Colorectal cancer detection on routine abdomen/pelvis CT

The Royal College of Radiologists Open Pub Date : 2024-01-01 DOI:10.1016/j.rcro.2024.100157

Stephen Wahlig, Omar Hassan, Spencer Behr

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Abstract

Purpose

To assess the performance of routine abdomen/pelvis CT in detecting colorectal cancer.

Methods

A retrospective dataset consisting of 204 routine abdomen/pelvis CTs was compiled based on review of our institution's pathology/imaging archives. 64 cases had pathologically confirmed colorectal cancer, while 140 cases had no colonic neoplasms on colonoscopy. Two radiologists blinded to the patient history and imaging indication reviewed the cases independently. They scored each case for any colonic abnormality which could represent colorectal cancer. The imaging abnormality location, morphology, presence of regional lymphadenopathy, and degree of diagnostic confidence were recorded.

Results

Reviewers demonstrated a sensitivity of 64–77% and specificity of 83–86% for detection of colorectal cancer. Detected tumors were significantly larger than missed cancers, with mean maximum diameter of 5.2–5.7 cm for detected cancer (n = 81) and 2.8–2.9 cm for missed cancer (n = 25) (reviewer 1 p < 0.001; reviewer 2 p = 0.01). Positive predictive value (PPV) strongly correlated with diagnostic confidence, with 100% of pooled cases (39/39) reported as 5 (Almost Certainly Neoplastic) positive for cancer compared to 53% of cases (17/32) reported as 3 (Could be Benign or Neoplastic). The presence of regional lymphadenopathy was a strong predictive feature, with 94% of pooled cases with identified lymphadenopathy (48/51) positive for cancer compared to 51% (42/82) without lymphadenopathy (p < 0.001).

Conclusion

While colorectal cancers larger than 3 cm were detected with relatively high specificity, abdomen/pelvis CT performed poorly with smaller tumors. Radiologist-reported diagnostic confidence was strongly associated with diagnostic accuracy. Regional lymphadenopathy is a highly specific finding, although insensitive.

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通过常规腹部/骨盆 CT 检测结肠直肠癌

目的评估常规腹部/盆腔 CT 在检测结肠直肠癌方面的性能。方法根据对本机构病理/影像档案的审查，编制了由 204 例常规腹部/盆腔 CT 组成的回顾性数据集。其中 64 例经病理证实为结直肠癌，140 例经结肠镜检查未发现结肠肿瘤。两名对患者病史和影像学指征保密的放射科医生对病例进行了独立审查。他们对每个病例中可能代表结直肠癌的结肠异常进行评分。结果审查结果显示，检测结直肠癌的灵敏度为 64-77%，特异度为 83-86%。检出的肿瘤明显大于漏检的癌症，检出癌症（81 例）的平均最大直径为 5.2-5.7 厘米，漏检癌症（25 例）的平均最大直径为 2.8-2.9 厘米（审稿人 1 p < 0.001；审稿人 2 p = 0.01）。阳性预测值（PPV）与诊断可信度密切相关，100% 的汇总病例（39/39）报告为 5（几乎肯定为肿瘤性）阳性，而 53% 的病例（17/32）报告为 3（可能为良性或肿瘤性）阳性。区域淋巴结病变是一个很强的预测特征，在已确定淋巴结病变的汇总病例中，94%（48/51）的癌症阳性率高于无淋巴结病变的 51%（42/82）（p <0.001）。放射医师报告的诊断信心与诊断准确性密切相关。区域淋巴结病虽然不敏感，但特异性很高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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The Royal College of Radiologists Open

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