Abstract
BackgroundThis study aimed to evaluate the computed tomography (CT) features of solitary pulmonary nodule (SPN), which can be a non-invasive diagnostic tool to differentiate between primary lung cancer (LC) and solitary lung metastasis (LM) in patients with colorectal cancer (CRC).MethodsThis retrospective study included SPNs resected in CRC patients between January 2011 and December 2019. The diagnosis of primary LC or solitary LM was based on histopathologic report by thoracoscopic wedge resection. Chest CT images were assessed by two thoracic radiologists, and CT features were identified by consensus. Predictive parameters for the discrimination of primary LC from solitary LM were evaluated using multivariate logistic regression analysis.ResultsWe analyzed CT data of 199 patients (mean age, 65.95 years; 131 men and 68 women). The clinical characteristic of SPNs suggestive of primary LC rather than solitary LM was clinical stages I–II CRC (P < 0.001, odds ratio [OR] 21.70). The CT features of SPNs indicative of primary LC rather than solitary LM were spiculated margin (quantitative) (P = 0.020, OR 8.34), sub-solid density (quantitative) (P < 0.001, OR 115.56), and presence of an air bronchogram (quantitative) (P = 0.032, OR 5.32).ConclusionsQuantitative CT features and clinical characteristics of SPNs in patients with CRC could help differentiate between primary LC and solitary LM.
Highlights
When a solitary pulmonary nodule (SPN) is detected in patients with colorectal cancer (CRC), differentiation between primary lung cancer (LC) and solitary lung metastasis (LM) can be crucial for treatment planning and predicting prognosis in clinical practice [1]
To this initial inclusion of 224 patients, we applied the exclusion criteria of patients whose SPN was not diagnosed as either primary LC or solitary LM (n = 13) and patients whose SPN deemed too small to characterize at pre-diagnostic chest computed tomography (CT) image (n = 12)
The proportion of patients in which the index tumor was located in the rectum was significantly higher in the solitary LM group than that in the primary LC group (63.6% vs. 41.4%, P = 0.003)
Summary
When a solitary pulmonary nodule (SPN) is detected in patients with colorectal cancer (CRC), differentiation between primary lung cancer (LC) and solitary lung metastasis (LM) can be crucial for treatment planning and predicting prognosis in clinical practice [1]. Surgical strategies for treating primary LC and solitary LM are quite different. The treatment of choice for LM is minimally invasive surgical resection in order to preserve as much healthy lung parenchyma as possible in case repeat operation is needed. It is sometimes difficult to determine whether a SPN is a primary LC or a solitary LM. This study aimed to evaluate the computed tomography (CT) features of solitary pulmonary nodule (SPN), which can be a non-invasive diagnostic tool to differentiate between primary lung cancer (LC) and solitary lung metastasis (LM) in patients with colorectal cancer (CRC)
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