Abstract
BackgroundThe Chinese Society of Clinical Oncology guidelines 2018 and the recent update of that (version 2020) recommends accurate examination before major treatment for decision(s) in cases of colon cancer. Also, the difficulty in the identification of the lesion during colectomy may lead to resection of a wrong segment of the colon or a more extensive resection than planned. Accurate pre-colectomy local staging of colon cancer is required to make decisions for treatment of colon cancer. The objective of the study was to evaluate the diagnostic performance of the computed tomography colonography (CTC) for pre-colectomy tumor location and tumor, node, and metastasis (TNM) staging of colon cancer.MethodsData of preoperative colonoscopies, CTC, surgeries, and surgical pathology of a total of 269 patients diagnosed with colon cancer by colonoscopy and biopsy and underwent pre-colectomy location and TNM staging by CTC were collected and analyzed. The consistency between the radiological and the surgery/surgical-pathological for location and TN stages of colon tumor were estimated with the weighted kappa or kappa coefficient (κ) at 95% confidence interval (CI).ResultsCTC detected 261 (93%) and colonoscopy detected 201 (72%) correct locations of tumors. Sensitivity and accuracy of CTC for detection of location of colon tumors were 100% and 92.58% (κ = 0.89; 95% Cl: 0.83–0.95). 72.48% sensitivity, 90.64% specificity, and 83.57% accuracy were reported for CTC in differentiation of tumors confined to the colon wall (T1/T2) from advanced tumors (T3/T4) (κ = 0.69, 95% Cl: 0.51–0.75). 81.01% sensitivity, 89.11% specificity, and 83.93% accuracy of CTC was reported for differentiation of tumors between low–intermediate risk and high risk (κ = 0.68, 95% Cl: 0.53–0.75). 69.31% sensitivity, 66.15% specificity, and 67.14% accuracy of CTC were reported for N staging of tumors (κ = 0.41, 95% Cl: 0.59–0.69).ConclusionsCTC has high diagnostic parameters for pre-colectomy location and T staging of colon tumors except patients of colon cancer who received neoadjuvant chemotherapy.Level of EvidenceIII.Technical Efficacy Stage2.
Highlights
The Chinese Society of Clinical Oncology guidelines 2018 and the recent update of that recommends accurate examination before major treatment for decision(s) in cases of colon cancer
Pre-colectomy colonoscopy and computed tomography colonography (CTC) examinations, surgeries, and surgical pathology of a total of 269 patients diagnosed with colon cancer by colonoscopy and biopsy and underwent pre-colectomy location and TNM staging by CTC were collected from the institutional records of patients and analyzed
A total of 280 tumors were evaluated by colonoscopy, CTC, exercised surgically, and examined surgical pathologically
Summary
The Chinese Society of Clinical Oncology guidelines 2018 and the recent update of that (version 2020) recommends accurate examination before major treatment for decision(s) in cases of colon cancer. The objective of the study was to evaluate the diagnostic performance of the computed tomography colonography (CTC) for pre-colectomy tumor location and tumor, node, and metastasis (TNM) staging of colon cancer. The computed tomography colonography (CTC) or virtual colonoscopy is effective for the detection of colon cancer [2] and is used for the examination of the whole colon [3, 4] It allows the identification and examination of lesions of the colon for local staging of cancer, which is difficult in conventional CT [4]. The prospective studies [4,5,6] and comparative studies [7,8,9] have evaluated CTC in the local staging of colon cancer and reported promising results with accuracies of 78–92%. Magnetic resonance imaging is the gold standard for rectal cancer diagnosis [4]
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