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

Yongue, Gabriella; Hotouras, Alexander; Murphy, Jamie; Mukhtar, Hasan; Bhan, Chetan; Chan, Christopher L.

doi:10.1097/meg.0000000000000315

Cited by 7 publications

(7 citation statements)

References 23 publications

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“…Most guidelines agree that the chest should be imaged for staging of CRC, but there is disagreement about the exact type of imaging modality (11). The National Comprehensive Cancer Network has recommended CT rather than plain film radiographic imaging of the chest (12).…”

Section: Discussionmentioning

confidence: 99%

“…The National Comprehensive Cancer Network has recommended CT rather than plain film radiographic imaging of the chest (12). The main reason for the use of CT for staging is early diagnosis of pulmonary metastases with high sensitivity of 51% to 73% and specificities of up to 74%, which increases the rate of resection of pulmonary metastasis (4,11). CCT is competent for identifying nodules of 2 -3 mm, whereas CXR identifies lesions 5-10 mm in size (13).…”

Section: Discussionmentioning

confidence: 99%

“…An indeterminate nodule is defined as a nodule that shows no calcification and was less than 5 mm in size when a prior CCT is not available (10). A suspicious nodule is defined as having a smooth margin, monogonal shape and diffuse scattered distribution (11) (Figure 1).…”

Section: Classification Of Lesionsmentioning

confidence: 99%

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Diagnostic Efficacy of CXR Compared to Chest CT in Preoperative Staging of Patients with Colorectal Cancer

2019

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Background: The high prevalence of colorectal cancer (CRC) and its increasing incidence can be a major problem in cancer management. Preoperative staging plays a significant role in the therapeutic process, especially in CRC which has high risk for lung metastases. Objectives: This study aimed to evaluate accuracy of chest X-ray (CXR) in comparison with chest CT (CCT) for diagnosing lung metastases in patients with CRC. Patients and Methods: A cross sectional study was conducted of 377 patients with newly diagnosed CRC which were evaluated with CXR and CCT. Results: CCT revealed normal/benign findings in 285 (75.6%), indeterminate nodules in 28 (17%) and suspicious nodules in 64 (17%) patients. Although CXR did not reveal any pulmonary metastatic lesions in of the 23 (7%) patients, the measure of agreement between CXR and CCT was good (0.64, P < 0.01) and CCT changed TNM staging in only eight (2%) patients. On logistic regression analysis, liver metastasis could increase the risk of pulmonary metastasis (P < 0.01). Conclusion: The study suggested CCT for preoperative staging in CRC patients, especially at stages 3 and 4 in TNM staging and for liver metastases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Diagnostic Efficacy of CXR Compared to Chest CT in Preoperative Staging of Patients with Colorectal Cancer

2019

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“…While ESMO guidelines suggest a CT scan of the abdomen and pelvis, without chest imaging, NCCN recommends contrast enhanced imaging of the chest [32,33]. In patients without hepatic metastasis, the rate of isolated pulmonary metastasis is extremely low at 1.4-6.3%, suggesting a relatively low yield for chest imaging [34][35][36]. A meta-analysis of 5873 patients demonstrated that although 9% of patients will be found to have an indeterminate nodule on chest imaging, only 10.8% of these will turn out to be metastatic colorectal metastasis, once again indicating a relatively low yield in the face of extensive work up that will be undertaken by many patients to evaluate indeterminate findings [37].…”

Section: Historical Overviewmentioning

confidence: 99%

Optimizing Adjuvant Therapy and Survivorship Care of Stage III Colon Cancer

Loree

Cheung

2016

Future Oncol.

