Pulmonary staging in colorectal cancer – is computerised tomography the answer?
| Autor: | J. McIntosh, Mark Callaway, P. A. Sylvester, M. G. Thomas, J. Virjee |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Male
medicine.medical_specialty Colectomies Lung Neoplasms Palliative care Colorectal cancer medicine.medical_treatment Sensitivity and Specificity medicine Humans Prospective Studies Aged Neoplasm Staging Colectomy Barium enema Aged 80 and over medicine.diagnostic_test business.industry General Medicine Middle Aged Double-contrast barium enema medicine.disease digestive system diseases medicine.anatomical_structure Abdomen Female Surgery Radiology Colorectal Neoplasms Tomography X-Ray Computed Chest radiograph business Research Article |
| Zdroj: | Annals of The Royal College of Surgeons of England. 87:331-333 |
| ISSN: | 1478-7083 0035-8843 |
| Popis: | INTRODUCTION: Pulmonary staging in colorectal cancer (CRC) has traditionally been carried out by means of plain chest radiograph (CXR), although computerised tomography (CT) imaging of the chest is increasingly being performed for this purpose. The aim of this study was to assess the value of pre-operative thoracic CT for pulmonary staging in CRC. PATIENTS AND METHODS: Data were collected prospectively on all patients referred into hospital over a 20-month study period for double contrast barium enema evaluation of symptoms suggestive of an underlying CRC. Patients with a CRC went on to have a staging intravenous, contrast-enhanced CT of the chest, abdomen and pelvis prior to an out-patient appointment with a colorectal surgeon. The CXRs of those patients in whom a radiological abnormality was seen on thoracic CT were reviewed blindly by an independent consultant radiologist. RESULTS: A total of 403 barium enemas were performed, of which 38 demonstrated a CRC (9%). In those patients diagnosed with CRC, nine (24%) had an abnormality on thoracic CT. Four patients with positive thoracic CTs had chemotherapy and or radiotherapy with no surgery. One patient underwent colectomy, and 2 patients who had primary lung tumours as opposed to metastases also underwent colectomies. One patient received palliative care only. In addition, one of the patients underwent multiple, non-diagnostic thoracic investigations prior to a diagnosis of sarcoidosis being made and then proceeding to surgery. An independent consultant radiologist reviewed seven out of the nine CXRs of patients with an abnormality on thoracic CT without knowledge of the clinical diagnosis, and reported three of the CXRs to be normal. CONCLUSIONS: Thoracic CT appears to improve the accuracy of pulmonary staging in CRC allowing a more appropriate level of intervention. However, CT is likely to identify more benign radiological abnormalities than CXR alone, and investigations should not occur to the detriment of treating the primary tumour. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|