Accuracy of helical computed tomography in the detection of pulmonary colorectal metastases.

Objective: This study assessed the sensitivity of helical computed tomography in the detection of pulmonary metastases in patients with colorectal cancer and the role of video-assisted thoracoscopic surgery in patients with pulmonary metastases.

Methods: A total of 120 operations for pulmonary metastases were performed in 91 patients with colorectal cancer. All patients received an open thoracotomy that allowed full operative inspection and palpation. Clinical data, including the size and number of pulmonary metastasis, were retrospectively collected. The difference in the number of pulmonary metastases as determined by computed tomography scan and surgical findings was determined and analyzed.

Results: Operative findings were consistent with the preoperative computed tomography scan reports in 64 of the 120 operations (53.3%). In 32 operations (26.7%), additional metastatic tumors were identified at open thoracotomy. The sensitivity of helical computed tomography in the detection of colorectal cancer metastatic lesions ranged from 35.5% to 95.5%. Unilateral solitary lesion demonstrated on computed tomography scan was an independent factor for the prediction of additional metastatic lesions (P = .023).

Conclusions: The sensitivity of helical computed tomography scan in the detection of pulmonary metastases can reach 95.5% in patients with colorectal cancer with a solitary metastatic lesion. A unilateral solitary lesion demonstrated on preoperative computed tomography scan is an independent factor for prediction of additional metastatic lesions. If feasible, video-assisted thoracoscopic surgery may be justified in patients with colorectal cancer with solitary pulmonary metastases.