( %t'er t'er"pies "re crret(6 .ei! se$ "s "(ter"tives t% sr!ic"(resecti%* ic($i! r"$i%,reec6 ".("ti%*=@4* @3> cr6%".("ti%*=@@> "$ c%veti%"(r"$i%t'er"p60 H%wever* /%st %, t'ese '"ve (i/ite$ "v"i(".i(it6 "$ /%st iv%(ve

er%((/et i " strctre$ c(iic"( tri"(0=@5* @* @* @>

T'ese tre"t/ets "re s"((6 per,%r/e$ "t e7periece$ ceters ,%r p"tiets w'%'"ve (! /"(i!"cies ;pri/"r6 (! c"cer %r p(/%"r6 /et"st"ses< "$ w'%"re %t c"$i$"tes ,%r sr!er6 wit' t'e itet t% resect0 T'ese t'er"pies /"6 "(s%.e se$ i c%cti% wit' %t'er tre"t/ets ;ie* c'e/%t'er"p6* r"$i%t'er"p6< ,%r.etter $ise"se c%tr%(0

,"!D M+," !*+T S"C+'D!,. L'& TM+,S +' M"DSC!P"

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18/21

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Pulmonary metastases

Dr Her6 ipe◉ "$ A0Pr%, Fr"? G"i(("r$◉ et "(0

Pulmonary metastases "re c%//% "$ t'e res(t %, /et"st"tic spre"$ t% t'e (!s ,r%/ " v"riet6%, t/%rs "$ c" spre"$ vi" .(%%$ %r (6/p'"tics0

T'is "rtic(e is ".%t wit' '"e/"t%!e%s p(/%"r6 /et"st"ses wit' (6/p'"!itisc"rci%/"t%sis $iscsse$ sep"r"te(60

Epidemiology

T'e epi$e/i%(%!6 wi(( /"tc' t'"t %, t'e $er(6i! /"(i!"c6 ;see .e(%w


19/21

Clinical presentation

P(/%"r6 /et"st"ses "re s"((6 "s6/pt%/"tic* wit' c%stitti%"( s6/pt%/s re("ti! t%$isse/i"te$ /et"st"tic $ise"se "$ t'%se "ttri.t".(e t% t'e pri/"r6 t/%r$%/i"ti! 0 H"e/%pt6sis "$ pe/%t'%r"7 "re s%/eti/es t'e preseti! s6/pt%/0

Pathology

T/%r ce((s re"c' t'e (!s vi" t'e p(/%"r6 circ("ti%* w'ere t'e6 (%$!e i s/"(( $ist"( vesse(s0

T'e /%st c%//% pri/"ries t% res(t i p(/%"r6 /et"st"ses ic($e 4*@:

• .re"st c"rci%/"

• c%(%rect"( c"rci%/"

• re"( ce(( c"rci%/"

• terie (ei%/6%s"rc%/"

• 'e"$ "$ ec? s"/%s ce(( c"rci%/"

A(ter"tive(6* pri/"ries w'ic' /%st ,reet(6 /et"st"sise t% (!s ;"(t'%!' i t'e/se(ves /c' (essc%//% t/%rs< ic($e 4*@:

• c'%ri%c"rci%/"

• Ewi! s"rc%/"

• /"(i!"t /e("%/"

• %ste%s"rc%/"• testic("r t/%rs

• t'6r%i$ c"rci%/"

Pri/"ries t'"t /et"st"si)e "s e$%.r%c'i"( $ep%sits c" ic($e:

• c%(%rect"( c"rci%/"

• re"( ce(( c"rci%/"

• (! c"cer

•

(6/p'%/"

Radiographic features

P(/%"r6 /et"st"ses t6pic"((6 "ppe"r "s perip'er"(* r%$e$ %$(es %, v"ri".(e si)e* sc"ttere$t'r%!'%t .%t' (!s 40 At6pic"( ,e"tres ic($e c%s%(i$"ti%* c"vit"ti%* c"(ci,ic"ti%* '"e/%rr'"!e"$ sec%$"r6 pe/%t'%r"70

