Systematic analysis of missed colorectal cancer cases and common pitfalls in diagnosis

Vaughan-Shaw, Peter G; Aung, M; Knight, Hannah; Williams, Tamasha; Borley, Neil; Wheeler, J. M. D.

doi:10.1136/flgastro-2014-100513

Cited by 5 publications

(2 citation statements)

References 26 publications

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“…Our reported missed rate of 48.8% is higher than reported rates for CT misses [17][18][19]. In the previous studies, missed CRCs occurred with all modalities, although highest with double contrast barium enema at 27% while CT had a miss rates between 6 to 20% depending on technique [17][18][19]. These studies evaluated missed cancers within 1 and 3 years of diagnosis for CT and all modalities, respectively [17,19].…”

Section: Stagementioning

confidence: 57%

“…In the previous studies, missed CRCs occurred with all modalities, although highest with double contrast barium enema at 27% while CT had a miss rates between 6 to 20% depending on technique [17][18][19]. These studies evaluated missed cancers within 1 and 3 years of diagnosis for CT and all modalities, respectively [17,19]. In the report from Klang, et al the missed colon cancers were missed because of absence of fat stranding, vascular engorgement, or mesenteric lymphadenopathy [17].…”

Section: Stagementioning

confidence: 99%

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Detecting Early Colorectal Cancer on Routine CT Scan of the Abdomen and Pelvis Can Improve Patient’s 5-year Survival

Rodriguez¹,

Perkins²,

Park³

et al. 2019

Arch Biomed Clin Res

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Purpose: Colorectal cancer (CRC) is the third most common cancer in the United States, and prognosis is greatly influenced by stage at diagnosis. Early colorectal cancer can be subtle on CT scans showing only mild wall thickening, small polyps, or subtle lymph nodes in atypical draining location. Identifying these lesions on CT scan performed for nonspecific symptoms can help identify interval CRC and improve patient outcome. The purpose of the present study is to classify the undetected CRC on abdominal CT scan by their imaging features and whether early identification can downstage CRC patients. Materials and methods:A retrospective analysis was conducted of patients (pts) diagnosed with CRC and receiving treatment or sought second opinion at Banner MD Anderson Cancer Center. Data collection included age, gender, ECOG, KRAS mutation status, and overall survival (OS). CT imaging was obtained from the time of diagnosis, as well as any prior abdominal imaging available. Images were reviewed for multiple CT features including appearance of mass, mesenteric infiltration, abnormal draining lymph nodes, contrast enhancement relative to adjacent mucosa, and intralesional calcifications. Staging was evaluated using available clinical note and CT scan, based on the TNM staging system for CRC. Results:The 41 pts with 51 prediagnostic CTs from 1/1/2012 -12/31/2015 had mean age of 68 years (range:44-90) Mean ECOG status for the population was 1.46. 41% of the prediagnostic CTs had undetected findings. 52 and 43 % of the undetected findings were in the rectosigmoid and ascending colon respectively. Of the 15 undetected masses, 9 appeared as asymmetric wall thickening, 3 as concentric wall thickening, and 3 as polyps. Of the 14 undetected lymph node groups, 2 were excluded due to stability or nonrelated condition. The remaining lymph nodes were found in the associated draining station and averaged 3±1.2 mm in size. On average, the stage at prediagnostic CT was 3A and the diagnostic CT was 3C (p=0.0015). Average time lapse between prediagnostic and diagnostic CT was 21 months (3-64 months). ConclusionOur study demonstrated that high percentage of early-stage CRC findings are undetected on abdominal CT due to their subtle feature, with most undetected location in the rectosigmoid and ascending colon. In general, these subtle features predate the actual diagnosis by up to two years. Early detection of CRC can improve survival by lowering the stage from 3C to 3A, thus providing 36% improvement in 5-year survival. A dedicated search can be performed on the abdominal CT to improve detection by specifically looking for polyps, wall thickening, and small lymph nodes in the draining station.

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