Assessment and diagnostic accuracy of lymph node status to predict stage III colon cancer using computed tomography

Rollvén, Erik; Abraham-Nordling, Mirna; Holm, Torbjörn; Blomqvist, Lennart

doi:10.1186/s40644-016-0104-2

Cited by 58 publications

(42 citation statements)

References 28 publications

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“…It is difficult to distinguish benign lymph nodes that are enlarged due to inflammation from those with metastatic deposits, and also to detect microscopic metastases in lymph nodes with a normal appearance. Multiple radiological CT criteria for detection of metastatic lymph nodes have been evaluated with no conclusive results, showing 78–85% sensitivity and 41–75% specificity, similar to our findings (74% sensitivity and 67.1% specificity). Therefore, at present, the diagnostic value of CT and also CTC in N staging remains poor, and it should not be used in isolation to select potential candidates for NAC.…”

Section: Discussionsupporting

confidence: 85%

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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Section: Discussionsupporting

confidence: 85%

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

et al. 2019

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“…Internal enhancement of CT images is an alternative method to assess the degree of metastasis to LNs (17). Internal heterogeneity is considered a marker of LN+ (17). Subtle changes in internal enhancement features may provide additional valuable information for diagnosing LNs metastasis.…”

Section: Introductionmentioning

confidence: 99%

Contrast‑enhanced CT imaging for the assessment of lymph node status in patients with colorectal cancer

Miao

Chen

et al. 2020

Oncol Lett

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The aim of the present study was to identify a novel strategy that predicts the metastatic status of lymph nodes (LNs) in patients diagnosed with colorectal cancer, using detailed characteristics of contrast-enhanced CT scan images. A total of 284 preoperative CT scans derived from patients diagnosed with colorectal cancer at Second Affiliated Hospital, Zhejiang University School of Medicine between January 2013 and July 2018 were retrospectively reviewed. A total of 794 LNs were assessed for size, margins, morphology and subtle internal enhancements in the equilibrium phase. Imaging features were analyzed by two abdominal radiologists

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“…The assessment of lymph node status (N0/N+) was limited to three morphological criteria in line with a previous study in assessment of lymph node metastases criteria in colon cancer with CT: (a) internal heterogeneity within at least one lymph node (IH) defined as mixed attenuation within the lymph node; (b) irregular outer border (IOB) defined as indistinct demarcation of the lymph node and; (c) combination of the two criteria, and therefore called combined criteria [11] (Fig. 2).…”

Section: Ct Evaluationmentioning

confidence: 99%

“…A recently published study showed that assessment of morphology in the lymph nodes assessed by a single investigator, the combination of the criteria IH and IOB performed best in predicting nodal involvement, resulting in a sensitivity and specificity of 85% and 75%, respectively [11].…”

Section: Introductionmentioning

confidence: 99%

Morphological predictors for lymph node metastases on computed tomography in colon cancer

et al. 2019

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Introduction/Background The aim of the study was to assess morphological predictors for lymph node metastases (Stage III disease) in colon cancer on computed tomography. Methods and materials Ninety-four patients with histology-proven colon cancer (adenocarcinoma) who underwent elective primary curative resection between the years 2012 and 2014 were included. Contrast-enhanced CT examinations were independently reviewed by two blinded observers regarding tumor location, depth of tumor invasion, and presence of lymph node metastases. Ocular presence of internal heterogeneity and presence of irregular outer border were used as morphological criteria for lymph node involvement. Protocol-based histopathology after curative surgery served as reference standard. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy for each morphological criterion for prediction of stage III disease were calculated. Inter-observer agreement was compared using Kappa statistics. Results According to histopathology, 59 patients were staged as I-II disease and 35 patients were staged as stage III disease. The presence of internal heterogeneity in a lymph node on CT resulted in moderate sensitivity (66-77%) but high specificity (95-95%) for prediction of Stage III disease by both observers. The presence of irregular outer border also resulted in poor sensitivity (49-54%) but high specificity (97-97%). The combination of either internal heterogeneity and/or irregular outer border per patient resulted in a moderate sensitivity (67-77%) and high specificity (95-95%), PPV (89-96%), and NPV (84-88%). Inter-observer agreement (Cohens Kappa) was 0.72. Consensus reading for the combined criteria resulted in sensitivity and specificity of 69% and 100%, respectively. Conclusion Using morphological criteria for lymph node metastases on CT examination in patients with colon cancer results in high specificity but moderate sensitivity in predicting stage III disease.

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Assessment and diagnostic accuracy of lymph node status to predict stage III colon cancer using computed tomography

Cited by 58 publications

References 28 publications

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

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

Contrast‑enhanced CT imaging for the assessment of lymph node status in patients with colorectal cancer

Morphological predictors for lymph node metastases on computed tomography in colon cancer

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