J Korean Surg Soc JKSS Journal of the Korean Surgical Society 1226-0053 The Korean Surgical Society 10.4174/jkss.2009.76.3.168 Original Article Usefulness of Chest CT in Colorectal Cancer Staging Lee Chang Ho M.D. Kim Jong Hun M.D. Jin Gong Yong M.D. 1 Lee Min Ro M.D. Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea. Department of Radiology, Chonbuk National University Medical School, Jeonju, Korea. gsminro@chonbuk.ac.kr 03 2009 31 03 2009 76 3 168 172 04 08 2008 24 11 2008 Copyright © 2009 The Korean Surgical Society 2009 Purpose

The lung represents the second most metastatic site after the liver in colorectal cancer (CRC). Traditionally, pulmonary metastasis has been evaluated by means of a chest X-ray. But, recently, chest computed tomography (CT) is increasingly being performed to detect pulmonary metastasis in CRC. This study was performed to evaluate the usefulness of chest CT over chest X-ray for early detection of pulmonary metastasis in preoperative staging in CRC.

 Methods

We retrospectively reviewed 108 cases of CRC patients surgically treated with a curative intent at Chonbuk National University Hospital from April, 2007 to December, 2007. All evaluated by both chest X-ray and chest CT preoperatively.

 Results

Five among 108 patients had metastatic lesions of the lung. Four of these 5 patients (80%) had a positive chest CT. But one of these 5 patients (20%) had a positive chest X-ray. Chest CT provided a sensitivity of 80% and a positive predictive value of 80% for the detection of metastatic lesions of the lung. In contrast, chest X-ray provided a sensitivity of 20% and a positive predictive value of 50% for the detection of metastatic lesion of the lung. Nine of these 108 patients (8%) were diagnosed with solitary pulmonary nodule (SPN) and one of them was confirmed to have metastatic lesion of the lung.

 Conclusion

There are isolated metastatic lung lesions without other organ involvement in CRC (4.6%). Chest CT is a more accurate imaging modality for detection of pulmonary metastasis in CRC. Also, we should carefully follow-up SPN detected by preoperative chest CT.

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Undetected right lung mass on chest X-ray: mass in the right lung in a 64-year-old man with colon cancer. (A) This figure shows no evidence of the malignant lesion of the chest. (B) This figure shows malignant lesion of the subpleural lesion of the right lung.

Neglected right lung mass: increased size of the mass in the right lung in a 77-year-old man with colon cancer. (A) This figure shows a lesion in the right lung and was not believed to be metastatic disease. (B) Four months later, the size of the mass was increased.

Patient characteristics of pulmonary metastasis

*CEA = carcinoembryonic antigen; †T-colon = transverse colon; ‡S-colon = sigmoid colon; §A-colon = ascending colon.

Statistical value of CXR

*Preop CXR = preoperative chest x-ray.

Statistical analysis of CXR and chest CT diagnosis

*CXR = chest x-ray; †CT = computed tomography.

Statistical value of CT

*Preop CT = preoperative computed tomography.