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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 references17

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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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            Diagnostic precision of CT in local staging of colon cancers: a meta-analysis.

            To determine the accuracy of computed tomography (CT) in detecting disease with invasion beyond the muscularis propria (MP) and malignant lymph nodes. A literature search of Ovid, Embase, the Cochrane database, and Medline using Pubmed, Google Scholar and Vivisimo search engines was performed to identify studies reporting on the accuracy of CT to predict the staging of colonic tumours. Publication bias was demonstrated by Funnel plots. The sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated using a bivariate random effects model and hierarchical summary operating curves (HSROC) were generated. Nineteen studies fulfilled all the necessary inclusion criteria. The pooled sensitivity, specificity, DOR for detection of tumour invasion were 86% (95% CI: 78-92%); 78% (95% CI: 71-84%); 22.4 (95% CI: 11.9-42.4). Similarly, the values for nodal detection were 70% (95% CI: 63-73%); 78% (95% CI: 73-82%); 8.1(95% CI: 4.7-14.1). In the subgroup analysis, the best results were obtained in studies utilizing multidetector CT (MDCT). Preoperative staging CT accurately distinguishes between tumours confined to the bowel wall and those invading beyond the MP; however, it is significantly poorer at identifying nodal status. MDCT provides the best results.
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              Preoperative T and N staging of colorectal cancer: accuracy of contrast-enhanced multi-detector row CT colonography--initial experience.

              To evaluate the accuracy of contrast material-enhanced multi-detector row computed tomographic (CT) colonography for preoperative staging of colorectal cancer. Forty-one patients with colorectal carcinoma underwent preoperative contrast-enhanced multi-detector row CT colonography. Images were obtained in the arterial (start delay of 35 seconds) and portal venous (start delay of 70 seconds) phases. The arterial phase was focused on the suspected region of neoplasm, whereas the venous phase included the whole abdomen and pelvis. Two radiologists independently evaluated the depth of tumor invasion into the colorectal wall (T) and regional lymph node involvement (N) on transverse CT images alone and in combination with multiplanar reformations (MPRs). Disagreements were resolved by means of consensus. CT findings were compared with pathologic results, which served as the reference standard. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were assessed. Differences in accuracy for T and N staging were assessed by using the McNemar test. In T staging, overall accuracy was 73% when transverse images were evaluated alone and 83% when they were evaluated in combination with MPRs. This difference was not significant. N staging was associated with an overall accuracy of 59% with transverse images alone and 80% with combined transverse and MPR images (P <.01). Contrast-enhanced multi-detector row CT colonography is an accurate technique for preoperative local staging of colorectal tumors. Copyright RSNA, 2004
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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
                : e0178522
                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.

                Author information
                http://orcid.org/0000-0001-8664-0356
                Article
                PONE-D-17-11247
                10.1371/journal.pone.0178522
                5453524
                28570580
                7f0250f5-e03e-4a6f-bbad-0e717844a0ab
                © 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.

                History
                : 22 March 2017
                : 15 May 2017
                Page count
                Figures: 5, Tables: 5, Pages: 15
                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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