Accuracy of multidetector computed tomography in identifying poor prognostic factors in colonic cancer

Dighe, Shwetal; Blake, H.; Koh, Maria; Swift, Ian; Arnaout, Abed; Temple, Larissa K.; Barbáchano, Yolanda; Brown, Gina

doi:10.1002/bjs.7096

Cited by 93 publications

(64 citation statements)

References 54 publications

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“…16 The accuracy of MRI in this study for the identification of EMVI was again good at 74% for Reader 1 and 69% for Reader 2. The accuracy of CT for the identification of EMVI is reported in three previous studies; Burton et al reported an accuracy of 55% for Observer 1 and 61% for Reader 2, 31 Dighe et al 32 reported an accuracy of 70% and Rollven et al reported an accuracy of 78% for Reader 1 and 69% for Reader 2. Rollven et al also reported the accuracy of MRI of 78% and 82%.…”

Section: Discussionmentioning

confidence: 90%

Local staging and assessment of colon cancer with 1.5-T magnetic resonance imaging

Hunter¹,

Blake²,

Jeyadevan³

et al. 2016

BJR

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Objective: The aim of this study was to assess the accuracy of 1.5-T MRI in the pre-operative local T and N staging of colon cancer and identification of extramural vascular invasion (EMVI). Methods: Between 2010 and 2012, 60 patients with adenocarcinoma of the colon were prospectively recruited at 2 centres. 55 patients were included for final analysis. Patients received pre-operative 1.5-T MRI with high-resolution T 2 weighted, gadolinium-enhanced T 1 weighted and diffusion-weighted images. These were blindly assessed by two expert radiologists. Accuracy of the T-stage, N-stage and EMVI assessment was evaluated using post-operative histology as the gold standard. Results: Results are reported for two readers. Identification of T3 disease demonstrated an accuracy of 71% and 51%, sensitivity of 74% and 42% and specificity of 74% and 83%. Identification of N1 disease demonstrated an accuracy of 57% for both readers, sensitivity of 26% and 35% and specificity of 81% and 74%. Identification of EMVI demonstrated an accuracy of 74% and 69%, sensitivity 63% and 26% and specificity 80% and 91%. Conclusion: 1.5-T MRI achieved a moderate accuracy in the local evaluation of colon cancer, but cannot be recommended to replace CT on the basis of this study. Advances in knowledge: This study confirms that MRI is a viable alternative to CT for the local assessment of colon cancer, but this study does not reproduce the very high accuracy reported in the only other study to assess the accuracy of MRI in colon cancer staging.

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Section: Discussionmentioning

confidence: 90%

Local staging and assessment of colon cancer with 1.5-T magnetic resonance imaging

Hunter¹,

Blake²,

Jeyadevan³

et al. 2016

BJR

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“…20,21 However, only one report described CT-pathological correlation of venous invasion in small-or medium-sized veins. 22 In that report, the interobserver agreement for CT detection of venous invasion was poor, and the architecture of the vessel wall did not seem to be confirmed pathologically by additional special staining such as Elastica van Gieson stain (EVG). We thought that the agreement between radiologists was limited by poor understanding of the histology of MVI in colorectal cancer.…”

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confidence: 88%

Local massive venous invasion in colorectal cancer: CT-pathological correlation and its clinical implication

Nakajima¹,

Aoki²,

Sakurai³

et al. 2015

BJR

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Objective: To identify CT findings of massive venous invasion (MVI) in colorectal cancer, compare them to pathological findings and evaluate its clinical implications. Methods: Among 423 patients who received surgical resection of colorectal cancer, pre-operative CT of 26 patients (15 males, 11 females; mean age, 63.0 6 12.1 years) with histopathologially proven MVI and 26 patients (14 males, 12 females; mean age, 71.1 6 9.6 years) with histopathologically proven lymph node (LN) metastases were reviewed and compared with histopathological findings. We evaluated CT detectability of MVI and the morphologic differences between MVI and LN metastasis. All cases were followed up for at least 6 months after surgery. Results: Pre-operative CT correctly diagnosed only one case as tumour thrombus. 9 lesions were not detected on CT, and others were misdiagnosed pre-operatively as regional LN metastasis (14 cases) and juxtatumoural abscess (2 cases). After reviewing these cases, MVIs were identifiable in 20 of 26 cases. MVI was depicted on CT as nodules (oval, lobulated), abscess-like or intravenous tumour thrombus. MVI was significantly larger than LN metastasis (p , 0.05), while contrast enhancement was significantly lower (p , 0.05), and MVI often had an enhanced rim. Ten patients had synchronous metastases, and six patients had metachronous distant metastases within 5 years. Conclusion: Many cases of MVI were distinguishable from LN metastases on pre-operative CT of colorectal cancer, but their appearances were varied, reflecting their histopathological behaviours. The distant metastatic rate was much higher in cases with MVI. Advances in knowledge: Radiologists should be aware of CT findings of MVI in colorectal cancer as a sentinel sign of distant metastasis.Radiological staging is indispensable for the management of colorectal cancer. The TNM classification is a worldwide method for the staging.

