Nordholm-Carstensen Andreas, Jorgensen Lars N, Wille-Jørgensen Peer A, Hansen Hanne, Harling Henrik
Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, NV, Denmark,
Ann Surg Oncol. 2015 Feb;22(2):543-9. doi: 10.1245/s10434-014-4063-1. Epub 2014 Sep 5.
The clinical significance of indeterminate pulmonary nodules (IPN) at staging computed tomography (CT) for colorectal cancer (CRC), and the optimal diagnostic approach, are debated. This study aimed to analyse variability in radiologists' detection of IPN at staging CT for CRC.
All patients with CRC referred to our center between 2006 and 2011 were included. Primary staging CT scans were re-evaluated by an experienced thoracic radiologist whose findings were entered into a dedicated database and merged with data from the Danish Colorectal Cancer Group database, the National Patient Registry, the Danish Pathology Registry, and the primary CT evaluation. Inter-reader agreement was calculated by Kappa statistics, and associations between variables and malignancy of pulmonary nodules were analyzed with χ (2) and Mann-Whitney-Wilcoxon tests. Multivariable logistic regression analyses were used to adjust for potential confounding variables.
In total, 841 patients were included. The primary CT assessment reported IPN in 9.8 % of patients and pulmonary metastases in 5.1 % of patients compared with 5.6 and 7.0 %, respectively, reported by the experienced thoracic radiologist. Kappa for agreement between the primary assessor and the thoracic radiologist on IPN was 0.31 and 0.65 for pulmonary metastases. Synchronous liver metastases were predictive of malignancy of IPN (adjusted odds ratio 20.1; 95 % confidence interval 2.64-437.66; p = 0.012), whereas no other investigated radiological characteristics or clinicopathological factors were significantly associated with malignancy of IPN.
The characterization of pulmonary findings on staging CT for CRC varied greatly between the radiologists, and double-reading of scans with IPN is recommended prior to further diagnostic work-up.
在结直肠癌（CRC）分期计算机断层扫描（CT）中，不确定肺结节（IPN）的临床意义以及最佳诊断方法存在争议。本研究旨在分析放射科医生在CRC分期CT中对IPN检测的变异性。
纳入2006年至2011年间转诊至本中心的所有CRC患者。由一位经验丰富的胸放射科医生重新评估原发性分期CT扫描，其结果录入专用数据库，并与丹麦结直肠癌组数据库、国家患者登记处、丹麦病理登记处的数据以及原发性CT评估数据合并。通过Kappa统计计算阅片者间一致性，并使用χ²检验和Mann-Whitney-Wilcoxon检验分析肺结节变量与恶性肿瘤之间的关联。采用多变量逻辑回归分析调整潜在的混杂变量。
共纳入841例患者。原发性CT评估报告9.8%的患者有IPN，5.1%的患者有肺转移，而经验丰富的胸放射科医生报告的比例分别为5.6%和7.0%。原发性评估者与胸放射科医生在IPN上的一致性Kappa为0.31，在肺转移上为0.65。同时性肝转移可预测IPN的恶性（调整后的优势比为20.1；95%置信区间为2.64 - 437.66；p = 0.012），而其他研究的放射学特征或临床病理因素与IPN的恶性无显著关联。
CRC分期CT上肺部表现的特征在放射科医生之间差异很大，建议在进一步诊断检查前对有IPN的扫描进行双人阅片。
