The Frequency and Significance of Radiologically Detected Indeterminate Pulmonary Nodules in Patients with Colorectal Cancer

Abstract

Objective: To investigate the frequency and significance of pulmonary nodules in patients with colorectal cancer (CRC). Subjects and Methods: Medical records of 1,344 patients with CRC who underwent thoracic computerized tomography scans between January 2003 and December 2009 were reviewed. Those with any distant metastatic disease or who were already known to have pulmonary malignancies were excluded. Number, size, shape and location of the nodules were evaluated. A multivariate analysis was performed to determine the predictive factors for evidence of metastases. Results: Of the 1,344 patients, 55 (4.09%) had nodules that met the criteria of an indeterminate pulmonary nodule. The mean follow-up time was 25 ± 17.9 months and the mean time to develop pulmonary metastasis was 15.5 ± 6.4 months. The nodules of 17 (30.9%) patients showed progression at follow-up; 8 had metastasized. Multivariate analysis showed multiple indeterminate pulmonary nodules (p = 0.006) of parenchymal localization (p = 0.016) with an irregular border (p = 0.002), which is predictive of metastatic disease. Conclusion: Our study has shown that multiple indeterminate pulmonary nodules with an irregular border in a parenchymal location were more likely to represent metastatic disease. However, the frequency of the occurrence of indeterminate pulmonary metastases of CRC was low.

Diagnostics of intrapulmonary metastases from colorectal cancer (literature survey)

“…This fact is explained by the way of vascularization of the rectum (27). The smooth borders and sub-pleural localization are more frequently related to benignant lesions (27). Based on his study Y. Varol et al (27) come to the conclusion that undefined multiple pulmonary nodes with irregular form and border, localized in parenchyma are more probable to be a metastatic disease.…”

“…Computed tomography of the thorax -The computed tomography of the chest (CT) has become an important additional tool for the doctor, which is usually used for finding of a tumor disease, evaluation of the therapeutic response and the appearance of relapse (27). Performing a literature analysis about the effectiveness in diagnosis of pulmonary metastases through conventional X-ray and CT of the thorax M.W.…”

“…According to some of the authors these are malignant in 10%-20% (10), but according to other publications the detected node in the lungs in 65% is a metastasis, and in the rest 35% -benignant lesion (35). According to Y. Varol et al (27) as a suspicious, undefined pulmonary node is defined one or more formations in the pulmonary parenchyma with size less than 1,5cm in diameter.…”

“…During the follow-up 31% of the patients have had progression. Metastases are established in 47% of them (27). In 35% of the patients has been determined that metastases' process has occurred during the follow-up period.…”

“…In most of the patients with rectal carcinoma the registered nodes are over 1cm. This fact is explained by the way of vascularization of the rectum (27). The smooth borders and sub-pleural localization are more frequently related to benignant lesions (27).…”