Computed tomography has low sensitivity for the diagnosis of early colon cancer

Ih, Lao; Chao, Hai-Lun; Yj, Wang; Cw, Mak; Ws, Tzeng; Rh, Wu; St, Chang; Jl, Fang

doi:10.1111/codi.12140

Cited by 26 publications

(18 citation statements)

References 15 publications

(16 reference statements)

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“…This is in line with other reports of between 0 % for T1 to 80 % for T3 tumors [18,19]. When grouping the primary tumor in local limited T0-2 and advanced T3/4, the percentage rose to over 90 % for T3/4 tumors which is quite superior to results from a meta-analysis including 19 studies [17].…”

Section: Discussionsupporting

confidence: 91%

Diagnostic value of preoperative CT scan to stratify colon cancer for neoadjuvant therapy

Wiegering

Kunz

Hussein

et al. 2015

Int J Colorectal Dis

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Section: Discussionsupporting

confidence: 91%

Diagnostic value of preoperative CT scan to stratify colon cancer for neoadjuvant therapy

Wiegering

Kunz

Hussein

et al. 2015

Int J Colorectal Dis

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“…The potential for using CT to produce a valid cTN stage has been discussed in several other studies. Some previous studies have shown acceptable agreement between cTN and pTN (5, 9), while others have, as in the present study, shown poor levels of agreement (10,11). Although some studies have presented moderately superior results compared to the current study, they have all struggled to identify high-risk tumors (4,6,9–11).…”

Section: Discussioncontrasting

confidence: 46%

Tumor and nodal staging of colon cancer: accuracy of preoperative computed tomography at a Swedish high-volume center

Korsbakke

Dahlbäck

Karlsson

et al. 2019

Acta Radiologica Open

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Background: When deciding treatment options for patients with colon cancer, accurate staging is required. In Sweden, the main preoperative evaluation modality to determine tumor and nodal stage is computed tomography (CT). Purpose: The aim of this study was to investigate how well the preoperative (CT-determined) clinical tumor and nodal stage (cTN) correlated with the postoperative histopathological stage (pTN). Another aim was to validate the tumor and nodal stage data in the Swedish Colorectal Cancer Registry (SCRCR). Material and Methods: The SCRCR was used to identify patients with colon cancer, treated at a Swedish high-volume center during 2013-2016 (n ¼ 974). Data were gathered from medical records regarding cTN and pTN stage, and predefined patient and tumor variables. The agreement between cTN and pTN was analyzed using kappa statistics. Results: After excluding patients with either pre-or postoperative TN stage missing, 383 patients remained for further analyses. The analyses showed an agreement between cT and pT of j: 0.27 and between cN and pN of j: 0.21 (fair agreement). When comparing tumors with low (T1-3; N0) versus high risk (T4; N1-2), the kappa value was 0.19 (slight agreement). When comparing the SCRCR to medical records, 78% of completely staged tumors had been correctly reported. Conclusion: The agreement between cTN and pTN was low in this study population, indicating a need for enhanced precision of the preoperative staging process. A high frequency of erroneous preoperative staging data in the SCRCR shows the need for further efforts of ensuring correct data transfers into the registry.

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“…Lao et al . evaluated the accuracy of conventional CT in local staging in colon cancer in 153 tumours. They showed that CT had a sensitivity of 70.2% and a specificity of 79.2%.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis [1] showed that CT is able to detect tumour invasion beyond the bowel wall (T1/T2 vs T3/T4), although the reported studies have a high variability, with wide ranges of sensitivity (55-98%) and specificity (33-100%). Lao et al [30] evaluated the accuracy of conventional CT in local staging in colon cancer in 153 tumours. They showed that CT had a sensitivity of 70.2% and a specificity of 79.2%.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of CT colonography in the preoperative staging of colon cancer: a prospective study of 217 patients

et al. 2019

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Aim The purpose of the present study was to evaluate the accuracy of computed tomography colonography (CTC) in the preoperative localization and TN staging of colon cancer. CTC can be an effective technique for preoperative evaluation of colon cancer and could facilitate the selection of high‐risk patients who may benefit from neoadjuvant chemotherapy. Method This was a prospective observational study conducted at a single tertiary‐care centre. It involved 217 patients (225 tumours) who had colon cancer and underwent preoperative CTC and elective colectomy. The radiologist determined the TNM stage using postprocessing software with multiplanar images and virtual colonoscopy. The following criteria were analysed for every colon tumour: location, size and signs of direct colon wall invasion. The histopathological findings of the surgical colectomy specimens served as the reference standard for local staging. Results CTC detected all tumours and achieved an exact location in 208 cases (92.4%). CTC findings changed the surgical plan in 31 patients (14.3%) following colonoscopy. The accuracy in differentiating T3/T4 vs T1/T2 tumours was 87.1%, with a sensitivity and specificity of 88.5% and 84.1%, respectively (kappa = 0.71). For high‐risk tumours (T3 ≥ 5 mm and T4), CTC showed an accuracy, sensitivity and specificity of 82.7%, 86% and 80%, respectively (kappa = 0.65). The accuracy of N‐stage evaluation was 69.3%, the sensitivity 74% and the specificity 67.1% (kappa = 0.37). Conclusion CTC provides accurate information for the assessment of tumour localization and T staging, allowing better surgical planning and also allows the selection of locally advanced tumours that may benefit from new treatments such as neoadjuvant chemotherapy.

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Computed tomography has low sensitivity for the diagnosis of early colon cancer

Abstract: CT scanning of colonic cancer showed 75% accuracy in identifying T1 and T2 cancers combined, but gave poor agreement between CT and histopathology for individual T stages.

Cited by 26 publications

References 15 publications

Diagnostic value of preoperative CT scan to stratify colon cancer for neoadjuvant therapy

Diagnostic value of preoperative CT scan to stratify colon cancer for neoadjuvant therapy

Tumor and nodal staging of colon cancer: accuracy of preoperative computed tomography at a Swedish high-volume center

Accuracy of CT colonography in the preoperative staging of colon cancer: a prospective study of 217 patients

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