Accuracy of radiological staging in identifying high-risk colon cancer patients suitable for neoadjuvant chemotherapy: a multicentre experience

• Published in: Colorectal disease Vol. 14; no. 4; pp. 438 - 444
• Main Authors: Dighe, S., Swift, I., Magill, L., Handley, K., Gray, R., Quirke, P., Morton, D., Seymour, M., Warren, B., Brown, G.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.04.2012
• Subjects: Aged; Antineoplastic Agents - therapeutic use; Chemotherapy, Adjuvant; Colectomy; colon cancer; Colonic Neoplasms - diagnostic imaging; Colonic Neoplasms - drug therapy; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; Female; Humans; Male; neoadjuvant chemotherapy; Neoadjuvant Therapy; Neoplasm Staging - methods; Pilot Projects; Risk; Sensitivity and Specificity; Tomography, Spiral Computed
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/j.1463-1318.2011.02638.x

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.