Abstract
BackgroundTo study different imaging criteria for prediction of lymph node metastases (Stage III disease) in colon cancer using CT.MethodsIn a retrospective setting, 483 consecutive patients with histology proven colon cancer underwent elective primary resection during 2008–2011, a cohort of 119 patients were included. Contrast enhanced CT examinations, in portal-venous phase, were reviewed with assessment of the number of lymph nodes, their anatomical distribution, size, size ratio, internal heterogeneity, presence of irregular outer border and attenuation values. Sensitivity, specificity, PPV and NPV for each studied criteria for prediction of stage III disease was calculated.ResultsAccording to histopathology 80 patients were stage I-II and 39 were stage III. Of the studied CT-criteria for lymph node metastases per patient, internal heterogeneity in at least one lymph node resulted in the best performance with sensitivity, specificity, PPV and NPV of 79, 84, 70 and 89%, Odds ratio (OR) 20. Presence of irregular outer border resulted in a sensitivity, specificity, PPV and NPV of 59, 81, 61 and 82%, OR 6.2. If both internal heterogeneity and/or irregular outer border was used as a criterion this resulted in a sensitivity, specificity, PPV and NPV of 85, 75, 62 and 91%, OR 16.5. None of the size criteria used were predictive for stage III disease.ConclusionsWhen performing preoperative CT in patients with colon cancer, the imaging criteria that allow best prediction of stage III disease on CT are either presence of at least one lymph node with internal heterogeneity or internal heterogeneity and/or irregular outer border. These criteria have to be validated in a prospective study.
Highlights
To study different imaging criteria for prediction of lymph node metastases (Stage III disease) in colon cancer using computed tomography (CT)
The aim of this study was to assess whether the number of lymph nodes, their anatomical distribution, size, size ratio, internal heterogeneity, irregular outer border and attenuation values on preoperative CT, either alone or in combination, were predictive for stage III disease
CT evaluation Number, anatomical distribution, size and size-ratio of lymph nodes At CT, most of the lymph nodes were located in region 1
Summary
To study different imaging criteria for prediction of lymph node metastases (Stage III disease) in colon cancer using CT. The treatment is surgical removal of the tumour containing segment of the bowel together with local and regional lymph nodes. Adjuvant chemotherapy is standard treatment for patients with stage III disease and in some patients with stage II disease, depending on presence of additional histological risk factors. Well-known important prognostic factors in colon cancer are tumour stage (T), extramural vascular invasion (EMVI) and lymph node involvement (N) [2]. Even the total number of harvested lymph nodes at surgery and lymph node ratio (the ratio between lymph node metastases and examined lymph nodes, LNR) assessed by the pathologist has a prognostic importance [3,4,5]
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