Accuracy of preoperative T and N staging in colon cancer--a national population-based study.
OBJECTIVE
To select patients for neoadjuvant therapy in colon cancer, there is a need to improve pre-therapeutic locoregional staging. There are now data showing that the TN stage can be adequately assessed by preoperative CT in dedicated centres. In Sweden the use of preoperative CT of the abdomen for staging of the primary tumour is increasing. The aim of this study was to determine to what extent the preoperatively reported radiological TN stage correlates with the histopathological TN stage in an entire population.


METHODS
Data were collected on the preoperative cTN stage according to the radiologist and postoperative pTN stage according to the pathologist on all patients operated on for colon cancer in Sweden 2007-2010. The correlation between cTN stage and pTN stage was calculated using kappa statistics.


RESULTS
T stage was compared in 4373 patients with cT and pT stage. The correlation coefficient was 0.44, indicating fair agreement. The cN and pN correlation coefficient was 0.28, indicating a slight correlation. There was no difference in correlation related to age, gender, tumour location, body mass index or emergent vs elective surgery. A slight difference was seen between different geographical regions.


CONCLUSIONS
Preoperative CT in an unselected population does not result in an accurate cTN staging as previously reported from dedicated centres. To achieve adequate preoperative cTN staging nationally, the education of radiologists and optimization of the radiological method will be necessary.
Department of Molecular Medicine and Surgery, Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
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Sjövall
Department of Molecular Medicine and Surgery, Department of Radiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
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L
Blomqvist
Department for Clinical Sciences, Intervention and Technology, Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
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M
Egenvall
Department of Oncology and Pathology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
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H
Johansson
Department of Molecular Medicine and Surgery, Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
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A
Martling
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D057234:Preoperative Period; D013548:Sweden; D014057:Tomography, X-Ray Computed; D055815:Young Adult
Colon cancer; TN staging; preoperative CT staging