title: Accuracy of radiological staging in identifying high-risk colon cancer patients suitable for neoadjuvant chemotherapy: a multicentre experience.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Mayday University Hospital, Croydon, Surrey, UK.
authors.forename: S
authors.initials: S
authors.lastname: Dighe
authors.forename: I
authors.initials: I
authors.lastname: Swift
authors.forename: L
authors.initials: L
authors.lastname: Magill
authors.forename: K
authors.initials: K
authors.lastname: Handley
authors.forename: R
authors.initials: R
authors.lastname: Gray
authors.forename: P
authors.initials: P
authors.lastname: Quirke
authors.forename: D
authors.initials: D
authors.lastname: Morton
authors.forename: M
authors.initials: M
authors.lastname: Seymour
authors.forename: B
authors.initials: B
authors.lastname: Warren
authors.forename: G
authors.initials: G
authors.lastname: Brown
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003082:Colectomy; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging / Q000379:methods*; D010865:Pilot Projects; D012306:Risk; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed
chemical_list: D000970:Antineoplastic Agents