• Mustafa Suker, Bas Groot Koerkamp, Joost J Nuyttens, Roy S Dwarkasing, Marjolein Y V Homs, Ferry A L M Eskens, and van Eijck Casper H J CHJ Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands..
• Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
• J Surg Oncol. 2020 Sep 1; 122 (3): 450-456.

ObjectiveTo evaluate the incidence of pulmonary metastases on chest computed tomography (CT) in patients with locally advanced pancreatic cancer (LAPC).MethodsAll patients diagnosed with LAPC in a single tertiary center (Erasmus MC) between October 2011 and December 2017 were reviewed. The staging chest CT scan and follow-up chest CT scans were evaluated. Pulmonary nodules were divided into three categories: apparent benign, too small to characterize, and apparent malignant.ResultsIn 124 consecutive patients diagnosed with LAPC, 119 (96%) patients underwent a staging chest CT scan at the initial presentation. In 88 (74%) patients no pulmonary nodules were found; in 16 (13%) patients an apparent benign pulmonary nodule was found, and in 15 (13%) patients a pulmonary nodule too small to characterize was found. Follow-up chest CT scan(s) were performed in 111 (93%) patients. In one patient with either no pulmonary nodule or an apparent benign pulmonary nodule at initial staging, an apparent malignant pulmonary nodule was found on a follow-up chest CT scan. However, a biopsy of the nodule was inconclusive. Of 15 patients in whom a pulmonary nodule too small to characterize was found at staging, 12 (80%) patients underwent a follow-up CT scan; in 4 (33%) of these patients, an apparent malignant pulmonary nodule was found.ConclusionIn patients with LAPC in whom at diagnosis a chest CT scan revealed either no pulmonary nodules or apparent benign pulmonary nodules, routine follow-up chest CT scans is not recommended. Patients with pulmonary nodules too small to characterize are at risk to develop apparent malignant pulmonary nodules during follow-up.© 2020 The Authors. Journal of Surgical Oncology published by Wiley Periodicals LLC.

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