title: Indeterminate pulmonary nodules in rectal cancer: a recommendation for follow-up guidelines.
abstract: BACKGROUND
  Incidental visualization of indeterminate pulmonary nodules is considered a clinical dilemma.
  
  
  METHODS
  We identified patients for inclusion in this study by searching for the term "indeterminate nodules" in the radiology database of rectal cancer patients who underwent surgery. Patients with definite metastatic disease were excluded.
  
  
  RESULTS
  In total, 224 patients underwent chest computerized tomography (CT) and 59 of these patients had indeterminate pulmonary nodules detected more than twice by CT scan. Six patients (10.2%) were confirmed to have metastatic lesions on follow-up evaluation. Pulmonary nodule size (P=0.028), pathologic N status (P=0.049), positive nodal status (P=0.036) and the number of positive lymph nodes (P=0.033) were significant risk factors for pulmonary metastasis. In the pulmonary metastasis group, the patients who had received adjuvant oxaliplatin-based (FOLFOX4) chemotherapy had longer intervals to developing metastasis compared to patients who had not received it.
  
  
  CONCLUSIONS
  It is not necessary to perform excessive surveillance routinely for all rectal cancer patients who have indeterminate pulmonary lesions. Intensive follow-up chest CT or other invasive diagnostic modalities should be considered only in patients with pulmonary nodules larger than 5.7 mm or positive nodal status. In addition, patients receiving adjuvant FOLFOX4 chemotherapy should be followed-up for longer periods.
authors.affiliation: Department of Surgery, Korea University College of Medicine, Seoul, Korea.
authors.forename: Se-Jin
authors.initials: SJ
authors.lastname: Baek
authors.forename: Seon-Hahn
authors.initials: SH
authors.lastname: Kim
authors.forename: Jung-Myun
authors.initials: JM
authors.lastname: Kwak
authors.forename: Jae-Sung
authors.initials: JS
authors.lastname: Cho
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Shin
authors.forename: Azali Hafiz Yafee
authors.initials: AH
authors.lastname: Amar
authors.forename: Jin
authors.initials: J
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D013902:Radiography, Thoracic; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed