Accuracy of radiological staging in identifying high‐risk colon cancer patients suitable for neoadjuvant chemotherapy: a multicentre experience

Dighe, Shwetal; Swift, Ian; Magill, Laura; Handley, Kelly; Gray, Richard; Quirke, Philip; Morton, Dion; Seymour, Michel; Warren, Bryan F.; Brown, Gina

doi:10.1111/j.1463-1318.2011.02638.x

Cited by 97 publications

(65 citation statements)

References 9 publications

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“…19 This was the initial entry criteria for the FOXTROT study and remains the entry criteria for patients who are older and frailer. Accuracy for the identification of T3 or greater disease has previously been reported for CT by Dighe et al 29 at 70%, and by Rollven et al 6 at 79% for Observer 1 and 76% for Observer 2. The Rollven et al study also reports that the accuracy of 1.5-T MRI is very high, with an accuracy of 90% (95% CI 74-96%) for Observer 1 and 93% (95% CI 78-98%) for Observer 2 in a study of 28 patients.…”

Section: Discussionmentioning

confidence: 83%

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: 83%

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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“…The ability of MRI to rule out EMVI provides clinicians with valuable information, because EMVI results in a poorer five-year survival (25.0%) than if EMVI is absent (57.4%) 22 . A recent large study 21 , which used CT to detect EMVI, described a low sensitivity and mediocre specificity (Table 4). Furthermore the study by Rollven et al 20 confirms the superior accuracy of MRI for EMVI while the study by Hunter et al 19 reports a low sensitivity with a good specificity (table 4).…”

Section: Discussionmentioning

confidence: 99%

MRI for Local Staging of Colon Cancer: Can MRI Become the Optimal Staging Modality for Patients With Colon Cancer?

Nerad

Lambregts²,

Kersten

et al. 2017

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Colon cancer is currently staged with CT. However, MRI is superior in the detection of colorectal liver metastasis, and MRI is standard in local staging of rectal cancer. Optimal (local) staging of colon cancer could become crucial in selecting patients for neoadjuvant treatment in the near future (Fluoropyrimidine Oxaliplatin and Targeted Receptor Preoperative Therapy trial). OBJECTIVE: The purpose of this study was to evaluate the diagnostic performance of MRI for local staging of colon cancer. DESIGN: This was a retrospective study. SETTINGS: The study was conducted at the Maastricht University Medical Centre. PATIENTS: In total, 55 patients with biopsy-proven colon carcinoma were included. MAIN OUTCOME MEASURES: All of the patients underwent an MRI (1.5-tesla; T2 and diffusion-weighted imaging) of the abdomen and were retrospectively analyzed by 2 blinded, independent readers. Histopathology after resection was the reference standard. Both readers evaluated tumor characteristics, including invasion through bowel wall (T3/T4 tumors), invasion beyond bowel wall of ≥5 mm and/or invasion of surrounding organs (T3cd/T4), serosal involvement, extramural vascular invasion, and malignant lymph nodes (N+). Interobserver agreement was compared using κ statistics. RESULTS: MRI had a high sensitivity (72%–91%) and specificity (84%–89%) in detecting T3/T4 tumors (35/55) and a low sensitivity (43%–67%) and high specificity (75%–88%) in detecting T3cd/T4 tumors (15/55). For detecting serosal involvement and extramural vascular invasion, MRI had a high sensitivity and moderate specificity, as well as a moderate sensitivity and specificity in the detection of nodal involvement. Interobserver agreements were predominantly good; the more experienced reader achieved better results in the majority of these categories. LIMITATIONS: The study was limited by its retrospective nature and moderate number of inclusions. CONCLUSIONS: MRI has a good sensitivity for tumor invasion through the bowel wall, extramural vascular invasion, and serosal involvement. In addition, together with its superior liver imaging, MRI might become the optimal staging modality for colon cancer. However, more research is needed to confirm this. See Video Abstract at http://links.lww.com/DCR/A309.

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“…First results are promising and show, in an equally randomized cohort, lower tumor stages after neoadjuvant chemotherapy compared to patients who undergo surgery immediately. In this setting, the crucial point is to identify patients who are suitable for neoadjuvant therapy [12].…”

Section: Introductionmentioning

confidence: 99%

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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Accuracy of radiological staging in identifying high‐risk colon cancer patients suitable for neoadjuvant chemotherapy: a multicentre experience

Abstract: In a multicentre setting, CT scanning identified high-risk (T3/4) colon cancers with minimal overstaging of T1/T2 tumours, thus establishing the feasibility of radiologically guided neoadjuvant chemotherapy.

Cited by 97 publications

References 9 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

MRI for Local Staging of Colon Cancer: Can MRI Become the Optimal Staging Modality for Patients With Colon Cancer?

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

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