Indeterminate Liver Lesions in Patients With Early Stage Rectal Cancer: Can They Be Ignored?,Practical Radiation Oncology

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Indeterminate Liver Lesions in Patients With Early Stage Rectal Cancer: Can They Be Ignored?
Practical Radiation Oncology ( IF 3.3 ) Pub Date : 2021-07-14 , DOI: 10.1016/j.prro.2021.07.002
Joris J van den Broek ₁ , Sabrine Q Kol ₂ , Jeroen Doodeman ₃ , Wilhelmina H Schreurs ₁ , Anne M van Geel ₄

Affiliation

Purpose

Small, hypoattenuating, indeterminate liver lesions are often encountered during staging computed tomography (CT) in patients with early-stage rectal cancer. This study aimed to determine the incidence and prognostic significance of these lesions.

Methods and Materials

A single institution's colorectal cancer (CRC) database was searched for patients with early-stage rectal cancer, defined as a cT1-2N0 tumor on magnetic resonance imaging (MRI). Abdominal CT scans of these patients were assessed for the presence of liver lesions and categorized according to their morphology. Preoperative MRI scans of the liver and abdominal follow-up imaging were assessed to determine whether the liver lesions found during staging CT appeared to be CRC metastases or not.

Results

In a consecutive cohort of 1232 patients with CRC who had undergone surgery, 84 patients with early-stage rectal cancer (cT1-2N0 on MRI) were identified. Of those 84 patients, 45 (54%) had 1 or more liver lesions on staging CT; a total of 122 liver lesions were observed, consisting of 95 indeterminate lesions (78%), 25 cysts (20%), and 2 hemangiomas (2%). Preoperative MRI of the liver and regular follow-up imaging revealed no synchronous or metachronous liver metastases in this cohort.

Conclusions

In this study, small, hypoattenuating, indeterminate lesions of the liver were common in patients diagnosed with early rectal cancer and seemed to have no clinical significance. Additional preoperative imaging or follow-up imaging for indeterminate liver lesions in such patients may be unnecessary.

中文翻译：

早期直肠癌患者的不确定肝脏病变：可以忽略吗？

目的

在早期直肠癌患者的分期计算机断层扫描 (CT) 期间，经常会遇到小的、低密度、不确定的肝脏病变。本研究旨在确定这些病变的发生率和预后意义。

方法和材料

在单个机构的结直肠癌 (CRC) 数据库中搜索了早期直肠癌患者，这些患者在磁共振成像 (MRI) 上定义为 cT1-2N0 肿瘤。这些患者的腹部 CT 扫描被评估是否存在肝脏病变，并根据其形态进行分类。评估术前肝脏 MRI 扫描和腹部随访成像，以确定分期 CT 期间发现的肝脏病变是否似乎是 CRC 转移。

结果

在 1232 名接受过手术的 CRC 患者的连续队列中，确定了 84 名早期直肠癌患者（MRI 为 cT1-2N0）。在这 84 名患者中，45 名 (54%) 在分期 CT 上有 1 个或多个肝脏病变；共观察到 122 个肝脏病变，包括 95 个不确定病变（78%）、25 个囊肿（20%）和 2 个血管瘤（2%）。术前肝脏 MRI 和定期随访成像显示该队列中没有同步或异时性肝转移。