{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T15:50:16Z","timestamp":1790178616905,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Kaohsiung J of Med Scie"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>It is challenging for radiologists to diagnose pulmonary metastases when they encounter only a few (<jats:italic>n<\/jats:italic>\u2009\u2264\u20095) small pulmonary nodules (&lt;\u200910\u2009mm) on staging CT in breast cancer patients. We conducted this study to assess clinical and imaging features related to metastasis for better risk stratification. Retrospective analysis of 249 pulmonary nodules present at the baseline CTs of 194 patients diagnosed with breast cancer between 2014 and 2021 was performed. The evaluated features included nodular characteristics, perifissural nodules, associated imaging findings, clinical stage, and breast cancer subtype. Nodules with interval change were determined to be metastases. A large proportion of the patients had single nodule (78.9%) presence, and most of the nodules were less than 6\u2009mm (86.3%). Among the 249 nodules, 63 (25.3%) nodules were in metastases. The independent predictors were nodule \u2265\u20096\u2009mm, mediastinal\/hilar lymphadenopathy, clinical Stages III and IV, and triple\u2010negative breast cancer subtype. Nodules (\u2265\u20096\u2009mm) were assessed as weak evidence to rule in metastasis, and the results were as follows: positive likelihood ratio (+LR), 3.74; sensitivity, 30.2%; and specificity, 91.9%. With weak evidence of small pulmonary nodules (\u2267\u20096\u2009mm) to rule in metastases, it may be appropriate to follow the recommendations of growing nodule management. By contrast, the nodular shape, margin, location, perifissural nodules, and pleural tag did not show an association with metastasis.<\/jats:p>","DOI":"10.1002\/kjm2.70014","type":"journal-article","created":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T08:14:30Z","timestamp":1743322470000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prediction of Metastasis in Small Pulmonary Oligonodules Detected in Breast Cancer Patients at Baseline <scp>CT<\/scp>"],"prefix":"10.1002","volume":"41","author":[{"given":"Huei\u2010Yi","family":"Tsai","sequence":"first","affiliation":[{"name":"Department of Medical Imaging Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Center for Big Data Research Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Graduate Institute of Clinical Medicine College of Medicine, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min\u2010Fang","family":"Chao","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzu\u2010Hsueh","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shen\u2010Liang","family":"Shih","sequence":"additional","affiliation":[{"name":"Center for Big Data Research Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Division of Breast Oncology and Surgery Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang\u2010Ming","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Breast Oncology and Surgery Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Surgery Kaohsiung Municipal Ta\u2010Tung Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Surgery Faculty and College of Medicine, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming\u2010Feng","family":"Hou","sequence":"additional","affiliation":[{"name":"Division of Breast Oncology and Surgery Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Biomedical Science and Environmental Biology College of Life Science, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming\u2010Yii","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Radiation Oncology School of Medicine, College of Medicine, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2953-2727","authenticated-orcid":false,"given":"Jui\u2010Sheng","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging Kaohsiung Medical University Hospital, Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Department of Radiology School of Medicine, College of Medicine, Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"World_Health_Organization_(WHO) \u201cBreast Cancer \u201d2021 https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/breast\u2010cancer."},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2017.4298"},{"key":"e_1_2_7_4_1","unstructured":"Network NCC Breast Cancer (Version 8. 2021) accessed October 27 2021 https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/breast.pdf."},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.12112351"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.180.1.2052672"},{"issue":"11","key":"e_1_2_7_7_1","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1007\/s11547-017-0790-2","article-title":"Prediction of Pulmonary Metastasis in Pulmonary Nodules (<\/=10\u2009Mm) Detected in Patients With Primary Extrapulmonary Malignancy at Thin\u2010Section Staging CT","volume":"122","author":"Yang Q.","year":"2017","journal-title":"La Radiologia Medica"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-016-4627-5"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1148\/ryct.2020190159"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.20.24907"},{"issue":"2","key":"e_1_2_7_11_1","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1097\/00004728-200303000-00029","article-title":"Posterior Subpleural Nodules in Patients With Underlying Malignancies: Value of Prone Computed Tomography","volume":"27","author":"Goo J. M.","year":"2003","journal-title":"Journal of Computer Assisted Tomography"},{"key":"e_1_2_7_12_1","unstructured":"Health Promotion Administration Ministry of Health And Welfare Taiwan \u201cCancer Registry Annual Report 2019 \u201d2022 https:\/\/www.hpa.gov.tw\/File\/Attach\/14913\/File_18302.pdf."},{"key":"e_1_2_7_13_1","unstructured":"Institute NC \u201cCancer Stat Facts: Female Breast Cancer Subtypes: National Cancer Institute \u201daccessed June 11 2022 https:\/\/seer.cancer.gov\/statfacts\/html\/breast\u2010subtypes.html."},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.1370"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.2147\/CMAR.S176763"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1309\/AJCPYO5FSV3UPEXS"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-020-01893-w"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiographics.21.2.g01mr17403"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/0887-2171(95)90027-6"},{"issue":"10","key":"e_1_2_7_20_1","doi-asserted-by":"crossref","first-page":"2100","DOI":"10.52768\/2766-7820\/2100","article-title":"Perifissural Pulmonary Nodules in Oncology Patients \u2013 Always Benign?","volume":"3","author":"Pompe E.","year":"2022","journal-title":"Journal of Clinical Images and Medical Case Reports"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinimag.2019.05.017"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.19.1.44"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2017161659"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9041209"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2005.051508"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.17322"},{"issue":"12","key":"e_1_2_7_27_1","doi-asserted-by":"crossref","first-page":"1958","DOI":"10.1097\/JTO.0b013e3181f2636e","article-title":"Follow\u2010Up of Small (4\u2009Mm or Less) Incidentally Detected Nodules by Computed Tomography in Oncology Patients: A Retrospective Review","volume":"5","author":"Munden R. F.","year":"2010","journal-title":"Journal of Thoracic Oncology"},{"issue":"100","key":"e_1_2_7_28_1","doi-asserted-by":"crossref","DOI":"10.1098\/rsif.2014.0640","article-title":"An Agent\u2010Based Model of Cancer Stem Cell Initiated Avascular Tumour Growth and Metastasis: The Effect of Seeding Frequency and Location","volume":"11","author":"Kerri\u2010Ann N.","year":"2014","journal-title":"Journal of the Royal Society Interface"},{"issue":"146","key":"e_1_2_7_29_1","doi-asserted-by":"crossref","first-page":"170025","DOI":"10.1183\/16000617.0025-2017","article-title":"Lung Nodules: Size Still Matters","volume":"26","author":"RL A.","year":"2017","journal-title":"European Respiratory Review"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2023.09.009"}],"container-title":["The Kaohsiung Journal of Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/kjm2.70014","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T12:15:11Z","timestamp":1750940111000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/kjm2.70014"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,27]]},"references-count":29,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1002\/kjm2.70014"],"URL":"https:\/\/doi.org\/10.1002\/kjm2.70014","archive":["Portico"],"relation":{},"ISSN":["1607-551X","2410-8650"],"issn-type":[{"value":"1607-551X","type":"print"},{"value":"2410-8650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,27]]},"assertion":[{"value":"2024-08-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70014"}}