A risk-based approach to identifying oligometastatic disease on imaging

Recognition of < 3 metastases in < 2 organs, particularly in cancers with a known predisposition to oligometastatic disease (OMD) (colorectal, prostate, renal, sarcoma and lung), offers the opportunity to focally treat the lesions identified and confers a survival advantage. The reliability with which OMD is identified depends on the sensitivity of the imaging technique used for detection and may be predicted from phenotypic and genetic factors of the primary tumour, which determine metastatic risk. Whole-body or organ-specific imaging to identify oligometastases requires optimization to achieve maximal sensitivity. Metastatic lesions at multiple locations may require a variety of imaging modalities for best visualisation because the optimal image contrast is determined by tumour biology. Newer imaging techniques used for this purpose require validation. Additionally, rationalization of imaging strategies is needed, particularly with regard to timing of imaging and follow-up studies. This article reviews the current evidence for the use of imaging for recognizing OMD and proposes a risk-based roadmap for identifying patients with true OMD, or at risk of metastatic disease likely to be OM. This article is protected by copyright. All rights reserved.

International journal of cancer. 2018 Aug 11 [Epub ahead of print]

Nandita M deSouza, Clare M Tempany

Cancer Research UK Imaging Centre at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, SM2 5PT, UK., Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.