Pulmonary staging in colorectal cancer: a review.

AIM: Assessment of the chest in colorectal cancer (CRC) staging is variable. The aim of this review was to look at different chest staging strategies and determine which has the greatest efficacy. METHOD: A review of studies assessing chest staging modalities for patients with CRC was performed. Modalities included chest X-ray (CXR), CT and positron emission tomography (PET). RESULTS: The majority of data consisted of case series. Two studies identified a low pick-up rate for CXR as a staging tool. Five studies showed increased detection rates of pulmonary metastases for chest CT vs CXR and abdominal CT. The clinical benefit of the increased detection rates was not clear. The incidence of indeterminate lung lesions (ILL) on staging chest CT varied from 4 to 42%. The majority (≥ 70%) of ILLs did not have any clinical significance. On CT scans, the incidence of pulmonary metastases in patients with rectal cancer ranged from 10 to 18% and in patients with colon cancer the incidence of pulmonary metastases ranged from 5-6%. The incidence of synchronous liver and pulmonary metastases compared with the overall incidence of pulmonary metastases ranged from 45 to 70%. There was no evidence reporting the superiority of PET/CT vs CT for the detection of pulmonary metastases or characterization of ILL. CONCLUSION: Studies show that chest CT scanning increases the detection rates for ILL and pulmonary metastases. The clinical benefit of the increased detection rates is not clear. There is a paucity of data assessing the optimal chest staging strategy for patients presenting with CRC.

Computed tomographic colonography in the diagnosis of colorectal cancer.

BACKGROUND: This study aimed to determine the sensitivity of computed tomographic colonography (CTC) in diagnosing colorectal cancer and to explore the reasons why these cancers are missed on CTC. METHODS: Patients who underwent CTC in the 56-month period from 1 January 2004 to 1 September 2008, and all cases of colorectal cancer recorded in the National Cancer Registry database from 1 January 2004 to 1 December 2008, were identified. Cases from the two data sets were then matched to identify all patients in whom CTC had been performed more than 6 weeks before a histological report was available. CTC reports and patients' records were reviewed to determine the cancer site, and images were reviewed. RESULTS: A total of 3888 patients underwent CTC over a 56-month interval. After matching with the National Cancer Registry database, colorectal cancer was identified in 131 patients, whereas it had been suspected on CTC in 123 patients. One of the patients with missed cancer was excluded, leaving seven (5.3 per cent) missed cancers, four of which were located in the caecum. Five cancers were missed because of technical limitations of CTC and two were due to perceptive errors. Systems errors and severe patient co-morbidity contributed to three of the cases. The sensitivity of CTC for colorectal cancer was 95 (95 per cent confidence interval 89 to 98) per cent. CONCLUSION: The sensitivity of 95 per cent for CTC in the diagnosis of colorectal cancer compares favourably with that of double-contrast barium enema (92 per cent) and colonoscopy (94 per cent).

Trends in gastrointestinal decontamination for deliberate self poisoning in Christchurch.

AIM: To examine changes in the choice of gastrointestinal decontamination for deliberate self poisoning in Christchurch. METHOD: A review of adult deliberate self poisoning cases for 9 months from July 1 1995 to March 31 1996 and a comparison with previously published figures from 1989 and 1992. RESULTS: Only 5% of patients received gastric lavage (compared with 26% in 1992 and 78% in 1989) and 52% received activated charcoal (compared with 46% in 1992 and 0.4% in 1989). No patients received syrup of ipecacuanha (compared with 1% in 1992 and 25% in 1989) and 43% had no gastrointestinal decontamination at all. CONCLUSION: The trend towards the use of activated charcoal and away from gastric lavage is consistent with sentiments expressed in the literature.