title: Assessment and diagnostic accuracy of lymph node status to predict stage III colon cancer using computed tomography.
abstract: BACKGROUND
  To study different imaging criteria for prediction of lymph node metastases (Stage III disease) in colon cancer using CT.
  
  
  METHODS
  In a retrospective setting, 483 consecutive patients with histology proven colon cancer underwent elective primary resection during 2008-2011, a cohort of 119 patients were included. Contrast enhanced CT examinations, in portal-venous phase, were reviewed with assessment of the number of lymph nodes, their anatomical distribution, size, size ratio, internal heterogeneity, presence of irregular outer border and attenuation values. Sensitivity, specificity, PPV and NPV for each studied criteria for prediction of stage III disease was calculated.
  
  
  RESULTS
  According to histopathology 80 patients were stage I-II and 39 were stage III. Of the studied CT-criteria for lymph node metastases per patient, internal heterogeneity in at least one lymph node resulted in the best performance with sensitivity, specificity, PPV and NPV of 79, 84, 70 and 89%, Odds ratio (OR) 20. Presence of irregular outer border resulted in a sensitivity, specificity, PPV and NPV of 59, 81, 61 and 82%, OR 6.2. If both internal heterogeneity and/or irregular outer border was used as a criterion this resulted in a sensitivity, specificity, PPV and NPV of 85, 75, 62 and 91%, OR 16.5. None of the size criteria used were predictive for stage III disease.
  
  
  CONCLUSIONS
  When performing preoperative CT in patients with colon cancer, the imaging criteria that allow best prediction of stage III disease on CT are either presence of at least one lymph node with internal heterogeneity or internal heterogeneity and/or irregular outer border. These criteria have to be validated in a prospective study.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Department of Radiology, Karolinska University Hospital, Solna, SE - 171 76, Stockholm, Sweden. erik.rollven@ki.se.
authors.forename: Erik
authors.initials: E
authors.lastname: Rollvén
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Mirna
authors.initials: M
authors.lastname: Abraham-Nordling
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Torbjörn
authors.initials: T
authors.lastname: Holm
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Department of Radiology, Karolinska University Hospital, Solna, SE - 171 76, Stockholm, Sweden.
authors.forename: Lennart
authors.initials: L
authors.lastname: Blomqvist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
keywords: Colon cancer; Computed tomography; Lymph nodes; Stage III; Staging