Indeterminate Pulmonary Nodules at Colorectal Cancer Staging: A Systematic Review of Predictive Parameters for Malignancy
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This study aimed to estimate the prevalence of indeterminate pulmonary nodules and specific radiological and clinical characteristics that predict malignancy of these at initial staging chest computed tomography (CT) in patients with colorectal cancer. A considerable number of indeterminate pulmonary nodules, which cannot readily be classified as either benign or malignant, are detected at initial staging chest CT in colorectal cancer patients.
A systematic review based on a search in EMBASE, Medline, the Cochrane library and science citation index, PubMed databases, Google scholar, and relevant conference proceedings was performed in cooperation with the Cochrane Colorectal Cancer Group.
A total of 2,799 studies were identified, of which 12 studies met the inclusion criteria. The studies primarily consisted of case series and included a total of 5,873 patients. Of these patients, 9 % (95 % confidence interval [95 % CI] 8.9–9.2 %) had indeterminate pulmonary nodules at chest CT, of which 10.8 % (95 % CI 10.3–11.2 %) turned out to be colorectal cancer metastases at follow-up. Generally, regional lymph node metastasis, and multiple numbers of indeterminate pulmonary nodules were reported to predict malignancy, whereas calcification of the nodules indicated benign lesions.
It was found that 1 in 100 colorectal cancer patients subjected to preoperative staging chest CT will have an indeterminate pulmonary nodule that proves to be metastatic disease. Such a low risk suggests that indeterminate pulmonary nodules should not cause further preoperative diagnostic workup or follow-up besides routine regimens.
KeywordsChest Computerize Tomography Lung Lesion General Study Population Positive Nodal Status International Clinical Trial Registry Platform
The authors thank the Trials Search Coordinator of the Cochrane Colorectal Cancer Group Marija Barbateskovic for her kind assistance in conducting the literature search. The study was financially supported by grants from the Danish Cancer Society, Aase and Ejnar Danielsen’s Foundation, and The Einar Willumsen Foundation.
- 7.National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology rectal cancer. 2013. http://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf. Accessed Apr 2, 2013.
- 8.National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology colon cancer. 2013. http://www.nccn.org/professionals/physician_gls/pdf/colon.pdf. Accessed Apr 2, 2013.
- 9.The Danish Colorectal Cancer Group. Guidelines for the Management of Colorectal Cancer. 2010. http://dccg.dk/03_Publikation/Retningslinier2009revOKT2010.pdf. Accessed Feb 2, 2013. In Danish.
- 10.The Association of Coloproctology of Great Britain and Ireland. Guidelines for the Management of Colorectal Cancer. 2007. http://www.acpgbi.org.uk/wp-content/uploads/2007-CC-Management-Guidelines.pdf. Accessed Feb 8, 2013.
- 19.Cho YK, Lee WY, Park CH, et al. The role of a routine preoperative chest CT in patients with colorectal cancer. Colorectal Dis. 2009;11,suppl 2:44.Google Scholar
- 23.Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B, et al. Oxford Centre for Evidence-based Medicine―Levels of Evidence. 2009. http://www.cebm.net/index.aspx?o=1025. Accessed Jun 22, 2012.
- 24.Scottish Intercollegiate Guidelines Network. Sign 50: a guideline developer’s handbook. 2011. http://www.sign.ac.uk/pdf/sign50.pdf. Accessed June 22, 2012.
- 25.Phillips N, Bhan C, Murphy J, Behar N, Allen C, Rowe PH. T1178 indeterminate lung lesions in patients with colorectal cancer: do they progress? (Abstract) Gastroenterology. 2009;136:A-517.Google Scholar
- 27.Walter C, Pietroni O, Defirend D. The outcomes of indeterminate lung lesions reported on staging CT scans for colorectal cancer. Colorectal Dis. 2010; 12(suppl. 1):19.Google Scholar
- 35.Kim HY, Lee SJ, Lee G, Song L, Kim SA, Kim JY, et al. Should preoperative chest CT be recommended to all colon cancer patients? Ann Surg. 2013. doi: 10.1097/SLA.0b013e3182865080. [Epub ahead of print].