Ann Surg Treat Res.  2014 Apr;86(4):212-216. 10.4174/astr.2014.86.4.212.

The availability of computed tomography for pulmonary staging in colorectal cancer

• Oh BY
• Noh GT
• Hong KS
• Chung SS
• Kim KH
• Lee RA

• KMID: 2167128
• DOI: http://doi.org/10.4174/astr.2014.86.4.212

Abstract

PURPOSE
Chest computed tomography is performed frequently for the preoperative pulmonary staging in colorectal cancers (CRCs) regardless of the result of chest x-ray (CXR) due to its high sensitivities and specificities. The advancement of CT technology detects more indeterminate lung lesions that may require further investigations, referrals and follow-up. The aim of this study was to suggest a guideline for performing chest CT for preoperative pulmonary staging in colorectal cancer.
METHODS
We performed a retrospective analysis of the records of patients who had chest CT preformed without the evidence of metastasis on CXR for preoperative pulmonary staging.
RESULTS
Of 21 patients with metastatic nodules on chest CT, 23.8% showed pulmonary metastasis on positron emission tomography, 47.6% showed extrapulmonary metastasis on preoperative evaluation and 61.9% showed elevated serum carcinoembryonic antigen level above 10 ng/mL. These results showed significant value compared to patients without metastatic nodules. But, in analyzing patients with or without indeterminate nodules in the three contents listed above, there was no significance.
CONCLUSION
In the patients with CRC who show normal CXR and exhibit positivity in PET, preoperative extrapulmonary metastasis and elevated serum CEA level above 10 ng/mL preoperatively, chest CT would be helpful in preoperative staging.

Keyword

Computed tomography; Staging; Pulmonary metastasis; Colorectal neoplasms

MeSH Terms

Carcinoembryonic Antigen
Colorectal Neoplasms*
Follow-Up Studies
Humans
Lung
Neoplasm Metastasis
Positron-Emission Tomography
Referral and Consultation
Retrospective Studies
Thorax
Tomography, X-Ray Computed
Carcinoembryonic Antigen

Figure

• 

  Fig. 1 Results of follow-up study for pulmonary nodules after surgery. a)Two patients with metastatic nodule on chest CT were performed surgical resection of metastatic pulmonary lesion; Lesions were proved as metastatic colon cancer, pathologically. CRC, colorectal cancer; CXR, chest x-ray.

Reference

1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010; 60:277–300.

2. Jung KW, Park S, Kong HJ, Won YJ, Lee JY, Park EC, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2008. Cancer Res Treat. 2011; 43:1–11.

3. McIntosh J, Sylvester PA, Virjee J, Callaway M, Thomas MG. Pulmonary staging in colorectal cancer: is computerised tomography the answer? Ann R Coll Surg Engl. 2005; 87:331–333.

4. McCormack PM, Attiyeh FF. Resected pulmonary metastases from colorectal cancer. Dis Colon Rectum. 1979; 22:553–556.

5. Davis SD. CT evaluation for pulmonary metastases in patients with extrathoracic malignancy. Radiology. 1991; 180:1–12.

6. Parnaby CN, Bailey W, Balasingam A, Beckert L, Eglinton T, Fife J, et al. Pulmonary staging in colorectal cancer: a review. Colorectal Dis. 2012; 14:660–670.

7. Murata K, Khan A, Herman PG. Pulmonary parenchymal disease: evaluation with high-resolution CT. Radiology. 1989; 170(3 Pt 1):629–635.

8. Murata K, Takahashi M, Mori M, Kawaguchi N, Furukawa A, Ohnaka Y, et al. Pulmonary metastatic nodules: CT-pathologic correlation. Radiology. 1992; 182:331–335.

9. Luketich JD, Friedman DM, Weigel TL, Meehan MA, Keenan RJ, Townsend DW, et al. Evaluation of distant metastases in esophageal cancer: 100 consecutive positron emission tomography scans. Ann Thorac Surg. 1999; 68:1133–1136.

10. Yankelevitz DF, Henschke CI. Small solitary pulmonary nodules. Radiol Clin North Am. 2000; 38:471–478.

11. Remy-Jardin M, Remy J, Giraud F, Marquette CH. Pulmonary nodules: detection with thick-section spiral CT versus conventional CT. Radiology. 1993; 187:513–520.

12. Kronawitter U, Kemeny NE, Heelan R, Fata F, Fong Y. Evaluation of chest computed tomography in the staging of patients with potentially resectable liver metastases from colorectal carcinoma. Cancer. 1999; 86:229–235.

13. Brent A, Talbot R, Coyne J, Nash G. Should indeterminate lung lesions reported on staging CT scans influence the management of patients with colorectal cancer? Colorectal Dis. 2007; 9:816–818.

14. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York: Springer;2010.

15. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer [Internet]. Canberra (AU): Australian Government National Health and Medical Research Council;c2013. cited 2012 Feb 16. Available from: http://www.nhmrc.gov.au/guidelines/publications/cp106.

16. Guidelines for the management of colorectal cancer [Internet]. London (UK): The Association of Coloproctology of Great Britain and Ireland;c2014. cited 2012 Feb 16. Available from: http://www.acpgbi.org.uk/resources/guidelines/guidelines-for-the-management-of-colorectal-cancer/.

17. NCCN clinical practice guidelines in oncology (NCCN Guidelines): Colon/rectal cancer. ver. 1. 2010 [Internet]. Fort Wathington: National Comprehensive Cancer Network;c2012. cited 2012 Feb 16. Available from: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.

18. Scottish Intercollegiate Guidelines Network. Colorectal cancer: a national clinical guideline recommended for use in Scotland. Edinburg: Scottish Intercollegiate Guidelines Network;1997.

19. Otchy D, Hyman NH, Simmang C, Anthony T, Buie WD, Cataldo P, et al. Practice parameters for colon cancer. Dis Colon Rectum. 2004; 47:1269–1284.

20. Grossmann I, Avenarius JK, Mastboom WJ, Klaase JM. Preoperative staging with chest CT in patients with colorectal carcinoma: not as a routine procedure. Ann Surg Oncol. 2010; 17:2045–2050.

21. Povoski SP, Fong Y, Sgouros SC, Kemeny NE, Downey RJ, Blumgart LH. Role of chest CT in patients with negative chest x-rays referred for hepatic colorectal metastases. Ann Surg Oncol. 1998; 5:9–15.

22. Kirke R, Rajesh A, Verma R, Bankart MJ. Rectal cancer: incidence of pulmonary metastases on thoracic CT and correlation with T staging. J Comput Assist Tomogr. 2007; 31:569–571.

23. Tan KK, Lopes Gde L Jr, Sim R. How uncommon are isolated lung metastases in colorectal cancer? A review from database of 754 patients over 4 years. J Gastrointest Surg. 2009; 13:642–648.