Selection of colon cancer patients for neoadjuvant chemotherapy by preoperative CT scan

Anne Nørgaard; Claus Dam; Anders Jakobsen; John Pløen; Jan Lindebjerg; Søren R Rafaelsen

doi:10.3109/00365521.2013.862294

Selection of colon cancer patients for neoadjuvant chemotherapy by preoperative CT scan

Forfattere:

Nørgaard, Anne ;
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Vejle Sygehus
Dam, Claus ;
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Department of Radiology, Institute of Regional Health Research, Faculty of Health Sciences, SDU
Jakobsen, Anders ;
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Department of Oncology, Institute of Regional Health Research, Faculty of Health Sciences, SDU
Pløen, John ;
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Department of Oncology, Institute of Regional Health Research, Faculty of Health Sciences, SDU
Lindebjerg, Jan ;
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Clinical Pathology, Institute of Regional Health Research, Faculty of Health Sciences, SDU
Rafaelsen, Søren R
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0000-0001-5182-5545
Department of Radiology, Institute of Regional Health Research, Faculty of Health Sciences, SDU

DOI:

10.3109/00365521.2013.862294

Resumé:

Abstract Objective: Preoperative staging is essential to plan correct treatment of colon cancer and calls for objective, accurate methods for the introduction of neoadjuvant chemotherapy, which represents a new treatment option. Purpose: To evaluate the diagnostic accuracy of multislice computed tomography (CT) in local staging of colon cancer correlated with histopathological parameters, including criteria for adjuvant chemotherapy. Material and methods. A total of 74 included patients had preoperative CT scans and surgical resection of their colon tumors. Tumor stage (T-stage), extramural tumor invasion (ETI), nodal stage (N-stage), extramural venous invasion (EVI) and the distance from tumor to nearest retroperitoneal fascia (DRF) were retrospectively assessed on the CT scan and compared blindly with the results of the pathological examination, including evaluation of the criteria for adjuvant chemotherapy. Advanced tumors were defined as T3 with ETI ≥5 mm or T4. Results. Sixty-nine percent of the tumors were correctly T-staged by CT, 7% were overstaged and 24% were understaged. As to correct recognition of ETI on the CT scan, the observer was 73% accurate compared with histology (70% sensitivity (95% CI: 53-82%), 78% specificity (95% CI: 60-90%), 81% positive predictive value (PPV) (95% CI: 63-91%) and 66% negative predictive value (NPV) (95% CI: 49-80%). N-stage, EVI and DRF had poor accuracy: 53%, 53% and 64%. All patients with advanced tumors on CT fulfilled the criteria for adjuvant chemotherapy. Positive predictive value: 100% (95% CI: 88-100%). Conclusion. CT has a potential in the preoperative selection of advanced tumors suitable for neoadjuvant chemotherapy without overtreatment of low-risk patients.

Type:

Tidsskrift-artikel

Sprog:

Engelsk

Udgivet i:

Scandinavian Journal of Gastroenterology. Supplement, 2014, Vol 49, Issue 2, p. 202-208

Hovedforskningsområde:

Medical science

Publikationsstatus:

Publiceret

Review type:

Peer Review

Indberetningsår:

2014

Videnskabeligt niveau:

Videnskabelig

ID:

258705290

Selection of colon cancer patients for neoadjuvant chemotherapy by preoperative CT scan

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