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Indeterminate Pulmonary Nodules in Colorectal-Cancer: Do Radiologists Agree?

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The clinical significance of indeterminate pulmonary nodules (IPN) at staging computed tomography (CT) for colorectal cancer (CRC), and the optimal diagnostic approach, are debated. This study aimed to analyse variability in radiologists’ detection of IPN at staging CT for CRC.

Methods

All patients with CRC referred to our center between 2006 and 2011 were included. Primary staging CT scans were re-evaluated by an experienced thoracic radiologist whose findings were entered into a dedicated database and merged with data from the Danish Colorectal Cancer Group database, the National Patient Registry, the Danish Pathology Registry, and the primary CT evaluation. Inter-reader agreement was calculated by Kappa statistics, and associations between variables and malignancy of pulmonary nodules were analyzed with χ 2 and Mann–Whitney–Wilcoxon tests. Multivariable logistic regression analyses were used to adjust for potential confounding variables.

Results

In total, 841 patients were included. The primary CT assessment reported IPN in 9.8 % of patients and pulmonary metastases in 5.1 % of patients compared with 5.6 and 7.0 %, respectively, reported by the experienced thoracic radiologist. Kappa for agreement between the primary assessor and the thoracic radiologist on IPN was 0.31 and 0.65 for pulmonary metastases. Synchronous liver metastases were predictive of malignancy of IPN (adjusted odds ratio 20.1; 95 % confidence interval 2.64–437.66; p = 0.012), whereas no other investigated radiological characteristics or clinicopathological factors were significantly associated with malignancy of IPN.

Conclusion

The characterization of pulmonary findings on staging CT for CRC varied greatly between the radiologists, and double-reading of scans with IPN is recommended prior to further diagnostic work-up.

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Acknowledgment

Research nurse Tina Brondum extracted data from all scan reports, and Steffen Høgskilde extracted data from the DCCG, the DPR, and the NPR. Funding was received from the Danish Cancer Society, The Gangsted Foundation, The Bispebjerg Hospital Research Foundation, The A.P. Møller Foundation, the Aase and Ejnar Danielsen Foundation, the Einar Willumsen Memorial Fund, and the Else and Mogens Wedell-Wedellsborg Foundation.

Conflict of interest

Andreas Nordholm-Carstensen, Lars N. Jorgensen, Peer A. Wille-Jørgensen, Hanne Hansen, and Henrik Harling have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, NV, Denmark

    Andreas Nordholm-Carstensen MD, Lars N. Jorgensen MD, DMSc, Peer A. Wille-Jørgensen MD, DMSc & Henrik Harling MD, DMSc

  2. Department of Radiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, NV, Denmark

    Hanne Hansen MD

Authors
  1. Andreas Nordholm-Carstensen MD
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  2. Lars N. Jorgensen MD, DMSc
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  3. Peer A. Wille-Jørgensen MD, DMSc
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  4. Hanne Hansen MD
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  5. Henrik Harling MD, DMSc
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Corresponding author

Correspondence to Andreas Nordholm-Carstensen MD.

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On behalf of the Danish Colorectal Cancer Group.

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Nordholm-Carstensen, A., Jorgensen, L.N., Wille-Jørgensen, P.A. et al. Indeterminate Pulmonary Nodules in Colorectal-Cancer: Do Radiologists Agree?. Ann Surg Oncol 22, 543–549 (2015). https://doi.org/10.1245/s10434-014-4063-1

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  • DOI: https://doi.org/10.1245/s10434-014-4063-1

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