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      CT volumetric measurement of colorectal cancer helps predict tumor staging and prognosis

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          Abstract

          Purpose

          To evaluate feasibility of CT colonography (CTC) volumetry of colorectal cancer (CRC) and its correlation with disease stage and patients’ survival.

          Materials and methods

          CTC volumetry was performed for 126 patients who underwent preoperative CTC. Reproducibility of tumor volume (Tvol) between two readers was assessed. One-way ANOVA and ROC analysis evaluated correlation between Tvol and pTNM staging. ROC analysis compared diagnostic performance to predict pTNM staging between Tvol and radiologist. Kaplan-Meier test compared overall survival.

          Results

          Reproducibility among readers was excellent (interclass correlation = 0.9829). Mean Tvol showed an incremental trend with T stage and Tvol of pT4b stage was significantly larger than other stages (P<0.0001). Az value (0.780) of Tvol to predict pT4b stage was significantly larger than that (0.591) of radiologist (P = 0.004). However, Tvol was not significantly different according to pN stage. Az values (0.723~0.857) of Tvol to predict M1 or M1b were comparable to those (0.772~0.690) of radiologist (P>0.05). Smaller tumor burden (≤12.85cm 3), ≤T3, N0, M0 stages, and curative surgery were significantly associated with patients’ longer survival (P<0.05).

          Conclusion

          CT volumetry has a limited value to predict N stage; however, it may outperform the radiologist’s performance when predicting pT4b and M1b stage and can be a useful prognostic marker.

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          Most cited references 19

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          Colorectal cancer statistics, 2014.

          Colorectal cancer is the third most common cancer and the third leading cause of cancer death in men and women in the United States. This article provides an overview of colorectal cancer statistics, including the most current data on incidence, survival, and mortality rates and trends. Incidence data were provided by the National Cancer Institute's Surveillance, Epidemiology, and End Results program and the North American Association of Central Cancer Registries. Mortality data were provided by the National Center for Health Statistics. In 2014, an estimated 71,830 men and 65,000 women will be diagnosed with colorectal cancer and 26,270 men and 24,040 women will die of the disease. Greater than one-third of all deaths (29% in men and 43% in women) will occur in individuals aged 80 years and older. There is substantial variation in tumor location by age. For example, 26% of colorectal cancers in women aged younger than 50 years occur in the proximal colon, compared with 56% of cases in women aged 80 years and older. Incidence and death rates are highest in blacks and lowest in Asians/Pacific Islanders; among males during 2006 through 2010, death rates in blacks (29.4 per 100,000 population) were more than double those in Asians/Pacific Islanders (13.1) and 50% higher than those in non-Hispanic whites (19.2). Overall, incidence rates decreased by approximately 3% per year during the past decade (2001-2010). Notably, the largest drops occurred in adults aged 65 and older. For instance, rates for tumors located in the distal colon decreased by more than 5% per year. In contrast, rates increased during this time period among adults younger than 50 years. Colorectal cancer death rates declined by approximately 2% per year during the 1990s and by approximately 3% per year during the past decade. Progress in reducing colorectal cancer death rates can be accelerated by improving access to and use of screening and standard treatment in all populations. © 2014 American Cancer Society, Inc.
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            Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging--a meta-analysis.

            To perform a meta-analysis to compare endoluminal ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging in rectal cancer staging. Relevant articles published between 1985 and 2002 were included if more than 20 patients were studied, histopathologic findings were the reference standard, and data were presented for 2 x 2 tables; articles were excluded if data were reported elsewhere in more detail. Two reviewers independently extracted data on study characteristics and results. Bivariate random-effects approach was used to obtain summary estimates of sensitivity and specificity for invasion of muscularis propria, perirectal tissue, and adjacent organs and for lymph node involvement. Summary receiver operating characteristic (ROC) curves were fitted for perirectal tissue invasion and lymph node involvement. Ninety articles fulfilled all inclusion criteria. For muscularis propria invasion, US and MR imaging had similar sensitivities; specificity of US (86% [95% confidence interval [CI]: 80, 90]) was significantly higher than that of MR imaging (69% [95% CI: 52, 82]) (P =.02). For perirectal tissue invasion, sensitivity of US (90% [95% CI: 88, 92]) was significantly higher than that of CT (79% [95% CI: 74, 84]) (P <.001) and MR imaging (82% [95% CI: 74, 87]) (P =.003); specificities were comparable. For adjacent organ invasion and lymph node involvement, estimates for US, CT, and MR imaging were comparable. Summary ROC curve for US of perirectal tissue invasion showed better diagnostic accuracy than that of CT and MR imaging. Summary ROC curves for lymph node involvement showed no differences in accuracy. For local invasion, endoluminal US was most accurate and can be helpful in screening patients for available therapeutic strategies. Copyright RSNA, 2004
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              Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison.

