Cardiothoracic Surgery |

Comparison of Pulmonary Nodule Detection Rates Between Computed Tomography, Intraoperative Lung Palpation, and Pathologic Analysis in Patients Who Undergo Pulmonary Metastasectomy in Colorectal Cancer FREE TO VIEW

Carmen Marron Fernandez, MD; Javier de la Cruz, MD; David Lora, PhD; Pablo Gamez, MD; Juan Jose Rivas, MD; Raul Embun, PhD; Laureano Molins, MD
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12 Octubre University Hospital, Madrid, Spain

Chest. 2014;145(3_MeetingAbstracts):57A. doi:10.1378/chest.1816609
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SESSION TITLE: Thoracic Surgery

SESSION TYPE: Slide Presentations

PRESENTED ON: Saturday, March 22, 2014 at 09:00 AM - 10:00 AM

PURPOSE: Surgical treatment for colorectal cancer (CRC) lung metastases requires resection of all malignant lesions. Computed Tomography (CT) findings may not agree with pathological ones. This lack of agreement can result in incomplete resection. The aim of this study was to estimate the determinants of disagreement between findings provided by CT and surgical pathology in patients undergoing removal of CRC lung lesions.

METHODS: Multicenter longitudinal study of the GECMP-CCR-SEPAR. Data collection was prospective. Patients included in the analysis underwent open-surgery for first time CRC pulmonary metastasectomy with complete resection by direct viewing and bi-manual palpation, and at least one metastatic lesion removed.

RESULTS: The complete series included 543 patients; 404 (74.4%) were eligible for this analysis. Radiological unilateral involvement was documented in 345 patients (85%), and 253 (63%) presented only one nodule. The number of nodules per patient was higher with bilateral than with multiple unilateral involvement. Radiological and malignant pathological findings were concordant in 316 (78%) patients. Univariate analysis showed that disagreement is more likely in patients with CRC advanced stages (III, IV), liver metastases, radiological bilateral involvement, multiple nodules on CT, smaller mean radiological nodule size per patient. The joint prognostic performance of determinants of disagreement in nodule count was estimated with logistic modeling. The two variables included in the final model were “uni/bilateral involvement” and “nodule count on CT”. The model explained 28% of the variability in the proportion of disagreement (R2=0.28), and it discriminated between agreement and disagreement in 85% of patients (AUC=0.85). Both in patients with unilateral and bilateral involvement, disagreement increased with nodule count, by an OR of 6.17 (4.08;9.33) for one nodule increase. For similar nodule count (>1, 2, 3, or ≥4), lower disagreement was observed in bilateral than in unilateral involvement (OR 0.2 (0.07;0.55).

CONCLUSIONS: Disagreement between radiological and pathological findings was documented in one in five patients. The combined prognostic information of number of nodules and uni/bilateral involvement showed the best performance for predicting disagreement.

CLINICAL IMPLICATIONS: The individualization of the radiological findings allows us to estimate the probability of achieving complete resection. Some patients require open surgical access to resect the maximum tumor load.

DISCLOSURE: The following authors have nothing to disclose: Carmen Marron Fernandez, Javier de la Cruz, David Lora, Pablo Gamez, Juan Jose Rivas, Raul Embun, Laureano Molins

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