Evaluation of chest computed tomography in the staging of patients with potentially resectable liver metastases from colorectal carcinoma.
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.
Division of Solid Tumor, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
U
U
Kronawitter
N E
NE
Kemeny
R
R
Heelan
F
F
Fata
Y
Y
Fong
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed