Abstract
ObjectiveTo retrospectively determine the sensitivity of preoperative CT in the detection of small (≤ 10 mm) colorectal liver metastasis (CRLM) nodules in patients undergoing liver resection.MethodsThe institutional review board approved the study and waived informed consent. We included 461 pathologically confirmed CRLM nodules in 211 patients (including 71 women; mean age, 66.4 years) who underwent 229 liver resections following abdominal CT. Prior to 163 resections, gadoxetic acid-enhanced liver MR imaging was also performed. Nodules were matched between pathology reports and prospective CT reports following a predefined algorithm. Per-nodule sensitivity of CT was calculated by nodule-size category. Generalized estimating equations were used to adjust for within-case correlation.ResultsFourteen nodule sizes were missing in the pathology report. Nodules of 1–5 mm and 6–10 mm accounted for 8.1% (n = 36) and 23.5% (n = 105) of the remaining 447 nodules, and the number of nodules gradually decreased as nodule size increased beyond 10 mm. The overall sensitivity of CT was 81.2% (95% confidence interval, 77.1%, 85.2%; 365/461). The sensitivity was 8% (0%, 17%; 3/36), 55% (45%, 65%; 59/105), 91%, 95%, and 100% for nodules of 1–5 mm, 6–10 mm, 11–15 mm, 16–20 mm, and >20 mm, respectively. The nodule-size distribution was similar between resections undergoing gadoxetic acid-enhanced MR imaging and those not undergoing the MR imaging.ConclusionCT has limited sensitivity for nodules of ≤ 10 mm and particularly of ≤ 5 mm.
Highlights
The overall survival rate in patients with colorectal liver metastasis (CRLM) is increased by the surgical removal of metastatic nodules in the liver [1, 2]
Smaller CRLM nodules are of particular diagnostic concern, as they are more difficult to detect than larger nodules with preoperative and intraoperative examinations
From the surgical database of Seoul National University Bundang Hospital, a teaching hospital in Korea, we identified 284 patients who had pathologically-confirmed colorectal cancer and underwent 311 liver resections from 2003 through 2014
Summary
The overall survival rate in patients with colorectal liver metastasis (CRLM) is increased by the surgical removal of metastatic nodules in the liver [1, 2]. Smaller CRLM nodules are of particular diagnostic concern, as they are more difficult to detect than larger nodules with preoperative and intraoperative examinations. Once detected, they are typically more amenable to surgical resection or local ablation. The reported sensitivity of CT in the detection of small ( 10 mm) CRLM nodules has ranged from 22% to 68% in previous studies [6]. This wide variation can be attributed to the differences in study methods and to the limited precision of individual studies due to the small numbers of nodules analyzed
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