Francesco Guerrera1, Stéphane Renaud2, Mickaël Schaeffer3, Victor Nigra4, Paolo Solidoro5, Nicola Santelmo6, Pier Luigi Filosso4, Pierre-Emmanuel Falcoz6, Enrico Ruffini4, Alberto Oliaro4, Gilbert Massard6. 1. Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy; Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France. Electronic address: fra.guerrera@gmail.com. 2. Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France; Department of Thoracic Surgery, Nancy University Hospital, Nancy, France. 3. Department of Biostatistics, Strasbourg University Hospital, Strasbourg, France. 4. Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy. 5. Unit of Pulmunology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy. 6. Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France.
Abstract
BACKGROUND: Minimally invasive surgery, stereotactic radiotherapy, and radiofrequency ablation are commonly proposed in the case of pulmonary colorectal-metastasis as alternatives to conventional open surgery. Preoperative imaging assessment by computed tomography (CT) scan and fluorodeoxyglucose positron emission tomography (FDG-PET) are critical to guide oncologic radical treatment. Our aim was to investigate the accuracy of CT and FDG-PET for the evaluation of the number of pulmonary colorectal metastases and thoracic lymph nodal involvement (LNI). METHODS: Patients who underwent lung surgical resection for pulmonary colorectal metastases from 2004 to 2014 were analyzed. Concordance between histology, CT scan, and FDG-PET findings were assessed. RESULTS: Data of 521 patients were analyzed. Of those, FDG-PET was performed in 435 (83.5%). A moderate agreement between both CT scan (kappa index: 0.42) and FDG-PET (kappa index: 0.42) findings and the histologically proven number of metastases was observed. The number of histologically proven metastases was correctly discriminated in 61.7% of cases with CT scan and in 61.8% of cases with FDG-PET. Multiple metastases were discovered in 20.9% of clinical single metastasis cases with CT scan, and in 24.4% of those cases with FDG-PET. One hundred fifty patients (29.1%) presented with pathologic LNI. A poor agreement was observed between LNI and CT scan findings (kappa index: 0.02), and a weak agreement was observed concerning LNI and FDG-PET findings (kappa index: 0.39). CONCLUSIONS: Computed tomography and FDG-PET have limitations if the objective is to detect all malignant nodules and to discriminate the LNI in cases of pulmonary metastases of colorectal cancer.
BACKGROUND: Minimally invasive surgery, stereotactic radiotherapy, and radiofrequency ablation are commonly proposed in the case of pulmonary colorectal-metastasis as alternatives to conventional open surgery. Preoperative imaging assessment by computed tomography (CT) scan and fluorodeoxyglucose positron emission tomography (FDG-PET) are critical to guide oncologic radical treatment. Our aim was to investigate the accuracy of CT and FDG-PET for the evaluation of the number of pulmonary colorectal metastases and thoracic lymph nodal involvement (LNI). METHODS:Patients who underwent lung surgical resection for pulmonary colorectal metastases from 2004 to 2014 were analyzed. Concordance between histology, CT scan, and FDG-PET findings were assessed. RESULTS: Data of 521 patients were analyzed. Of those, FDG-PET was performed in 435 (83.5%). A moderate agreement between both CT scan (kappa index: 0.42) and FDG-PET (kappa index: 0.42) findings and the histologically proven number of metastases was observed. The number of histologically proven metastases was correctly discriminated in 61.7% of cases with CT scan and in 61.8% of cases with FDG-PET. Multiple metastases were discovered in 20.9% of clinical single metastasis cases with CT scan, and in 24.4% of those cases with FDG-PET. One hundred fifty patients (29.1%) presented with pathologic LNI. A poor agreement was observed between LNI and CT scan findings (kappa index: 0.02), and a weak agreement was observed concerning LNI and FDG-PET findings (kappa index: 0.39). CONCLUSIONS: Computed tomography and FDG-PET have limitations if the objective is to detect all malignant nodules and to discriminate the LNI in cases of pulmonary metastases of colorectal cancer.
Authors: Stefan Sponholz; Selma Oguzhan; Mesut Mese; Moritz Schirren; Andreas Kirschbaum; Joachim Schirren Journal: Int J Colorectal Dis Date: 2021-03-12 Impact factor: 2.571
Authors: Francesco Londero; Angelo Morelli; Orlando Parise; William Grossi; Sara Crestale; Cecilia Tetta; Daniel M Johnson; Ugolino Livi; Jos G Maessen; Sandro Gelsomino Journal: J Surg Oncol Date: 2019-07-11 Impact factor: 3.454
Authors: Anton Uporov; Samantha Taber; Lope Estèvez Schwarz; Joern Groene; Lothar R Pilz; Gregor Foerster; Roland Bittner; Joachim Pfannschmidt Journal: Innov Surg Sci Date: 2021-12-24