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. 2020 Aug;4(4):605-621.
doi: 10.1002/bjs5.50291. Epub 2020 May 6.

Preoperative imaging for colorectal liver metastases: a nationwide population-based study

A K E Elfrink  1   2 , M Pool  3   4 , L R van der Werf  1   5 , E Marra  1 , M C Burgmans  6 , M R Meijerink  7 , M den Dulk  8 , P B van den Boezem  9 , W W Te Riele  10   11 , G A Patijn  12 , M W J M Wouters  1 , W K G Leclercq  13 , M S L Liem  14 , P D Gobardhan  15 , C I Buis  2 , K F D Kuhlmann  16 , C Verhoef  5 , M G Besselink  3 , D J Grünhagen  5 , J M Klaase  2 , N F M Kok  16 ; the Dutch Hepato-Biliary Audit Group
Affiliations

Preoperative imaging for colorectal liver metastases: a nationwide population-based study

A K E Elfrink et al. BJS Open. 2020 Aug.

Abstract
in English, Spanish

Background: In patients with colorectal liver metastases (CRLM) preoperative imaging may include contrast-enhanced (ce) MRI and [18 F]fluorodeoxyglucose (18 F-FDG) PET-CT. This study assessed trends and variation between hospitals and oncological networks in the use of preoperative imaging in the Netherlands.

Methods: Data for all patients who underwent liver resection for CRLM in the Netherlands between 2014 and 2018 were retrieved from a nationwide auditing database. Multivariable logistic regression analysis was used to assess use of ceMRI, 18 F-FDG PET-CT and combined ceMRI and 18 F-FDG PET-CT, and trends in preoperative imaging and hospital and oncological network variation.

Results: A total of 4510 patients were included, of whom 1562 had ceMRI, 872 had 18 F-FDG PET-CT, and 1293 had combined ceMRI and 18 F-FDG PET-CT. Use of ceMRI increased over time (from 9·6 to 26·2 per cent; P < 0·001), use of 18 F-FDG PET-CT decreased (from 28·6 to 6·0 per cent; P < 0·001), and use of both ceMRI and 18 F-FDG PET-CT 16·9 per cent) remained stable. Unadjusted variation in the use of ceMRI, 18 F-FDG PET-CT, and combined ceMRI and 18 F-FDG PET-CT ranged from 5·6 to 100 per cent between hospitals. After case-mix correction, hospital and oncological network variation was found for all imaging modalities.

Discussion: Significant variation exists concerning the use of preoperative imaging for CRLM between hospitals and oncological networks in the Netherlands. The use of MRI is increasing, whereas that of 18 F-FDG PET-CT is decreasing.

Antecedentes: En pacientes con metástasis hepáticas colorrectales (colorrectal liver metastases, CRLM), los estudios de imagen preoperatorios pueden incluir resonancia magnética con contraste (ce)MRI y 18 F-FDG-PET-CT. Este estudio evaluó las tendencias y la variación entre los hospitales y las redes oncológicas en el uso de estudios de imagen preoperatorios en los Países Bajos. MÉTODOS: Todos los pacientes que se sometieron a una resección hepática por CRLM en los Países Bajos entre 2014 y 2018 fueron seleccionados a partir de una base de datos a nivel nacional auditada. El análisis de regresión logística multivariable se utilizó para evaluar el uso de ceMRI, de 18 F-FDG-PET-CT y de ceMRI combinado con 18 F-FDG-PET-CT, así como para determinar las tendencias en los estudios de imagen preoperatorios y las variaciones hospitalarias y de la red oncológica.

Resultados: En total, se incluyeron 4.510 pacientes, de los cuales 1.562 se sometieron a ceMRI, 872 a 18 F-FDG-PET-CT y 1.293 a ceMRI combinado con 18 F-FDG-PET-CT. El uso de ceMRI aumentó con el tiempo del 9,6% al 26,2% (P < 0,001), el uso de 18 F-FDG-PET-CT disminuyó (25% a 6,0%, P < 0,001) y el uso de ceMRI y 18 F-FDG-PET- CT (17%) se mantuvo estable. La variación no ajustada entre hospitales en el uso de ceMRI, 18 F-FDG-PET-CT y la combinación de ceMRI y 18 F-FDG-PET-CT oscilaba del 5% al 10%. Después de la corrección por case-mix, la variación hospitalaria y de la red oncológica persistía en todas las pruebas de imagen. CONCLUSIÓN: En los Países Bajos existe una variación significativa entre hospitales y redes oncológicas respecto al uso de pruebas de imagen preoperatorias para el CRLM. El uso de MRI está aumentando, mientras que el uso de 18 F-FDG-PET-CT está disminuyendo.

