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Performance of CT in the locoregional staging of colon cancer: detailed radiology-pathology correlation with special emphasis on tumor deposits, extramural venous invasion and T staging

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Abstract

Purpose

To investigate the performance of computed tomography (CT) in the local staging of colon cancer in different segments, with emphasis on parameters that have been found to be significant for rectal cancer, namely, extramural venous invasion (EMVI) and tumor deposits (TDs).

Methods

CT and pathology data from 137 patients were independently reviewed by radiology and pathology teams. The performance of CT in categorizing a given patient into good, versus poor prognostic groups was assessed for each segment, as well as the presence of lymph nodes (LNs), TDs and EMVIs. Discordant cases were re-evaluated to determine potential sources of error. Elastic stain was applied for EMVI discordance.

Results

The T staging accuracy was 80.2%. For T stage stratification, CT performed slightly better in the left colon, and the lowest accuracy was in the transverse colon. Under-staging was more common (in 12.4%), and most of the mis-staged cases were in sigmoid colon. According to the first comprehensive correlative analysis, the sensitivity, specificity, and accuracy of CT for detecting TDs were found to be 57.9%, 92.4%, 87.6%, respectively. These figures were 44.7%, 72.7%, and 63.5% for LN, and 58.5%, 82.1% and 73% for EMVI. The detection rate was better for multifocal EMVI. The detection rate was also comparable (although substantially underestimated) for LNs, with the half of the LNs missed by CT being < 5 mm. Four patients that were classified as TD by CT, disclosed to be LNs by pathology. Correlative analysis led to refinement of the pathology criteria, with subsequent modifications of the initial reports in 13 (9.5%) patients.

Conclusion

Overall, CT performed well in the evaluation of colon cancer, as did TD and EMVI. It is advisable to include these parameters in CT-based staging. Radiologists should be aware of the pitfalls that occur more commonly in different segments.

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The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Radiology, Koç University School of Medicine, 34010, Istanbul, Turkey

    Duygu Karahacioglu & Bengi Gurses

  2. Department of Pathology, Koç University School of Medicine, Istanbul, Turkey

    Orhun Cig Taskin, Ayse Armutlu, Burcu Saka & Volkan Adsay

  3. Koç University School of Medicine, Istanbul, Turkey

    Rohat Esmer

  4. Department of General Surgery, Koç University School of Medicine, Istanbul, Turkey

    Ibrahim Halil Ozata, Ahmet Rencuzogullari, Dursun Bugra & Emre Balik

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  1. Duygu Karahacioglu
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Contributions

DK: conceptualization; data curation; formal analysis; investigation; methodology; validation; writing original draft. OCT: conceptualization; data curation; formal analysis; methodology; validation; visualization. RE: conceptualization; data curation; formal analysis; methodology; validation. AA: conceptualization; data curation; formal analysis; methodology; validation; visualization. BS: conceptualization; data curation; formal analysis; methodology; validation; visualization. IHO: conceptualization; data curation, investigation. AR: conceptualization; data curation, investigation. DB: conceptualization; supervision. EB: conceptualization; methodology; validation; supervision. VA: conceptualization; data curation; methodology; investigation; supervision; writing—review & editing. BG: conceptualization; data curation; formal analysis; investigation; methodology; validation; visualization; writing—review & editing; supervision.

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Correspondence to Duygu Karahacioglu.

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Ethical approval was waived by the local Ethics Committee of Koç University in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Karahacioglu, D., Taskin, O.C., Esmer, R. et al. Performance of CT in the locoregional staging of colon cancer: detailed radiology-pathology correlation with special emphasis on tumor deposits, extramural venous invasion and T staging. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04203-0

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