Plain radiograph

P("i ,i(/s "re isesitive* "(t'%!' ,reet(6 ".(e t% /"?e t'e $i"!%sis* "s %,te p(/%"r6

/et"st"ses "re ("r!e "$ /er%s0

http://radiopaedia.org/articles/haemoptysis-1http://radiopaedia.org/articles/haemoptysis-1http://radiopaedia.org/articles/pneumothoraxhttp://radiopaedia.org/articles/breast-carcinomahttp://radiopaedia.org/articles/colorectal-carcinomahttp://radiopaedia.org/articles/renal-cell-carcinoma-1http://radiopaedia.org/articles/uterine-leiomyosarcomahttp://radiopaedia.org/articles/choriocarcinomahttp://radiopaedia.org/articles/ewing-sarcomahttp://radiopaedia.org/articles/malignant-melanomahttp://radiopaedia.org/articles/osteosarcomahttp://radiopaedia.org/articles/testicular-cancerhttp://radiopaedia.org/articles/thyroid-malignancieshttp://radiopaedia.org/articles/lymphomahttp://radiopaedia.org/articles/air-space-opacification-1http://radiopaedia.org/articles/air-space-opacification-1http://radiopaedia.org/articles/haemoptysis-1http://radiopaedia.org/articles/pneumothoraxhttp://radiopaedia.org/articles/breast-carcinomahttp://radiopaedia.org/articles/colorectal-carcinomahttp://radiopaedia.org/articles/renal-cell-carcinoma-1http://radiopaedia.org/articles/uterine-leiomyosarcomahttp://radiopaedia.org/articles/choriocarcinomahttp://radiopaedia.org/articles/ewing-sarcomahttp://radiopaedia.org/articles/malignant-melanomahttp://radiopaedia.org/articles/osteosarcomahttp://radiopaedia.org/articles/testicular-cancerhttp://radiopaedia.org/articles/thyroid-malignancieshttp://radiopaedia.org/articles/lymphomahttp://radiopaedia.org/articles/air-space-opacification-1


20/21

CT

CT is e7ce((et "t vis"(isi! p(/%"r6 %$(es0 T6pic"((6 /et"st"ses "ppe"r %, s%,t tisse"tte"ti%* we(( circ/scri.e$ r%$e$ (esi%s* /%re %,te i t'e perip'er6 %, t'e (!0 T'e6 "res"((6 %, v"ri".(e si)e* " ,e"tre w'ic' is %, s%/e se i $isti!is'i! t'e/ ,r%/ " !r"(%/" @0

A pr%/iet p(/%"r6 vesse( '"s ,reet(6 .ee %te$ 'e"$i! it% " /et"st"sis0 T'is '"s .eeter/e$ t'e ,ee$i! vesse( si! 50 It is c(e"r w'et'er t'is is " tre ,i$i! %r t'e res(t %, %($ersc"ers wit' t'ic?er s(ices res(ti! i v%(/e "ver"!i! 50 H%wever* " /.er %, "t6pic"( ,e"tres"re c%//%(6 ec%tere$0

S%/e t/%rs '"ve " pre$i(ecti% ,%r i/er".(e s/"(( /et"st"ses ;/i(i"r6 p"tter


21/21

Treatment and prognosis

I !eer"( presece %, p(/%"r6 /et"st"ses is " %/i%s ,i$i!* i$ic"ti! p%%r pr%!%sis0 T'especi,ic pr%!%sis wi(( '%wever $epe$ % t'e pri/"r6 t/%r0

Complications

T/%rs wit' pr%/iet ecr%sis (%c"te$ e"r " p(er"( sr,"ce /"6 res(t i "pe/%t'%r"70 Oste%s"rc%/" is c("ssic"((6 $escri.e$ "s t'e p(/%"r6 /et"st"sis t'"t res(ts ipe/%t'%r"70 A%t'er c"se %, pe/%t'%r"ces ic($e c6stic %r c"vit"t%r6 p(/%"r6 /et"st"ses0

