title: Accuracy of computed tomography in nodal staging of colon cancer patients.
abstract: OBJECTIVE
  To predict node-positive disease in colon cancer using computed tomography (CT).
  
  
  METHODS
  American Joint Committee on Cancer stage I-III colon cancer patients who underwent curavtive-intent colectomy between 2007-2010 were identified at a single comprehensive cancer center. All patients had preoperative CT scans with original radiology reports from referring institutions. CT images underwent blinded secondary review by a surgeon and a dedicated abdominal radiologist at our institution to identify pericolonic lymph nodes (LNs). Comparison of outside CT reports to our independent imaging review was performed in order to highlight differences in detection in actual clinical practice. CT reviews were compared with final pathology. Results of the outside radiologist review, secondary radiologist review, and surgeon review were compared with the final pathologic exam to determine sensitivity, specificity, positive and negative predictive values, false positive and negative rates, and accuracy of each review. Exclusion criteria included evidence of metastatic disease on CT, rectal or appendiceal involvement, or absence of accompanying imaging from referring institutions.
  
  
  RESULTS
  From 2007 to 2010, 64 stageI-III colon cancer patients met the eligibility criteria of our study. The mean age of the cohort was 68 years, and 26 (41%) patients were male and 38 (59%) patients were female. On final pathology, 26 of 64 (40.6%) patients had node-positive (LN+) disease and 38 of 64 (59.4%) patients had node-negative (LN-) disease. Outside radiologic review demonstrated sensitivity of 54% (14 of 26 patients) and specificity of 66% (25 of 38 patients) in predicting LN+ disease, whereas secondary radiologist review demonstrated 88% (23 of 26) sensitivity and 58% (22 of 38) specificity. On surgeon review, sensitivity was 69% (18 of 26) with 66% specificity (25 of 38). Secondary radiology review demonstrated the highest accuracy (70%) and the lowest false negative rate (12%), compared to the surgeon review at 67% accuracy and 31% false negative rate and the outside radiology review at 61% accuracy and 46% false negative rate.
  
  
  CONCLUSIONS
  CT LN staging of colon cancer has moderate accuracy, with administration of NCT based on CT potentially resulting in overtreatment. Active search for LN+ may improve sensitivity at the cost of specificity.
authors.affiliation: Audrey H Choi, Hans F Schoellhammer, Won Cho, Michelle Ko, Amanda Arrington, Christopher R Oxner, Stephen M Sentovich, Julio Garcia-Aguilar, Joseph Kim, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, United States.
authors.forename: Audrey H
authors.initials: AH
authors.lastname: Choi
authors.affiliation: Audrey H Choi, Hans F Schoellhammer, Won Cho, Michelle Ko, Amanda Arrington, Christopher R Oxner, Stephen M Sentovich, Julio Garcia-Aguilar, Joseph Kim, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, United States.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Nelson
authors.affiliation: Audrey H Choi, Hans F Schoellhammer, Won Cho, Michelle Ko, Amanda Arrington, Christopher R Oxner, Stephen M Sentovich, Julio Garcia-Aguilar, Joseph Kim, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, United States.
authors.forename: Hans F
authors.initials: HF
authors.lastname: Schoellhammer
authors.affiliation: Audrey H Choi, Hans F Schoellhammer, Won Cho, Michelle Ko, Amanda Arrington, Christopher R Oxner, Stephen M Sentovich, Julio Garcia-Aguilar, Joseph Kim, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, United States.
authors.forename: Won
authors.initials: W
authors.lastname: Cho
authors.affiliation: Audrey H Choi, Hans F Schoellhammer, Won Cho, Michelle Ko, Amanda Arrington, Christopher R Oxner, Stephen M Sentovich, Julio Garcia-Aguilar, Joseph Kim, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, United States.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ko
authors.affiliation: Audrey H Choi, Hans F Schoellhammer, Won Cho, Michelle Ko, Amanda Arrington, Christopher R Oxner, Stephen M Sentovich, Julio Garcia-Aguilar, Joseph Kim, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, United States.
authors.forename: Amanda
authors.initials: A
authors.lastname: Arrington
authors.affiliation: Audrey H Choi, Hans F Schoellhammer, Won Cho, Michelle Ko, Amanda Arrington, Christopher R Oxner, Stephen M Sentovich, Julio Garcia-Aguilar, Joseph Kim, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, United States.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Oxner
authors.affiliation: Audrey H Choi, Hans F Schoellhammer, Won Cho, Michelle Ko, Amanda Arrington, Christopher R Oxner, Stephen M Sentovich, Julio Garcia-Aguilar, Joseph Kim, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, United States.
authors.forename: Marwan
authors.initials: M
authors.lastname: Fakih
authors.affiliation: Audrey H Choi, Hans F Schoellhammer, Won Cho, Michelle Ko, Amanda Arrington, Christopher R Oxner, Stephen M Sentovich, Julio Garcia-Aguilar, Joseph Kim, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, United States.
authors.forename: Jimmie
authors.initials: J
authors.lastname: Wong
authors.affiliation: Audrey H Choi, Hans F Schoellhammer, Won Cho, Michelle Ko, Amanda Arrington, Christopher R Oxner, Stephen M Sentovich, Julio Garcia-Aguilar, Joseph Kim, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, United States.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Sentovich
authors.affiliation: Audrey H Choi, Hans F Schoellhammer, Won Cho, Michelle Ko, Amanda Arrington, Christopher R Oxner, Stephen M Sentovich, Julio Garcia-Aguilar, Joseph Kim, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, United States.
authors.forename: Julio
authors.initials: J
authors.lastname: Garcia-Aguilar
authors.affiliation: Audrey H Choi, Hans F Schoellhammer, Won Cho, Michelle Ko, Amanda Arrington, Christopher R Oxner, Stephen M Sentovich, Julio Garcia-Aguilar, Joseph Kim, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
keywords: Clinical staging; Colon cancer; Computed tomography; Lymph nodes; Neoadjuvant therapy