Abstract
Objective
To assess the effect of true axial computed tomography on the accuracy of staging of colonic cancers.
Method
Fifty consecutive datasets were independently assessed by three radiologists, experienced in colorectal cancer staging. The first read was of standard axial images only. The second read was 6 weeks later and true axial images, through the tumour and perpendicular to its long axis, were included.
Results
The overall accuracy for tumour staging was 56% for reader 1, 48% for reader 2 and 64% for reader 3 for standard axial CT. This improved to 72% (p = 0.012), 66% (p = 0.012) and 80% (p = 0.021) when the true axial images were added. For nodal staging, overall accuracy improved from 56% to 70% (p = 0.065) for reader 1, 58% to 76% (p = 0.012) for reader 2 and 60% to 76% (p = 0.021) for reader 3 between reads.
Conclusion
The accuracy of CT staging of colonic tumours is significantly improved by reviewing images reconstructed in a plane perpendicular to the long axis of the tumour. The accuracy achieved by this analysis is similar to that of CT colonography but avoids the extra complexity, additional cost and increased complications.
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References
CancerStats. 2007; Available from: http://info.cancerresearchuk.org/cancerstats/incidence/?a=5441. Accessed November 16, 2010
Balthazar EJ, Megibow AJ, Hulnick D, Naidich DP (1988) Carcinoma of the colon: detection and preoperative staging by CT. AJR Am J Roentgenol 150(2):301–306
Freeny PC, Marks WM, Ryan JA, Bolen JW (1986) Colorectal carcinoma evaluation with CT: preoperative staging and detection of postoperative recurrence. Radiology 158(2):347–353
Hundt W, Braunschweig R, Reiser M (1999) Evaluation of spiral CT in staging of colon and rectum carcinoma. Eur Radiol 9(1):78–84
Mauchley DC, Lynge DC, Langdale LA, Stelzner MG, Mock CN, Billingsley KG (2005) Clinical utility and cost-effectiveness of routine preoperative computed tomography scanning in patients with colon cancer. Am J Surg 189(5):512–517, discussion 517
Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25(21):3061–3068
Brown G, Daniels IR, Richardson C, Revell P, Peppercorn D, Bourne M (2005) Techniques and trouble-shooting in high spatial resolution thin slice MRI for rectal cancer. Br J Radiol 78(927):245–251
Sobin LH, Wittekind C (eds) (2002) TNM classification of malignant tumors, 6th edn. Wiley-Liss, New York
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174
Wieder HA, Rosenberg R, Lordick F, Geinitz H, Beer A, Becker K et al (2007) Rectal cancer: MR imaging before neoadjuvant chemotherapy and radiation therapy for prediction of tumor-free circumferential resection margins and long-term survival. Radiology 243(3):744–751
MECURY (2006) Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 333(7572):779
Smith NJ, Bees N, Barbachano Y, Norman AR, Swift RI, Brown G (2007) Preoperative computed tomography staging of nonmetastatic colon cancer predicts outcome: implications for clinical trials. Br J Cancer 96(7):1030–1036
Burton S, Brown G, Bees N, Norman A, Biedrzycki O, Arnaout A et al (2008) Accuracy of CT prediction of poor prognostic features in colonic cancer. Br J Radiol 81(961):10–19
Gray PR, Morton MD, Seymour PM. FOxTROT: fluoropyrimidine, oxaliplatin & targeted receptor pre-operative therapy for colon cancer. A randomised trial assessing whether preoperative chemotherapy and/or an anti-EGFR monoclonal antibody improve outcome in high-risk opera- ble colon cancer. [cited 2009 20/07/2009]; Available from: http://www.foxtrot.bham.ac.uk/
Chung DJ, Huh KC, Choi WJ, Kim JK (2005) CT colonography using 16-MDCT in the evaluation of colorectal cancer. AJR Am J Roentgenol 184(1):98–103
Harvey CJ, Amin Z, Hare CM, Gillams AR, Novelli MR, Boulos PB et al (1998) Helical CT pneumocolon to assess colonic tumors: radiologic-pathologic correlation. AJR Am J Roentgenol 170(6):1439–1443
Kanamoto T, Matsuki M, Okuda J, Inada Y, Tatsugami F, Tanikake M et al (2007) Preoperative evaluation of local invasion and metastatic lymph nodes of colorectal cancer and mesenteric vascular variations using multidetector-row computed tomography before laparoscopic surgery. J Comput Assist Tomogr 31(6):831–839
Filippone A, Ambrosini R, Fuschi M, Marinelli T, Genovesi D, Bonomo L (2004) Preoperative T and N staging of colorectal cancer: accuracy of contrast-enhanced multi-detector row CT colonography–initial experience. Radiology 231(1):83–90
Sinha R, Verma R, Rajesh A, Richards CJ (2006) Diagnostic value of multidetector row CT in rectal cancer staging: comparison of multiplanar and axial images with histopathology. Clin Radiol 61(11):924–931
Kulinna C, Eibel R, Matzek W, Bonel H, Aust D, Strauss T et al (2004) Staging of rectal cancer: diagnostic potential of multiplanar reconstructions with MDCT. AJR Am J Roentgenol 183(2):421–427
Brown G, Kirkham A, Williams GT, Bourne M, Radcliffe AG, Sayman J et al (2004) High-resolution MRI of the anatomy important in total mesorectal excision of the rectum. AJR Am J Roentgenol 182(2):431–439
Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT (2003) Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg 90(3):355–364
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Anderson, E.M., Betts, M. & Slater, A. The value of true axial imaging for CT staging of colonic cancer. Eur Radiol 21, 1286–1292 (2011). https://doi.org/10.1007/s00330-010-2019-9
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DOI: https://doi.org/10.1007/s00330-010-2019-9