This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Accuracy of multidetector computed tomography in identifying poor prognostic factors in colonic cancer. BJS 2010; 97: 1407-1415.
Published: 16th June 2010
Authors: S. Dighe, H. Blake, M.‐D. Koh, I. Swift, A. Arnaout, L. Temple et al.
Background
Recent neoadjuvant strategies for high‐risk colonic tumours have renewed interest in accurate preoperative staging. The aim of this study was to validate prospectively the accuracy of multidetector computed tomography (MDCT) in stratifying patients into good and poor prognostic groups in a multicentre setting.
Method
Staging MDCT scans of 84 patients with colonic cancer were reviewed by two independent radiologists and stratified into low‐risk (T1/T2 and T3 with extramural tumour depth (EMD) of less than 5 mm) and high‐risk (T3 with EMD of at least 5 mm and T4) tumours. Nodal status and extramural venous invasion (EMVI) were also assessed.
Results
The accuracy, sensitivity, specificity and positive predictive value of stratification by CT compared with histological examination was 74 (95 per cent confidence interval 64 to 82), 78 (65 to 87), 67 (49 to 81) and 81 (68 to 89) per cent respectively. Accuracy for detecting malignant lymph nodes and EMVI was 58 and 70 per cent respectively. The agreement for predicting prognostic stratification was moderate (κ = 0·54).
Conclusion
As the ability of CT to identify node status is poor, the depth of tumour invasion beyond the muscularis propria is the most accurate way to identify patients with a poor prognosis who may be suitable for neoadjuvant treatment. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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