Diagnostic Usefulness of Routinely Performed Preoperative Chest Computed Tomography for Colorectal Cancer

Pulmonary staging in colorectal cancer: a review

“…Five nonrandomized studies (one abstract and four published manuscripts) compared either CXR and abdominal CT or abdominal CT alone with combined chest/abdominal CT for detecting pulmonary abnormalities in patients with CRC (Table 1) [10–14].…”

“…Hwang et al. [10] compared pulmonary staging using abdominal CT alone vs combined chest/abdominal CT in 150 nonconsecutive patients with CRC. The incidence of ILLs and of pulmonary metastases was higher in the chest/abdominal CT group (32% vs 12% and 11.3% vs 7.3%, respectively).…”

The diagnostic yield of preoperative staging computed tomography of the thorax in colorectal cancer patients without hepatic metastases

“…Conversely, 1/5 (20%) patients who were initially diagnosed with pulmonary metastases was later downgraded to a benign lesion on review of interval chest CT examination. CXR has a sensitivity of only 33% in comparison with 75% for CT [10,15,16], with chest CT examinations capable of reliably identifying nodules of ∼ 2-3 mm, whereas CXR can only demonstrate lesions that are 5-10 mm in size [17]. This is because none of these individuals met the criteria for metastasectomy, which include absence of extrathoracic disease (or extrathoracic disease that is resectable), pulmonary disease that is completely resectable, or adequate cardiopulmonary reserve [11][12][13].…”

Radiographic staging practices of newly diagnosed colorectal cancer vary according to medical specialty

“…3,4 However, resection of pulmonary metastases in a select group of patients may lead to improved 5-year survival rates of 40% to 50% from !5% if untreated. [5][6][7][8] Recent revisions of societal guidelines have endorsed incorporating cross-sectional chest imaging into CRC preoperative staging. Since 2008, the National Comprehensive Cancer Network (NCCN) has recommended CT rather than plain film radiographic imaging of the chest (grade 2A).…”

“…[3][4][5][6] Earlier studies reported very poor prognoses for the approximately 10% of CRC patients presenting with isolated pulmonary metastases. 3,4 However, resection of pulmonary metastases in a select group of patients may lead to improved 5-year survival rates of 40% to 50% from !5% if untreated.…”