Pulmonary nodules in extrapulmonary cancer: a clinical problem to be answered

Introduction: The objective of this study was to describe the clinical, radiological, and causal characteristics of pulmonary nodules, analyzing the association between findings in subjects with a prior diagnosis of extrapulmonary malignancies between 2018 and 2023 at an oncological center in Colombia.Method: A single-center, retrospective observational study evaluating cases identified from a thoracic surgery database, all with histopathological evaluation of the dominant nodule.Results: One hundred ninety-seven individuals (median age: 65 years, 59.9% women).The most frequent oncological histories were lower digestive tract tumors (18.5%) and breast tumors (14.8%).Overall, 72.1% of the nodules were malignant: 55.3% metastases and 16.8% de novo primary lung tumors.In the logistic regression, metastatic etiology was associated with multiple nodules (OR: 3.88), lobulated edges (OR: 9.23), and a time interval greater than 12 months from the primary tumor (OR: 2.82).Likewise, de novo primary tumor etiology was associated with female sex (OR: 3.91), subsolid nodules (OR: 6.08), lobulated edges (OR: 6.77), and spiculated edges (OR: 5.44).Agreement between diagnostic imaging and histopathological results was low (κ = 0.18), but improved after an expert review of the studies (κ = 0.48).Conclusions: In individuals with extrapulmonary malignancies, the presence of multiple nodules, lobulated edges, and intervals exceeding 12 months suggests metastatic etiology.Conversely, female sex, subsolid nodules, and lobulated or spiculated edges point toward a de novo primary lung tumor.Specialized review of images contributes to improving diagnostic accuracy.