BACKGROUND: Chest computed tomography (CT) often is used to rule out lung metastases in patients with potentially resectable liver metastases from colorectal carcinoma. In the current study the authors evaluated whether CT of the chest was necessary in patients with a negative chest radiograph. METHODS: The authors performed a retrospective analysis of 202 patients with negative initial chest X-rays who were undergoing evaluation for potentially resectable liver metastases from colorectal carcinoma. Patients with highly suspicious pulmonary lesions on the initial chest CT scan underwent a thoracoscopy and biopsy. All patients were monitored for the development of pulmonary metastases. RESULTS: Sixty patients (30%) had a positive initial chest CT scan. Two patients were found to have metastases by comparison with prior CT scans. Seventeen patients had highly suspicious lesions that were biopsied, but only 2 were found to have pulmonary metastases; the other lesions were benign. An additional 13 of these 60 patients developed lung metastases during follow-up, 6 of whom were diagnosed in retrospect. Of the 142 patients with a negative initial CT scan, 33 (23%) developed pulmonary metastases. The rate of pulmonary metastases in both groups was not significantly different, regardless of whether the CT scans were positive or negative. CONCLUSIONS: During routine preoperative workup for liver resection, the majority of lesions appearing on chest CT scans of patients with negative chest radiographs were not malignant. The positive yield of CT-guided workup was only 10 of 202 patients (5%). Based on this review the authors question the use of chest CT scans in this setting.
BACKGROUND: Chest computed tomography (CT) often is used to rule out lung metastases in patients with potentially resectable liver metastases from colorectal carcinoma. In the current study the authors evaluated whether CT of the chest was necessary in patients with a negative chest radiograph. METHODS: The authors performed a retrospective analysis of 202 patients with negative initial chest X-rays who were undergoing evaluation for potentially resectable liver metastases from colorectal carcinoma. Patients with highly suspicious pulmonary lesions on the initial chest CT scan underwent a thoracoscopy and biopsy. All patients were monitored for the development of pulmonary metastases. RESULTS: Sixty patients (30%) had a positive initial chest CT scan. Two patients were found to have metastases by comparison with prior CT scans. Seventeen patients had highly suspicious lesions that were biopsied, but only 2 were found to have pulmonary metastases; the other lesions were benign. An additional 13 of these 60 patients developed lung metastases during follow-up, 6 of whom were diagnosed in retrospect. Of the 142 patients with a negative initial CT scan, 33 (23%) developed pulmonary metastases. The rate of pulmonary metastases in both groups was not significantly different, regardless of whether the CT scans were positive or negative. CONCLUSIONS: During routine preoperative workup for liver resection, the majority of lesions appearing on chest CT scans of patients with negative chest radiographs were not malignant. The positive yield of CT-guided workup was only 10 of 202 patients (5%). Based on this review the authors question the use of chest CT scans in this setting.
Authors: Baburao Koneru; Lewis W Teperman; Cosme Manzarbeitia; Marcelo Facciuto; Kyunghee Cho; David Reich; Patricia Sheiner; Adrian Fisher; Khristian Noto; Alec Goldenberg; Maria Korogodsky; Donna Campbell Journal: Ann Surg Date: 2005-04 Impact factor: 12.969
Authors: Eric P van der Stok; Manon C W Spaander; Dirk J Grünhagen; Cornelis Verhoef; Ernst J Kuipers Journal: Nat Rev Clin Oncol Date: 2016-12-20 Impact factor: 66.675
Authors: Giacomo Puppa; Graeme Poston; Per Jess; Guy F Nash; Kenneth Coenegrachts; Axel Stang Journal: World J Gastroenterol Date: 2013-02-28 Impact factor: 5.742
Authors: Charlotte E N M Rosenbaum; M A A J van den Bosch; W B Veldhuis; J E Huijbregts; M Koopman; M G E H Lam Journal: Eur Radiol Date: 2012-10-31 Impact factor: 5.315