Dierential diagnosis

T'e $i,,ereti"( $epe$s % t'e /.er %, %$(es/"sses "$ t'eir i/"!i! c'"r"cteristics0

• $i,,ereti"( %, /(tip(e p(/%"r6 %$(es

• $i,,ereti"( %, " si!(e p(/%"r6 %$(e

• $i,,ereti"( %, /i(i"r6 p(/%"r6 %$(es

• $i,,ereti"( %, " c"vit"ti! (! /"ss

• $i,,ereti"( %, " p(/%"r6 /"ss wit' c"(ci,ic"ti%

• $i,,ereti"( %, " p(/%"r6 /"ss wit' srr%$i! !r%$9!("ss '"(%

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References
http://radiopaedia.org/articles/osteosarcomahttp://radiopaedia.org/articles/osteosarcomahttp://radiopaedia.org/articles/osteosarcomahttp://radiopaedia.org/articles/missing?article%5Btitle%5D=differential-of-multiple-pulmonary-noduleshttp://radiopaedia.org/articles/differential-of-a-single-pulmonary-nodulehttp://radiopaedia.org/articles/miliary-opacitieshttp://radiopaedia.org/articles/pulmonary-cavityhttp://radiopaedia.org/articles/hyperdense-pulmonary-masshttp://radiopaedia.org/articles/missing?article%5Btitle%5D=differential-of-a-pulmonary-mass-with-surrounding-ground-glass-halohttp://radiopaedia.org/articles/lung-cancer-3http://radiopaedia.org/articles/non-small-cell-lung-cancerhttp://radiopaedia.org/articles/pulmonary-metastaseshttp://radiopaedia.org/articles/pulmonary-neuroendocrine-tumourshttp://radiopaedia.org/articles/pulmonary-metastaseshttp://radiopaedia.org/articles/preinvasive-lesions-of-the-lunghttp://radiopaedia.org/articles/pulmonary-metastaseshttp://radiopaedia.org/articles/pulmonary-metastaseshttp://radiopaedia.org/articles/cannonball-metastases-1http://radiopaedia.org/articles/cavitating-pulmonary-metastaseshttp://radiopaedia.org/articles/cystic-pulmonary-metastaseshttp://radiopaedia.org/articles/lung-cancer-screeninghttp://radiopaedia.org/articles/pulmonary-metastaseshttp://radiopaedia.org/articles/pulmonary-metastaseshttp://radiopaedia.org/articles/osteosarcomahttp://radiopaedia.org/articles/missing?article%5Btitle%5D=differential-of-multiple-pulmonary-noduleshttp://radiopaedia.org/articles/differential-of-a-single-pulmonary-nodulehttp://radiopaedia.org/articles/miliary-opacitieshttp://radiopaedia.org/articles/pulmonary-cavityhttp://radiopaedia.org/articles/hyperdense-pulmonary-masshttp://radiopaedia.org/articles/missing?article%5Btitle%5D=differential-of-a-pulmonary-mass-with-surrounding-ground-glass-halohttp://radiopaedia.org/articles/lung-cancer-3http://radiopaedia.org/articles/non-small-cell-lung-cancerhttp://radiopaedia.org/articles/pulmonary-metastaseshttp://radiopaedia.org/articles/pulmonary-neuroendocrine-tumourshttp://radiopaedia.org/articles/pulmonary-metastaseshttp://radiopaedia.org/articles/preinvasive-lesions-of-the-lunghttp://radiopaedia.org/articles/pulmonary-metastaseshttp://radiopaedia.org/articles/pulmonary-metastaseshttp://radiopaedia.org/articles/cannonball-metastases-1http://radiopaedia.org/articles/cavitating-pulmonary-metastaseshttp://radiopaedia.org/articles/cystic-pulmonary-metastaseshttp://radiopaedia.org/articles/lung-cancer-screeninghttp://radiopaedia.org/articles/pulmonary-metastaseshttp://radiopaedia.org/articles/pulmonary-metastases

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