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

Abstract

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.

National differences in implementation of minimally invasive surgery for colorectal cancer and the influence on short-term outcomes

“…In line with a previous collaborative project, we found that Dutch and Swedish patients had different patient-, tumour-, and surgical characteristics [8]. In addition, cTand cN-stages in colon cancer were more often defined by Swedish radiologists, despite the previously published unreliability of CT imaging for this purpose [48,49]. However, this had no clinical consequences, given similar proportions of neoadjuvant chemotherapy and pathological disease stages.…”

Clinical TNM staging for esophageal, gastric, and colorectal cancers in the era of neoadjuvant therapy: A systematic review of the literature

“…For lymph node staging (Table 3B), the sensitivity was found to range from 44% to 73%, and the specificity ranged from 41% to 84% 84‐90 . The accuracies of these studies were around 50%–60%.…”

“…For lymph node staging (Table 3B), the sensitivity was found to range from 44% to 73%, and the specificity ranged from 41% to 84%. [84][85][86][87][88][89][90] The accuracies of these studies were around 50%-60%. PET showed a relatively high specificity of 84%, but a sensitivity of only 44%.…”

The Impact of Patient Characteristics and Tumor Biology on the Accuracy of Preoperative Staging of Colon Cancer in Denmark. A Nationwide Cohort Study

“…Other patient and tumor characteristics, such as age, sex, body mass index (BMI) and tumor location (left vs. right colon), may also influence the accuracy of preoperative staging. Two recent Swedish studies were not able to demonstrate this unequivocally, but this may be because only Kappa statistics were used [8,9]. Since MMR status may be associated with both sidedness and histopathology, we suggest that adjusted, separate multivariate analysis of under-and over-staging may provide new and more useful information.…”