Low Accuracy of Computed Tomography and Positron Emission Tomography to Detect Lung and Lymph Node Metastases of Colorectal Cancer

Guerrera, Francesco; Renaud, Stã©phane; Schaeffer, Mickaã«l; Nigra, Victor Auguste; Solidoro, Paolo; Santelmo, Nicola; Filosso, Pier Luigi; Falcoz, Pierre‐Emmanuel; Ruffini, Enrico; Oliaro, A; Massard, Gilbert

doi:10.1016/j.athoracsur.2017.05.002

Cited by 20 publications

(15 citation statements)

References 29 publications

(47 reference statements)

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“…In our series and in accordance with what has been reported by the International Registry, only 6.9% of patients who underwent lymphadenectomy had histologically proven lymph nodal involvement although other authors have described this figure to range between 5% and 32% . We might hypothesize that the low prevalence of nodal metastases might be due to our close follow‐up protocol and the consequent early referral of patients and to the strict preoperative work‐up to select candidates for surgical treatment.…”

Section: Commentsupporting

confidence: 90%

“…If the results will confirm a non‐inferiority of SBRT over surgery, the former might become an attractive option for this patients due to its lower invasiveness and reduced overall risks . However, it must be considered that, although the reported incidence of involved lymph nodes is not high, the CT scan has a high incidence of false‐negative and the positive predictive value of PET in detecting lymph node involvement is low, thus rendering histological confirmation necessary, even if the patient is offered a nonsurgical approach.…”

Section: Commentmentioning

confidence: 99%

“…In accordance with our practice, recent investigations showed how the number of metastases was correctly identified both by CT and PET scan in only about 60% of cases. Agreement between clinical and pathological nodal involvement is quite low for both techniques, however with a little advantage for PET scan . Therefore, given the impact of nodal involvement on the prognosis of these patients we usually prefer to reserve this investigation and delay surgical treatment only for patients with high suspicion of more advanced disease.…”

Section: Commentmentioning

confidence: 99%

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Lymphadenectomy during pulmonary metastasectomy: Impact on survival and recurrence

Londero

Morelli

Parise

et al. 2019

Journal of Surgical Oncology

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Background and Objectives: Lymphadenectomy during pulmonary metastasectomy (PM) is widely carried out. We assessed the potential benefit on patient survival and tumor recurrence of this practice. Methods: One hundred eighty‐one patients undergoing a first PM were studied. Eighty‐six patients (47.5%) underwent lymphadenectomy (L+ group) whereas 95 (52.5%) did not undergo nodal harvesting (L−group). Main outcomes were overall survival (OS) and disease‐free survival (DFS). Median follow‐up was 25 months (interquartile range [IQR], 13‐49). Results: At follow‐up 84 patients (46.4%) died, whereas 97 (53.6%) were still alive with recurrence in 78 patients (43%). There was no difference in 5‐year survival (L+ 30.0% vs L− 43.2%; P = .87) or in the 5‐year cumulative incidence of recurrence (L + 63.2% vs L−80%; P = .07) between the two groups. Multivariable analysis indicated that disease‐free interval (DFI) less than 29 months (P < .001) and lung comorbidities (P = .003) were significant predictors of death. Metastases from non‐small–cell lung cancer increased the risk of lung comorbidities by a factor of 19.8, whereas the risk of DFI less than 29 months was increased nearly 11‐fold. Competing risk regression identified multiple metastases (P = .004), head/neck primary tumor (P = .009), and age less than 67 years (P = .024) as independent risk factors for recurrence. Conclusion: Associated lymphadenectomy showed not to give any additional advantage in terms of survival and recurrence after PM.