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Figures

Figure 1
Figure 1
Case mix‐corrected trend analysis using multivariable logistic regression for the use of pretreatment imaging modalities for colorectal liver metastases in the Netherlands, 2014–2018 Adjusted odds ratios (ORs) are shown with 95 per cent confidence intervals. Case‐mix variables for contrast‐enhanced (ce) MRI were age, Charlson Co‐morbidity Index (CCI) score, BMI, ASA grade, history of liver resection, number of colorectal liver metastases (CRLM), maximum diameter of largest CRLM, location of primary tumour, type of metastases, extrahepatic metastases and type of hospital. Case‐mix variables for [18F]fluorodeoxyglucose (18F‐FDG) PET–CT were CCI score, preoperative chemotherapy, number of CRLM, maximum diameter of largest CRLM, bilobar disease, location of primary tumour, nodal status of primary tumour, extrahepatic metastases and type of hospital. Case‐mix variables for ceMRI and 18F‐FDG PET–CT were ASA grade, BMI, history of liver disease, history of liver resection, number of CRLM, maximum diameter of largest CRLM, bilobar disease, location of primary tumour and nodal status of primary tumour.
Figure 2
Figure 2
Unadjusted rates of hospital variation and case mix‐corrected funnel plots of between‐hospital and oncological network variation in the use of preoperative contrast‐enhanced MRI in patients with colorectal liver metastases in the Netherlands, 2014–2018 a Unadjusted rates of between‐hospital variation in use of contrast‐enhanced (ce) MRI. b Funnel plot of between‐hospital variation, case mix‐corrected for age, Charlson Co‐morbidity Index (CCI) score, BMI, ASA grade, history of liver resection, number of colorectal liver metastases (CRLM), maximum diameter of largest CRLM, location of primary tumour, type of metastases, extrahepatic metastases and type of hospital. c Funnel plot of oncological network variation, case mix‐corrected for age, CCI score, BMI, ASA grade, history of liver resection, number of CRLM, maximum diameter of largest CRLM, location of primary tumour, type of metastases, extrahepatic metastases and type of hospital. O/E, observed/expected.
Figure 3
Figure 3
Unadjusted rates of hospital variation and case mix‐corrected funnel plots of between‐hospital and oncological network variation in the use of preoperative [18F]fluorodeoxyglucose PET–CT in patients with colorectal liver metastases in the Netherlands, 2014–2018 a Unadjusted rates of between‐hospital variation in use of [18F]fluorodeoxyglucose (18F‐FGD) PET–CT. b Funnel plot of between‐hospital variation, case mix‐corrected for Charlson Co‐morbidity Index (CCI) score, preoperative chemotherapy, number of colorectal liver metastases (CRLM), maximum diameter of largest CRLM, bilobar disease, location of primary tumour, nodal status of primary tumour, extrahepatic metastases and type of hospital. c Funnel plot of oncological network variation, case mix‐corrected for CCI score, preoperative chemotherapy, number of CRLM, maximum diameter of largest CRLM, bilobar disease, location of primary tumour, nodal status of primary tumour, extrahepatic metastases and type of hospital. O/E, observed/expected.
Figure 4
Figure 4
Unadjusted rates of hospital variation and case mix‐corrected funnel plots of between‐hospital and oncological network variation in the preoperative use of combined contrast‐enhanced MRI and [18F]fluorodeoxyglucose PET–CT in patients with colorectal liver metastases in the Netherlands, 2014–2018 a Unadjusted rates of between‐hospital variation in use of combined contrast‐enhanced (ce) MRI and [18F]fluorodeoxyglucose (18F‐FGD) PET–CT. b Funnel plot of between‐hospital variation, case mix‐corrected for ASA grade, BMI, history of liver disease, history of liver resection, number of colorectal liver metastases (CRLM), maximum diameter of CRLM, bilobar disease, location of primary tumour and nodal status of primary tumour. c Funnel plot of oncological network variation, case mix‐corrected for ASA grade, BMI, history of liver disease, history of liver resection, number of CRLM, maximum diameter of largest CRLM, bilobar disease, location of primary tumour and nodal status of primary tumour. O/E, observed/expected.
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References

    1. Netherlands Comprehensive Cancer Organization (IKNL). Dutch Cancer Registry; 2018. https://www.iknl.nl/kankersoorten/darmkanker/registratie/incidentie [accessed 27 September 2019].
    1. Takahashi H, Kahramangil B, Kose E, Berber E. A comparison of microwave thermosphere versus radiofrequency thermal ablation in the treatment of colorectal liver metastases. HPB (Oxford) 2018; 20: 1157–1162. - PubMed
    1. Mitchell D, Puckett Y, Nguyen QN. Literature review of current management of colorectal liver metastasis. Cureus 2019; 11: e3940. - PMC - PubMed
    1. Maffione AM, Lopci E, Bluemel C, Giammarile F, Herrmann K, Rubello D. Diagnostic accuracy and impact on management of 18F‐FDG PET and PET/CT in colorectal liver metastasis: a meta‐analysis and systematic review. Eur J Nucl Med Mol Imaging 2015; 42: 152–163. - PubMed
    1. Parikh U, Marcus C, Sarangi R, Taghipour M, Subramaniam RM. FDG PET/CT in pancreatic and hepatobiliary carcinomas: value to patient management and patient outcomes. PET Clin 2015; 10: 327–343. - PubMed

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