Rationale and Objectives
To predict the T stage of nonrectal colon cancer using contrast-enhanced computed tomography colonography.
Materials and Methods
Sixty-one patients with 67 nonrectal colon cancers consecutively underwent contrast-enhanced computed tomography colonography after an incomplete colonoscopy. Two readers evaluated wall deformity and perilesional fat abnormality on three-dimensional double contrast enema-like views and multiplanar reconstructions. Pathology was used as the standard of reference. McNemar, Fisher, and Cohen κ statistics were used.
Results
At pathologic examination, we found the following stages: T1 ( n = 5), T2 ( n = 10), T3 ( n = 41), T4a ( n = 6), and T4b ( n = 5). Intraobserver and interobserver reproducibilities were almost perfect for wall deformity (κ = 1.00 and κ = 0.88, respectively), substantial for perilesional fat abnormality (κ = 0.79 and κ = 0.74, respectively). Using the results of the more experienced reader, accuracy of wall deformity ≥50% (apple-core) alone for T ≥ 3 was 62 of 67 (0.93, 95% confidence interval [CI] 0.83–0.97) and that of perilesional fat abnormality alone was 37 of 67 (0.55, 95% CI 0.43–0.67) ( P < .001). Predictive value for ≥ T3 of the association wall deformity ≥50% with perilesional fat abnormality was 22 of 22 (1.00, 95% CI 0.85–1.00), higher, but not significantly, than that of wall deformity ≥50% with normal perilesional fat 29 of 33 (0.88, 95% CI 0.72–0.97) ( P = .148, Fisher exact test).
Conclusions
The presence of apple-core wall deformity, regardless of perilesional fat abnormality, is highly predictive of stage T3 or higher.
Computed tomography (CT) colonography (CTC) represents a good alternative to optical colonoscopy in diagnosing polyps and colorectal cancers because it has been shown to have similar accuracy, a higher patient compliance, and a lower rate of complications . Moreover, patients with a colorectal cancer detected on optical colonoscopy still benefit from CTC if optical colonoscopy is incomplete ; since contrast-enhanced CT is usually performed for staging, added benefit can be obtained by converting the routine staging CT into a contrast-enhanced CTC instead. Contrast-enhanced CT for preoperative T staging of colorectal cancer was first reported in 1986 but an acceptable accuracy was reached only with the advent of spiral CT using pneumocolon in 1998 . With the development of CTC, also known as virtual colonoscopy, different reports have described the usefulness of CTC in patients with known colorectal cancer and incomplete optical colonoscopy. Only a few studies have evaluated the accuracy of CTC in preoperative T staging of colorectal cancer, reporting values between 0.78 and 0.84 .
Preoperative T staging of rectal cancers has been well established, and magnetic resonance imaging (MRI) is the standard examination, while the same issue, not currently valid for colon cancers, may soon become more relevant. In particular, preoperative contrast-enhanced CTC staging could help with decisions concerning an appropriate type of surgery or chemoradiation.
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Materials and methods
Population
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Bowel Preparation
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CTC Protocol
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Image Analysis
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Reference Standard
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Statistical Analysis
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Results
Population and Colon Cancer
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Technical Quality of CE-CTC
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CE-CTC Findings
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Table 1
Sensitivity, Specificity, Predictive Values, and Accuracy of Apple-core WD Alone and Perilesional Fat Abnormality Alone for T Stage ≥ 3 at CE-CTC
Apple-core WD Perilesional Fat Abnormality Ratio Point Estimate 95% CI Ratio Point Estimate 95% CI Sensitivity 51/52 0.98 0.90–1.00 22/52 0.42 0.29–0.57 Specificity 11/15 0.73 0.45–0.92 15/15 1.00 0.78–1.00 Positive predictive value 51/55 0.93 0.82–0.98 22/22 1.00 0.85–1.00 Negative predictive value 11/12 0.92 0.62–1.00 15/45 0.33 0.20–0.49 Accuracy ∗ 62/67 0.92 0.83–0.97 37/67 0.55 0.43–0.67
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Discussion
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Acknowledgments
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