UNASSIGNED: 9527 Background: Cure rates for metastatic @entity2828 are poor and justify the stratification of treatment protocols by the presence of @entity3 at diagnosis. Lung @entity3 ( @entity3 ) are the most common form of disseminated disease. Our goal was to assess the diagnostic performance of CT imaging of nodules at diagnosis to discriminate benign from malignant lesions. METHODS: We reviewed the CT scan of all @entity1 (pts) treated at four French centres, prospectively enrolled on the EuroEwing 99 trial between January 1999 and December 2009. RESULTS: 342 @entity1 were identified, 141 of whom had lung nodules at diagnosis, 18 with extra-pulmonary @entity3 . Among the 123 other pts, 54 were considered as having lung @entity3 without needing a biopsy (bx), 32 non-metastatic without needing a bx and 37 with doubtful lung lesions had a bx as part of the disease staging process. Of those 37 pts, three had lesions identified on plain chest x- @entity16039 and 35 had nodules only detected by CT. 16 pts had unilateral nodule(s). Bx showed lung @entity3 in 21 and benign lesions in 16. The median number of nodules detected for the bx positive group was 4 (range 1-22) and 2 for the bx negative group (range 1-12). The median size of the largest nodule was 6 mm (range 3-15) for the bx positive group and 3mm for the bx negative group (range 1.5-8). Both ROC curves showed the poor diagnostic performance of the number of nodules and the size of the largest considered separately and advocate for combining the 2 criteria. According to the practice guidelines of the protocol 47 pts had nodule characteristics that placed them in the "treat as lung @entity3 without bx." Among those, 11 had a bx, of which 9 were positive. All 7 pts with more than 2 nodules and largest nodule greater than 6 mm were metastatic, but 2 of 4 @entity1 with more than 2 nodules the largest being 6 mm were not metastatic. 20 of 42 pts classified as requiring a bx had a bx, 11 of which were positive. Of the 22 pts for whom "bx was to be discussed on a case by case basis" five had a bx, which were all negative. CONCLUSIONS: Combining nodule imaging characteristics is appropriate. All @entity1 with at least one nodule measuring between 3 and 10mm should have a lung biopsy. Nodules greater than 10mm in diameter can be considered metastatic.

The management of pulmonary nodules at diagnosis in XXXX with @entity2828 ( @entity2828 ).

@entity1 :: ('9606', 'Species') :: ['patients'] @entity2828 :: ('MESH:D012512', 'Disease') :: ['ES'] @entity16039 :: ('255564', 'Species') :: ['ray'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastases', 'mets']
@entity1 :: (9606,Species) :: ['patients']
