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Annals of Surgical Oncology

, Volume 20, Issue 12, pp 4022–4030 | Cite as

Indeterminate Pulmonary Nodules at Colorectal Cancer Staging: A Systematic Review of Predictive Parameters for Malignancy

  • Andreas Nordholm-Carstensen
  • Peer A. Wille-Jørgensen
  • Lars N. Jorgensen
  • Henrik Harling
Thoracic Oncology

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Chest Computerize Tomography Lung Lesion General Study Population Positive Nodal Status International Clinical Trial Registry Platform 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

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.

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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Andreas Nordholm-Carstensen
    • 1
  • Peer A. Wille-Jørgensen
    • 1
  • Lars N. Jorgensen
    • 1
  • Henrik Harling
    • 1
  1. 1.Department of Surgery K, Bispebjerg HospitalUniversity of CopenhagenCopenhagenDenmark

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