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The MOSAIC trial demonstrated nearly a decade ago that the addition of oxaliplatin to 5-fluorouracil improves outcomes in the adjuvant treatment of colon cancer, but no new agents have been shown to be superior to standard FOLFOX therapy. Oncologists have refined the use of oxaliplatin containing regimens to optimize outcomes, improved patient selection for multi-agent chemotherapy and expanded survivorship care to meet the needs of the growing number of survivors. In this article, we review the historical contexts of current therapy, appropriate staging investigations, the importance of timely initiation of therapy and key survivorship issues. We also discuss exciting opportunities for change, including reduced duration of adjuvant chemotherapy and the use of circulating tumor cells and DNA in surveillance.

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“…The benefit of staging chest CT can be measured in terms of diagnostic yield (DY) and false-referral rate (FRR), which indicate the proportions of patients with true-positive metastases and false-positive metastases, respectively (8,9). There have been studies that reported DY or FRR of staging contrastenhanced chest CT, but all those studies stratified their patients by pathologic stage, which is frequently unavailable at the time of initial diagnosis and treatment planning (10,11). We hypothesized that the value of staging contrast-enhanced chest CT in patients with colon cancer may differ across clinical stage determined from contrast-enhanced abdominal CT. Our study aimed to measure DY and FRR of staging contrast-enhanced chest CT based on the clinical stage from contrast-enhanced abdominal CT in patients with colon cancer.…”

mentioning

confidence: 99%

Diagnostic Yield and False-Referral Rate of Staging Chest CT in Patients with Colon Cancer

Lee¹,

Park²,

Kim³

et al. 2018

Radiology

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Purpose To measure the diagnostic yield and false-referral rate (FRR) of staging contrast material-enhanced chest CT based on the clinical stage from contrast-enhanced abdominal CT in patients with colon cancer. Materials and Methods This retrospective study included 1743 patients (mean age, 63.4 years; range, 18-96 years) with a diagnosis of colon cancer. The primary outcomes were diagnostic yield and FRR of contrast-enhanced chest CT in the detection of thoracic metastasis. The proportions of patients with occult thoracic metastasis and those undergoing pulmonary metastasectomy for true-positive metastases were key secondary outcomes. The outcomes were stratified according to clinical stage at contrast-enhanced abdominal CT. Results The diagnostic yields in clinical stage 0/I, cII, cIII, and cIV were 0% (95% confidence interval [CI]: 0%, 0.8%), 1.3% (95% CI: 0.4%, 3.3%), 4.4% (95% CI: 3.0%, 6.1%), and 43.3% (95% CI: 36.8%, 49.9%), respectively. The corresponding FRRs were 5.7% (95% CI: 3.8%, 8.2%), 2.9% (95% CI: 1.3%, 5.5%), 6.7% (95% CI: 5.0%, 8.8%), and 6.1% (95% CI: 3.4%, 10.0%), respectively. The proportions of patients with occult metastasis were 0% (95% CI: 0%, 0.8%), 3.3% (95% CI: 1.6%, 5.9%), 1.5% (95% CI: 0.8%, 2.7%), and 6.1% (95% CI: 3.4%, 10.0%), respectively. The proportion of patients who underwent pulmonary metastasectomy was 0% (none of 474; 95% CI: 0%, 0.8%) for clinical stage 0/I tumors. Conclusion In clinical stages 0 and I, the diagnostic yield of staging contrast-enhanced chest CT in detecting thoracic metastasis was zero. For clinical stages II, III, and IV, contrast-enhanced chest CT as a baseline examination was helpful for the detection of thoracic metastasis and allowed for the possibility of a curative metastasectomy. There was no significant association between clinical stage and false-referral rate. © RSNA, 2018 Online supplemental material is available for this article.

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

Cited by 7 publications

References 23 publications

Diagnostic Efficacy of CXR Compared to Chest CT in Preoperative Staging of Patients with Colorectal Cancer

Diagnostic Efficacy of CXR Compared to Chest CT in Preoperative Staging of Patients with Colorectal Cancer

Optimizing Adjuvant Therapy and Survivorship Care of Stage III Colon Cancer

Diagnostic Yield and False-Referral Rate of Staging Chest CT in Patients with Colon Cancer

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