Consistency of Radiological Staging in Resectable Mismatch-Repair Proficient Colon Cancer: An Interobserver Agreement Study

IF 2.7 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer Pub Date : 2026-06-01 Epub Date: 2026-02-05 DOI:10.1016/j.clcc.2026.01.007

Vincenzo Nasca , Gabriele Tinè , Marta Vaiani , Raffaella Vigorito , Francesca Gabriella Greco , Alessandra Casale , Gaetano Ramondo , Alessandro Rago , Luigi Asmundo , Cristiano Sgrazzutti , Dania Cioni , Roberto Francischello , Emanuele Neri , Marco Calandri , Carolina Sciortino , Laura Sanchez , Margherita Ambrosini , Isacco Montroni , Federica Marmorino , Chiara Cremolini , Giovanni Randon

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引用次数: 0

Abstract

Background

Reproducibility and accuracy of radiological classification with CT imaging is crucial for selecting patients with resectable, nonmetastatic colon cancer (CC) who may benefit from neoadjuvant strategies.

Methods

We evaluated interobserver agreement among 4 independent radiology equipes in classifying patients with resectable, nonmetastatic, mismatch repair proficient CC with available preoperative CT imaging. Radiology equipes were blinded to clinical and pathological data, and categorized tumors according to FOxTROT and Node-RADS criteria, classifying T (T1/2, T3, T4, including stratification by extramural invasion [EMI]) and N status. The primary endpoint was interobserver agreement (Cohen’s κw); secondary endpoints included concordance with pathological staging and diagnostic performance metrics. Bayesian and cross-validation analyses assessed robustness.

Results

Among 109 patients (32.1% pT2, 33.9% pT3, 33.9% pT4; 45.9% pN0/1c, 54.1% pN1-2), overall interobserver agreement indicated inadequate concordance for both cT (κw = 0.56; 95% CI, 0.43-0.68) and cN category (κw = 0.51; 95% CI, 0.36-0.66). Of 109 patients, 38 (35%) were classified identically for T stage by all 4 Radiology groups, while 74 (68%) showed some disagreement. When considering risk stratification into high risk (cT3 with EMI ≥5 mm or cT4) versus low risk (cT1/cT2 or cT3 with EMI <5 mm) 56 patients (51%) received the same classification all 4 groups, and 95 patients (87%) were classified consistently by at least 3 groups. Overall concordance between radiology and pathological staging was inadequate for both T (κw = 0.47; 95% CI, 0.35-0.57) and N staging (κw = 0.16; 95% CI, 0.07-0.33). The mean sensitivity and specificity of CT scan for pT3/T4 and pT4 were 72%/78% and 33%/93%.

Conclusions

Identification of high-risk features in resectable CC by CT scan should be implemented to guide patients’ selection for neoadjuvant therapies.

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可切除错配修复结肠癌放射分期的一致性：一项观察者间的一致研究。

背景：CT影像放射学分类的再现性和准确性对于选择可切除的非转移性结肠癌（CC）患者至关重要，这些患者可能受益于新辅助策略。方法：我们评估了4个独立的放射设备对可切除、非转移、错配修复熟练的CC患者进行分类的观察者之间的一致性，并提供了术前CT成像。放疗设备盲取临床和病理资料，根据FOxTROT和Node-RADS标准对肿瘤进行分类，分为T （T1/2、T3、T4，包括外侵分层[EMI]）和N状态。主要终点是观察者间一致性（Cohen’s κw）；次要终点包括与病理分期和诊断性能指标的一致性。贝叶斯和交叉验证分析评估了稳健性。结果：109例患者（32.1% pT2, 33.9% pT3, 33.9% pT4, 45.9% pn1 /1c, 54.1% pN1-2），总体观察者间一致表明cT （κw = 0.56, 95% CI, 0.43-0.68）和cN分类（κw = 0.51, 95% CI, 0.36-0.66）的一致性不足。109例患者中，38例（35%）患者的T期被4个放射学组完全一致，74例（68%）患者的T期表现不一致。当考虑高风险（cT3伴EMI≥5mm或cT4）与低风险（cT1/cT2或cT3伴EMI）的风险分层时，结论：应通过CT扫描识别可切除CC的高危特征，以指导患者选择新辅助治疗。

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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来源期刊

Clinical colorectal cancer 医学-肿瘤学

CiteScore

5.50

自引率

2.90%

发文量

审稿时长

27 days

期刊介绍： Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.