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Accuracy of radiological staging in identifying high‐risk colon cancer patients suitable for neoadjuvant chemotherapy: a multicentre experience
Author(s) -
Dighe S.,
Swift I.,
Magill L.,
Handley K.,
Gray R.,
Quirke P.,
Morton D.,
Seymour M.,
Warren B.,
Brown G.
Publication year - 2012
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2011.02638.x
Subject(s) - medicine , colorectal cancer , radiology , pathological , histopathology , radiological weapon , neoadjuvant therapy , chemotherapy , cancer , pathology , breast cancer
Aim A pilot study was undertaken to determine the accuracy of computed tomography (CT) staging in identifying patients with high‐risk colon cancers who would be considered as candidates for a neoadjuvant therapy trial (FOxTROT) and those at low risk (T1/T2) who would be excluded. Method Participating radiologists from 19 centres attended workshops for standardization of image interpretation according to previously defined prognostic criteria: good prognosis tumours, including, T1/T2; intermediate prognosis, T3 < 5 mm tumour invasion beyond the muscularis propria (MP); and poor prognosis tumours, including T3 with tumour extension ≥ 5 mm beyond the MP or T4. The CT findings were compared with histopathology as the reference standard. Results Of 94 patients with radiological and pathological data, 71% were categorized by CT as having a poor prognosis. The sensitivity and specificity of CT in identifying these tumours were 87% (95% CI, 74–94) and 49% (95% CI, 33–65). Sensitivity and specificity for tumour infiltration beyond the MP (T3/T4 vs T1/T2) were 95% (95% CI, 87–98) and 50% (95% CI, 22–77), respectively. Including all CT‐staged T3 and T4 patients in the trial would have increased the proportion eligible for entry to 89% ( n = 84) without affecting the false‐positive rate of 7%. Some 20% of T3/T4 patients would have been ineligible for FOxTROT because of synchronous metastases. Conclusion In a multicentre setting, CT scanning identified high‐risk (T3/4) colon cancers with minimal overstaging of T1/T2 tumours, thus establishing the feasibility of radiologically guided neoadjuvant chemotherapy.