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Locoregional CT staging of colon cancer: does a learning curve exist?

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Abstract

Purpose

To evaluate the learning curve for locoreginal staging of colon cancer in radiologist trainees.

Methods

Eighty-eight cases of colon cancer CT were included in this retrospective study. Four senior radiology residents staged the CTs according to TNM classification. Two out of four radiologists received feedback after reading every 20 cases. Radiologic staging was compared with pathologic staging and the learning curve, diagnostic performance, reader confidence and reading time were evaluated and compared between the two groups (feedback vs. no feedback). Generalized estimating equations logistic regression, QICu statistic, ANOVA and t test/Mann–Whitney test were utilized.

Results

Radiologists demonstrated a significant increase in their performance to distinguish between ≤ T2 and ≥ T3 and reached an inflection point at 38 cases, with a significant association with increased number of cases reviewed (P < 0.001). Sensitivity (P < 0.001), specificity (P = 0.030) and NPV (P = 0.002) demonstrated significant associations with increased experience. The overall reader’s confidence was significantly higher in the group which received feedback (P < 0.001). There was no significant improvement in performance nor in reader’s confidence for N staging (N0 vs. ≥ N1) for all readers. Reading time decreased with experience and showed a significant negative association with experience (P < 0.001).

Conclusion

Diagnostic performance of senior radiology trainees in differentiating between T2 and T3 colon cancer on CTs improved with increased experience. In contrast, evaluation of lymph node involvement did not improve with more experience. Feedback had no significant effect on improvement of diagnostic performances.

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Authors and Affiliations

  1. Department of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands

    Eun Kyoung Hong, Francesca Castagnoli, Nicolo Gennaro, Federica Landolfi, Carlos Perez-Serrano, Ieva Kurilova & Regina Beets-Tan

  2. Department of Radiology, Seoul National University Hospital, Seoul, Korea

    Eun Kyoung Hong

  3. Department of Radiology, University of Brescia, Brescia, Italy

    Francesca Castagnoli

  4. Department of Radiology, Humanitas Clinical and Research Center IRCCS, Milan, Italy

    Nicolo Gennaro

  5. Radiology Unit, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy

    Federica Landolfi

  6. Department of Radiology, Hospital Clinic of Barcelona, Barcelona, Spain

    Carlos Perez-Serrano

  7. GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands

    Ieva Kurilova

  8. Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, Netherlands

    Sander Roberti

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  1. Eun Kyoung Hong
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Correspondence to Eun Kyoung Hong.

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Hong, E.K., Castagnoli, F., Gennaro, N. et al. Locoregional CT staging of colon cancer: does a learning curve exist?. Abdom Radiol 46, 476–485 (2021). https://doi.org/10.1007/s00261-020-02672-7

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  • DOI: https://doi.org/10.1007/s00261-020-02672-7

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