Dealing with indeterminate pulmonary nodules in colorectal cancer patients; a systematic review.
Joris J van den Broek, Tess van Gestel, Sabrine Q Kol, Anne M van Geel, Remy W F Geenen, Wilhelmina H Schreurs
Author Information
Joris J van den Broek: Department of Surgery, Northwest Clinics, PO Box 501, 1815 JD, Alkmaar, the Netherlands. Electronic address: jorisvdbroek@gmail.com.
Tess van Gestel: Department of Surgery, Northwest Clinics, PO Box 501, 1815 JD, Alkmaar, the Netherlands.
Sabrine Q Kol: Department of Radiology, AUMC, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
Anne M van Geel: Department of Radiology, Northwest Clinics, PO Box 501, 1815 JD, Alkmaar, the Netherlands.
Remy W F Geenen: Department of Radiology, Northwest Clinics, PO Box 501, 1815 JD, Alkmaar, the Netherlands.
Wilhelmina H Schreurs: Department of Surgery, Northwest Clinics, PO Box 501, 1815 JD, Alkmaar, the Netherlands.
INTRODUCTION: Indeterminate pulmonary nodules (IPNs) are frequently encountered on staging computed tomography (CT) in colorectal cancer (CRC) patients and they create diagnostic dilemmas. This systematic review and pooled analysis aims to estimate the incidence and risk of malignancy of IPNs and provide an overview of the existing literature on IPNs in CRC patients. MATERIALS AND METHODS: EMBASE, Pubmed and the Cochrane database were searched for papers published between January 2005 and April 2020. Studies describing the incidence of IPNs and the risk of malignancy in CRC patients and where the full text was available in the English language were considered for inclusion. Exclusion criteria included studies that used chest X-ray instead of CT, liver metastasis cohorts, studies with less than 60 CRC patients and reviews. RESULTS: A total of 18 studies met the inclusion criteria, involving 8637 patients. Pooled analysis revealed IPNs on staging chest CT in 1327 (15%) of the CRC patients. IPNs appeared to be metastatic disease during follow up in 16% of these patients. Regional lymph node metastases, liver metastases, location of the primary tumour in the rectum, larger IPN size and multiple IPNs are the five most frequently reported parameters predicting the risk of malignancy of IPNs. CONCLUSION: A risk stratification model for CRC patients with IPNs is warranted to enable an adequate selection of high risk patients for IPN follow up and to diminish the use of unnecessary repetitive chest CT-scans in the many low risk patients.