              To evaluate signal intensity and border characteristics of lymph nodes at high-spatial-resolution magnetic resonance (MR) imaging in patients with rectal cancer and to compare these findings with size in prediction of nodal status. Forty-two patients who underwent total mesorectal excision of the rectum to determine if they had rectal carcinoma were studied with preoperative thin-section MR imaging. Lymph nodes were harvested from 42 transversely sectioned surgical specimens. The slice of each lymph node was carefully matched with its location on the corresponding MR images. Nodal size, border contour, and signal intensity on MR images were characterized and related to histologic involvement with metastases. Differences in sensitivity and specificity with border or signal intensity were calculated with CIs by using method 10 of Newcombe. Of the 437 nodes harvested, 102 were too small (<3 mm) to be depicted on MR images, and only two of these contained metastases. In 15 (68%) of 22 patients with nodal metastases, the size of normal or reactive nodes was equal to or greater than that of positive nodes in the same specimen. Fifty-one nodes were above the area imaged, and seven of these contained metastases. The diameter of benign and malignant nodes was similar; therefore, size was a poor predictor of nodal status. If a node was defined as suspicious because of an irregular border or mixed signal intensity, a superior accuracy was obtained and resulted in a sensitivity of 51 (85%) of 60 (95% CI: 74%, 92%) and a specificity of 216 (97%) of 221 (95% CI: 95%, 99%). Prediction of nodal involvement in rectal cancer with MR imaging is improved by using the border contour and signal intensity characteristics of lymph nodes instead of size criteria. Copyright RSNA, 2003
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                1 June 2017
                2017
                : 12
                : 6
                Affiliations
                [1 ]Dongnam Institute of Radiological and Medical Sciences Cancer Center, Busan, Korea
                [2 ]Department of Radiology, Seoul National University Hospital, Seoul, Korea
                [3 ]Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
                [4 ]Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea
                [5 ]Department of Radiology, Jeju National University Hospital, Jeju, Korea
                [6 ]Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
                Chang Gung Memorial Hospital Kaohsiung Branch, TAIWAN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: JYP SHK JKH.

                • Data curation: JYP SML JSL.

                • Formal analysis: JYP SHK.

                • Funding acquisition: SHK.

                • Investigation: JYP.

                • Methodology: JYP SHK.

                • Project administration: SHK JKH.

                • Resources: JYP SHK.

                • Supervision: SHK.

                • Validation: SHK.

                • Visualization: JYP SHK.

                • Writing – original draft: JYP SHK.

                • Writing – review & editing: JYP SHK.

                Article
                PONE-D-17-11247
                10.1371/journal.pone.0178522
                5453524
                28570580
                © 2017 Park et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 5, Tables: 5, Pages: 15
                Product
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100003725, National Research Foundation of Korea;
                Award ID: NRF­ 2016R1A2B4007762
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100004332, Seoul National University Hospital;
                Award ID: 03-2016-450
                Award Recipient :
                This research was supported by the Basic Science Research Program through the National Research Foundation of Korea [NRF] funded by the Ministry of Science, ICT & Future Planning [NRF­ 2016R1A2B4007762] http://www.nrf.re.kr and by the Seoul National University Hospital Research Fund No. 03-2016-450( http://www.snuh.org) to SHK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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