Newly detected liver nodules with a history of colorectal cancer: are they metastatic? Review of 2,632 cases in a single center.
Newly detected liver nodules with a history of colorectal cancer: are they metastatic? Review of 2,632 cases in a single center.
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新发现有结直肠癌病史的肝结节：它们是否转移？
DOI：
10.21037/atm-20-8153
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发表时间：
2021-07
影响因子：
--
通讯作者：
Wang X
中科院分区：
文献类型：
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作者：
Zhu K;Wang W;Luo R;Song D;Wang X;Gao Q;Fan J;Zhou J;Rao S;Wang X
结直肠癌（CRC）患者中新发现的肝结节的诊断对于确定预后和治疗至关重要。准确识别良性结节有助于避免不必要的治疗。本研究的目的是回顾性分析在我们医院因良性肝结节误诊为结直肠癌转移（CRLM）而接受肝切除术的结直肠癌患者。方法我们回顾了2012年1月至2019年12月在我院接受肝切除术的所有有CRC病史的患者。我们特别关注病理证实为良性的结节。由独立病理学家复查病理学。收集这些患者的临床病理特征。回顾术前影像学检查，包括超声（US）、磁共振成像（MRI）和正电子发射断层扫描-计算机断层扫描（PET-CT）。结果2012年至2019年，共有2,632例术前诊断为CRLM的CRC患者接受了肝切除术，其中2,584例（98.2%）被证实为恶性，48例（1.8%）为良性。其中24例经病理证实为局灶性结节增生（FNH），9例为紫癜，10例为炎性病变，5例为血管瘤。至少一次术前影像学检查提示CRLM，中位尺寸为2.0 cm（范围：0.4-8.0 cm）。在肝切除术前，10名患者在发现肝结节后接受了化疗。结论有结直肠癌病史的患者中新发现的肝结节可能是良性的。准确诊断结直肠癌肝结节是必要的，以避免过度治疗，并确定具有成本效益的药物。
Background The diagnosis of newly detected liver nodules in patients with colorectal cancer (CRC) is crucial for determining prognosis and treatment. Accurate identification of benign nodules can help avoid unnecessary therapy. The aim of our study was to retrospectively review patients with CRC who underwent liver resection for benign liver nodules misdiagnosed as CRC metastasis (CRLM) in our institution. Methods We reviewed all patients with a history of CRC who underwent liver resection from January 2012 to December 2019 in our institution. We specifically focused on nodules pathologically confirmed as benign. The pathology was rechecked by an independent pathologist. The clinicopathological characteristics of these patients were collected. Preoperative imaging examinations, including ultrasound (US), magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET-CT) were reviewed. Results From 2012 to 2019, a total of 2,632 patients with CRC who were preoperatively diagnosed CRLM received liver resection, among which 2,584 (98.2%) cases were proven to be malignant, and 48 (1.8%) cases were benign. Among these 48 cases, 24 were pathologically confirmed as focal nodular hyperplasia (FNH), 9 were peliosis, 10 were inflammatory lesions, and 5 were hemangioma. At least one preoperative imaging examination indicated CRLM, with a median size of 2.0 cm (range, 0.4–8.0 cm). Before liver resection, ten patients received chemotherapy after the discovery of liver nodules. Conclusions It should be noted that newly detected liver nodules in patients with a history of CRC could be benign. Accurate diagnosis of liver nodules in CRC is necessary to avoid overtreatment and to identify cost-effective medication.