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The Role of Neoadjuvant Therapy in Characterizing Indeterminate Lung Lesions in Patients with Resectable Colorectal Liver Metastases

Annals of Surgical Oncology volume 22, pages 2201–2208 (2015)Cite this article

Abstract

Background

Incidental pulmonary lesions are frequently found during the preoperative evaluation of patients considered for resection of colorectal liver metastases (CRLM), and their presence can confound management decisions. This study investigates the role of clinical and radiologic factors, including response to preoperative systemic chemotherapy, in determining the malignant probability of these lesions.

Methods

Computed tomography (CT) scans of 33 patients with small (≤1 cm) lung lesions undergoing resection for CRLM after preoperative chemotherapy were reviewed. Radiological features were recorded from three sequential CT scans (baseline, postchemotherapy, and follow-up). Malignancy was diagnosed either by resection or serial imaging. Chemotherapy response comparing lung lesions and CRLM was categorized as: (1) concordant or (2) discordant. Chemotherapy response, imaging features, and other clinical factors were evaluated in multivariate analyses as predictors of malignancy.

Results

Among the 86 indeterminate lung lesions identified, 23 % (20/86) were found to be metastases on follow-up. Lesions 6–10 mm were more likely to be metastases (odds ratio [OR] = 3.14, p = 0.045), as were lesions located in the lower lobes (OR = 4.50, p = 0.018). Concordant chemotherapy response was found in 13 of 86 (15 %) and was independently associated with metastatic disease (OR = 19.87, p < 0.001), with 11 of 13 (85 %) lesions determined to be metastases. In contrast, only 9 of 73 lesions (12 %) with discordant response were found to be metastases.

Conclusions

Lesion size, location, and chemotherapy response pattern were independent predictors of malignancy for patients with resectable CRLM and small indeterminate lung lesions. Utilization of preoperative chemotherapy can be a useful method of ruling out pulmonary metastases in these patients.

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Acknowledgment

Georgios Karagkounis was supported in part by the Anne Brennan Memorial Research Fund, Baltimore, Maryland. Guoxiang Cai was partly supported by the fellowship awarded by the Chinese Society of Clinical Oncology. We appreciate the assistance on statistical analyses from Mrs. Carol B. Thompson at the Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health.

Disclosures

The authors do not have any conflict of interests to disclose.

Author information

Author notes

    Affiliations

    1. Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9031, USA

      Michael A. Choti MD

    2. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, USA

      Georgios Karagkounis MD, Guoxiang Cai MD & Timothy M. Pawlik MD, MPH, PhD

    3. Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, USA

      Pamela T. Johnson MD & Elliot K. Fishman MD

    4. Department of General Surgery, Cleveland Clinic Foundation, Cleveland, USA

      Georgios Karagkounis MD

    5. Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China

      Guoxiang Cai MD

    Authors
    1. Georgios Karagkounis MD
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    2. Guoxiang Cai MD
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    3. Pamela T. Johnson MD
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    4. Timothy M. Pawlik MD, MPH, PhD
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    Correspondence to Michael A. Choti MD.

    Additional information

    Georgios Karagkounis and Guoxiang Cai contributed equally to this manuscript.

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    Karagkounis, G., Cai, G., Johnson, P.T. et al. The Role of Neoadjuvant Therapy in Characterizing Indeterminate Lung Lesions in Patients with Resectable Colorectal Liver Metastases. Ann Surg Oncol 22, 2201–2208 (2015). https://doi.org/10.1245/s10434-014-4206-4

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    • DOI: https://doi.org/10.1245/s10434-014-4206-4

    Keywords

    • Liver Metastasis
    • Pulmonary Metastasis
    • Preoperative Chemotherapy
    • National Comprehensive Cancer Network
    • Lung Lesion