Koloretal Karsinomlu Hastlarda Akciğer Metastazının Tesbitinde Bilgisayarlı Tomografinin Yeri

Öz

Giriş Kolorektal karsinomların(KRK) tanı anında %20’si metastatiktir ve metastatic hastaların %1-9’unda akciğer metastazı vardır. Güncel rehberler preoperative evreleme için akciğer bilgisayarlı tomografisini(TBT) önermektedirler, fakat bu hem maliyetlidir, hem de radyasyona maruziyeti fazladır. Ayrıca çoğu hastada tedavi planı değişmemektedir. Bundan yola çıkılarak akciğer grafisi(PPACG) ve bilgisayarlı tomografinin(BT) KRK’lı hastalarda kıyaslaması yapılıdı. Materyal ve Metod Bu çalışma da Mayıs 2019-Mayıs 2023 yılları arasında KRK nedeni ile Ankara Bilkent Şehir Hastanesi Genel Cerrahi Kliniği’ne yatışı yapılan 630 hasta retrospektif olarak tarandı. Takip dosyalarına göre akciğer metastazlı hastaların biyopsi, BT ve/veya PET/BT sonuçları ile metastaz varlığı kabul edildi. Akciğer metastazı olan 13 hasta Grup 1 ve propensity score match analizi ile belirlenen akciğer metastazı olmayan 31 hasta Grup 2 olarak ayrıldı ve toplamda 44 hasta analiz edildi. Bulgular Preoperastif taramalar sonucu Grup 1’deki 13 hastanın 4’ünde metastatik lezyonlar PAACG’de tesbit edilmiş olup, lezyonların ortalama çapı 1.5 (min: 0.5, max: 5.0) cm idi. PAACG’de saptanmayan 9 hastanın TBT’de ki saptanan kitlelerin ortalama çapı 7mm bulundu. TBT ve PAACGnin yapılan sensivite ve spesifite analizide sırasıyla %30.77 ve %100 olarak bulundu( Tablo 2). PAACG’nin pozitif prediktif ve negative prediktif değerleri sırasıyla 100%(39.76%-100%) ve 77.50%(70.57%-83.19%)’dır. Sonuç Her ne kadar güncel rehberler TBT’yi tarama amaçlı önerselerde bizim çalışmamızda TBT’nin hastanın tedavi planında bir değişikliğe yol açmadığı tesbit edildi. KRK’lı hastaların evrelemesinde TBT’nin kullanımının sınırlandırılması düşünülebilir.

Anahtar Kelimeler

• Kolorektal Kanser
• Akciğer Direk Grafi
• Toraks Bilgisayarlı Tomografi

The Role of Computed Tomography in Detection of Lung Metastases in Patients with Colorectal Carcinoma

Öz

Objective: At the time of diagnosis, 20% of colorectal carcinomas (CRC) are metastatic, and 1-9% of these metastatic patients have lung metastasis. Current guidelines recommend thoracic computed tomography (TCT) for preoperative staging, but this is costly and involves significant radiation exposure. Additionally, in most cases, the treatment plan does not change. Therefore, a comparison between chest X-ray (CXR) and computed tomography (CT) in patients with CRC was conducted. Material and Method: In this study, 630 patients admitted to our hospital between May 2019 and May 2023 for CRC were retrospectively screened. According to follow-up records, the presence of lung metastasis was confirmed based on biopsy, CT, and/or PET/CT results. Thirteen patients with lung metastasis were classified as Group 1, and 31 patients without lung metastasis, identified using propensity score matching, were classified as Group 2, totaling 44 patients for analysis. Results: Preoperative screening revealed that metastatic lesions were detected by CXR in 4 out of 13 patients in Group 1, with an average lesion diameter of 1.5 cm (min: 0.5, max: 5.0 cm). The average diameter of lesions detected by TCT in the remaining 9 patients, which were not visible on CXR, was 7 mm. The sensitivity and specificity of TCT and CXR were found to be 30.77% and 100%, respectively (Table 2). The positive predictive value and negative predictive value of CXR were 100% (39.76%-100%) and 77.50% (70.57%-83.19%), respectively. Conclusion: Although current guidelines recommend TCT for screening, our study found that TCT did not lead to a change in the treatment plan for patients. The use of TCT in the staging of CRC patients may need to be reconsidered.

Anahtar Kelimeler

• Colorectal Cancer
• Lung X-Ray
• Toraks Computed Tomography

Kaynakça

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