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Endoscopic ultrasonography and computed tomography scanning for preoperative staging of colonic cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

With an increasing demand for more accurate preoperative staging methods for colon cancer, we aimed to compare preoperative tumour (T)- and nodal (N)-stage in patients with left-sided colon cancer by endoscopic ultrasonography (EUS) and computed tomography (CT) with post-operative histology as gold standard.

Methods

A total of 44 patients were prospectively recruited at Herlev and Roskilde University Hospitals during November 2014–January 2016. Thirty-five patients were included in the final analysis and underwent EUS, CT and surgery within 2 weeks. Diagnostic values were evaluated for “low risk” (T1+T2+T3 with ≤5 mm extramural invasion) and “high risk” (T3 with >5 mm of extramural spread + T4) colonic cancer.

Results

Sensitivity and specificity in “low risk” colonic cancer evaluated with EUS was 0.90 [0.74;0.98] and 0.75 [0.19;0.99] and with CT 0.96 [0.80;0.99] and 0.25 [<0.01;0.81]. EUS and CT were poor in predicting N0 or N+ disease.

Conclusions

The sensitivity of EUS and CT were good and comparable regarding T-stage evaluation, while EUS had a significantly higher specificity in the evaluation of “low risk” tumours. The results obtained for “high risk” colonic cancer were difficult to evaluate due to small patient numbers. EUS could be considered as a supplement to CT scans in selecting patients for neoadjuvant therapies, or local transmural treatment, in the future.

Trial registration

NCT02324023

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Acknowledgements

We thank project nurses Louise Rasmussen, Helle Kaels and Julia Lyhne Fiehn and secretary Anette Eildal from Herlev Hospital as well as project nurse Helle Buck Rasmussen and secretary Bettina Nissen Ravn Appelsø from Roskilde Hospital for great work and enthusiasm. A thanks also to all involved doctors at both Roskilde and Herlev Hospitals, introducing the projects to the patients at primary admission and to the staff at the endoscopy unit at Herlev Hospital. A special thanks to Roald Flesland Havre, a visiting consultant from Bergen, Norway, and to radiographer Ulrik Jermiin Frost from Herlev Hospital, for technical CT assistance.

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Authors and Affiliations

  1. Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark

    ML Malmstrøm, H Hassan & P Vilmann

  2. Department of Surgery, Zealand University Hospital, University of Copenhagen, Køge, Denmark

    ML Malmstrøm & I Gögenur

  3. Department of Pathology, Herlev Hospital, University of Copenhagen, Herlev, Denmark

    LB Riis

  4. Department of Hematology, Herlev Hospital, University of Copenhagen, Herlev, Denmark

    TW Klausen

  5. Department of Radiology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark

    T Perner

  6. Research Centre of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania

    A Săftoiu

Authors
  1. ML Malmstrøm
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  2. I Gögenur
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  3. LB Riis
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  4. H Hassan
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  5. TW Klausen
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  6. T Perner
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  7. A Săftoiu
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  8. P Vilmann
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Corresponding author

Correspondence to ML Malmstrøm.

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Funding

The study was funded by Agnes and Poul Friis Fund, Astrid Thaysens Legat, Axel Muusfeldts Fund, Dansk Medicinsk Selskab, Krista and Viggo Petersens Fund, Arvid Nilssons Fund, Director Jacob Madsens and wife Olga Madsens Fund, Director Svend Espersens Fund, Lykfeldts Fund, Harboefonden and the Research Councils of Herlev and Køge Hospitals.

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Malmstrøm, M., Gögenur, I., Riis, L. et al. Endoscopic ultrasonography and computed tomography scanning for preoperative staging of colonic cancer. Int J Colorectal Dis 32, 813–820 (2017). https://doi.org/10.1007/s00384-017-2820-x

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  • DOI: https://doi.org/10.1007/s00384-017-2820-x

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