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“…In a prospective audit of 84 patients with colon cancer undergoing pre-operative multidetector computerised tomography (CT) scanning, the accuracy, sensitivity and specificity for detection of LN disease was 58% [95% confidence interval (CI) 48% to 68%], 64% (95% CI 48% to 77%) and 53% (95% CI 39% to 67%), respectively, with poor interobserver agreement for node status. 15 Further, when nodes were assessed according to tumour node metastasis classification by separating into N0, N1 and N2 disease, the accuracy, sensitivity and specificity fell to 50% for all values. A meta-analysis of 19 studies has reported an overall sensitivity and specificity for CT-detected malignant LNs to be 70% (95% CI 59% to 80%) and 78% (95% CI 66% to 86%), respectively, with a diagnostic odds ratio of 8.1 (95% CI 4.7 to 14.1).…”

Section: Preoperative Lymph Node Stagingmentioning

confidence: 89%

Next Generation intraoperative Lymph node staging for Stratified colon cancer surgery (GLiSten): a multicentre, multinational feasibility study of fluorescence in predicting lymph node-positive disease

et al. 2016

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Background5-aminolevulinic acid (5-ALA) is used for fluorescence diagnosis (FD) in neurological, gynaecological and urological malignancies. The Medical Research Council/Efficacy and Mechanism Evaluation (EME) programme/National Institute for Health Research’s Next Generation intraoperative Lymph node staging for Stratified colon cancer surgery (GLiSten) study investigated its use to predict lymph node (LN)-positive disease in colon cancer as an aid to stratified surgery.ObjectivesThe primary objective was to optimise the dose of oral 5-ALA for intraoperative FD of metastatic LNs in colon cancer. Secondary objectives included standardisation of pre-operative computerised tomography (CT) LN reporting, intraoperative fluorescence detection, surgical resection with D3 lymphadenectomy and histopathological examination of resected specimens.DesignThis was a feasibility study to determine optimal strategies for 5-ALA positive LN detection. Patients with locally advanced disease identified using the Fluoropyrimidine, Oxaliplatin and Targeted-Receptor pre-Operative Therapy for patients with high-risk, operable colon cancer (FOxTROT) criteria were recruited from two sites between October 2013 and June 2015. Cohort 1 received 20 mg/kg and cohort 2 received 30 mg/kg of oral 5-ALA, 1–6 hours preoperatively. Laparoscopic assessment of fluorescence was performed using the Storz D-Light system (KARL STORZ GmbH & Co. KG; Tuttlingen, Germany), with marking of fluorescent LNs, followed by oncological resection. The specimen was subjected to histological analysis with step sectioning of marked fluorescent LNs. Progression to an evaluation phase using the optimal dosing schedule was dependent on positively identifying at least 2 out of 10 patients with metastatic LN disease in either cohort.ResultsA total of 44 patients were recruited with a male to female ratio of 26 : 18 and a mean age of 71 years (range 52–88 years). Cohort 1 consisted of 18 patients, of whom six had fluorescent primary cancers and three of these had fluorescent LNs. One out of 10 patients with metastatic LN disease had a fluorescent involved LN. Cohort 2 consisted of 26 patients, of whom eight had fluorescent primary cancers and four of these had fluorescent LNs. None of the fluorescent LNs contained disease in this cohort. No serious adverse events (SAEs) occurred but two mild, self-limiting, photosensitivity reactions were observed in cohort 2. The sensitivity and specificity for 5-ALA detection of LN-positive disease were: cohort 1 11.1%, 75%; and cohort 2 0%, 75%.LimitationsThis was a feasibility study exploring the use of 5-ALA for LN disease in a select cohort of patients with advanced colorectal cancer. The study population was small and generalisation to other cancers is not possible. The study was limited by the ability to determine LN-positive patients on the basis of pre-operative CT staging, which is often inaccurate, resulting in our cohorts containing several patients without LN disease.Conclusions5-ALA fluorescent diagnosis has poor sensitivity for discriminating LN-positive colon cancer. Its use as an aid to stratified colon cancer surgery is not supported. No SAEs were observed, suggesting that photosensitisers may be useful for intraoperative FD.Future work5-ALA has poor sensitivity for detecting LN metastases and cannot be recommended for intraoperative staging. Other, more sensitive fluorescent probes are required if this strategy is to be used.Study registrationCurrent Controlled Trials ISRCTN79949827 and EudraCT number 2012–002623–15.Funding detailsThis project was funded by the EME programme, a Medical Research Council and National Institute for Health Research partnership.

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Accuracy of multidetector computed tomography in identifying poor prognostic factors in colonic cancer

Abstract: As the ability of CT to identify node status is poor, the depth of tumour invasion beyond the muscularis propria is the most accurate way to identify patients with a poor prognosis who may be suitable for neoadjuvant treatment.

Cited by 93 publications

References 54 publications

Local staging and assessment of colon cancer with 1.5-T magnetic resonance imaging

Local staging and assessment of colon cancer with 1.5-T magnetic resonance imaging

Local massive venous invasion in colorectal cancer: CT-pathological correlation and its clinical implication

Next Generation intraoperative Lymph node staging for Stratified colon cancer surgery (GLiSten): a multicentre, multinational feasibility study of fluorescence in predicting lymph node-positive disease

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