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Section: Commentsupporting

confidence: 90%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

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Lymphadenectomy during pulmonary metastasectomy: Impact on survival and recurrence

Londero

Morelli

Parise

et al. 2019

Journal of Surgical Oncology

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“…However, new minimally invasive biopsy techniques (15,16) and high definition imaging rise doubts on unavoidability of such aggressive nodal assessment. Nevertheless, several studies reported an unexpected high occurrence of a node-positive occult disease in primary and secondary lung tumors (36)(37)(38)(39) probably due to microscopic lymph nodal involvement. Contrariwise, this happened in less than 4% of cases ACOSOG Z0030 trial (23); in this study, systematic nodal dissection showed no survival benefit of over nodal sampling (NS).…”

Section: Discussionmentioning

confidence: 99%

Risk of recurrence in stage I adenocarcinoma of the lung: a multi-institutional study on synergism between type of surgery and type of nodal staging

Guerrera¹,

Lococo²,

Evangelista³

et al. 2019

J. Thorac. Dis

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Background: In last years, an increasing interest emerges on the role of sub-lobar resection and lobespecific lymph nodal dissection in the treatment of early-stage lung cancer. The aim of our study was to define the impact on cumulative incidence of recurrence (CIR) of type of surgical resection and type of nodal staging in this subset of patients. Furthermore, we evaluated the possible synergism between the different kinds of procedure. Methods: An analysis of 969 consecutive stage I pulmonary adenocarcinoma patients, operated in six Thoracic Surgery Institutions between 2001 and 2013, was conducted. Type of surgical resection included lobectomy and sub-lobar resection; while pneumonectomy and bilobectomy were excluded from the analysis. Nodal staging procedures were classified in nodal sampling (NS), lobe-specific lymph node dissection (LS-ND) and systematic lymph node dissection (SND). Multivariable-adjusted comparisons for CIR was performed using Fine and Grey model, taking into account of death by any cause as competing event. In order to evaluate synergism between the different procedures, the test of interaction between type of surgical resection and type of nodal staging was carried out and results presented in a stratified way. Results: Eight-hundred forty-six (87%) patients were submitted to lobectomy, while 123 (13%) to sublobar resection. Four-hundred fifty-five (47%) patients received SND, 98 (10%) LS-ND and 416 (43%) NS. Two-hundred forty-seven (26%) patients developed a local/distant recurrence with a 5-year CIR of 24.2%. Multivariable-adjusted comparisons showed an independent negative effect of sub-lobar resection (HR =1.52; 95% CI: 1.07-2.17), LS-ND (HR =1.74; 95% CI: 1.16-2.6) and NS (HR =1.49; 95% CI: 1.12-1.98) on CIR. Test of interaction showed a homogeneity of results among subgroups.

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“…Knowing that the rate of unexpected lymph node metastases in renal cell cancer metastasectomy is high 23 and the accuracy to detect additional lung or lymph node metastases for chest computed tomography is low, 24 we did not perform a minimal invasive approach. By open approach we were able to palpate the lung, and the rate of detecting additional lung or lymph node metastases may be higher.…”

Section: Methodsmentioning

confidence: 99%

Long-term Outcome After Resection of Isolated Thoracic Lymph Node Metastases of Renal Cell Cancer

Sponholz

Schirren

Oguzhan

et al. 2020

The Annals of Thoracic Surgery

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Low Accuracy of Computed Tomography and Positron Emission Tomography to Detect Lung and Lymph Node Metastases of Colorectal Cancer

Abstract: Computed tomography and FDG-PET have limitations if the objective is to detect all malignant nodules and to discriminate the LNI in cases of pulmonary metastases of colorectal cancer.

Cited by 20 publications

References 29 publications

Lymphadenectomy during pulmonary metastasectomy: Impact on survival and recurrence

Lymphadenectomy during pulmonary metastasectomy: Impact on survival and recurrence

Risk of recurrence in stage I adenocarcinoma of the lung: a multi-institutional study on synergism between type of surgery and type of nodal staging

Long-term Outcome After Resection of Isolated Thoracic Lymph Node Metastases of Renal Cell Cancer

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