Pulmonary staging in colorectal cancer – is computerised tomography the answer?

Abstract

Thoracic CT appears to improve the accuracy of pulmonary staging in CRC allowing a more appropriate level of intervention. However, CT is likely to identify more benign radiological abnormalities than CXR alone, and investigations should not occur to the detriment of treating the primary tumour.

Significance of pulmonary nodules in patients with colorectal cancer

“…We agree with previous authors that finding indeterminate PNs should not prompt any modification of the treatment plan for primary colorectal cancer [14,17,30,33], but the diagnostic issue becomes particularly important in the patients concerned, because the treatment options that include surgery and chemotherapy, or some combination of them, improve for metastatic disease [34][35][36].…”

“…CXR detected a size increase during the follow-up in 6 (31.5 %) of 19 patients whose PNs were seen to grow on chest CT. This proportion is comparable to the 2/6 and 4/7 patients with visible pulmonary metastases on CXR in another two studies comparing CXR with chest CT findings [17,30]. Given its poor performance, routine CXR becomes pointless in the follow-up of colorectal cancer patients.…”

“…The available studies concentrated on specific concerns, such as the utility of lower chest CT images [9], the significance of PNs in primary rectal cancer revealing positive local lymph nodes at histopathology [14], or the clinical relevance of PNs in patients undergoing resection surgery for colorectal cancer liver metastases [15]. Although CT is considered the most appropriate technique for detecting pulmonary metastases [16][17][18], an internationally shared consensus on the optimal imaging follow-up for colorectal cancer patients has yet to take shape. Practice guidelines on colorectal cancer surveillance after surgery recommend periodic chest CT [19][20][21].…”

Oncological treatment and outcome of colorectal cancer in Greenland

“…Only 29% in Greenland vs. 92% in Denmark (2012) received a full CT scan of chest and abdomen [19]. This might be partly due to changing national guidelines during 2004–2012, featuring a transition from chest X-ray and abdominal US to chest and abdominal CT. Today it is well known that CT is more sensitive than abdominal US and chest X-ray in detection of hepatic and pulmonary CRC metastasis [21,22]. Another important difference during primary staging was lymph node harvest.…”

Staging chest radiography is not useful in patients with colorectal cancer

“…20] The use of multi-detector CT does not significantly improve the detection rates of extra-hepatic metastases. [21] The PET/CT has shown to be very accurate for the detection of metastases. [22] Compared to CT, PET/CT is superior in the detection of extra-hepatic metastases.…”