| 1. Morton D, Seymour M, Magill L, et al. Preoperative Chemotherapy for Operable Colon Cancer: Mature Results of an International Randomized Controlled Trial. J Clin Oncol 2023;41:1541-52. |
Observational-Tx |
699 patients (NAC group) and 354 patients (control grouup) |
To assess the potential advantages neoadjuvant chemotherapy (NAC) has over standard postoperative chemotherapy for locally advanced colon cancer. |
Of 699 patients allocated to NAC, 674 (96%) started and 606 (87%) completed NAC. In total, 686 of 699 (98.1%) NAC patients and 351 of 354 (99.2%) control patients underwent surgery. Thirty patients (4.3%) allocated to NAC developed obstructive symptoms requiring expedited surgery, but there were fewer serious postoperative complications with NAC than with control. NAC produced marked T and N downstaging and histologic tumor regression (all P < .001). Resection was more often histopathologically complete: 94% (648/686) versus 89% (311/351), P < .001. Fewer NAC than control patients had residual or recurrent disease within 2 years (16.9% [118/699] v 21.5% [76/354]; rate ratio, 0.72 [95% CI, 0.54 to 0.98]; P = .037). Tumor regression correlated strongly with freedom from recurrence. Panitumumab did not enhance the benefit from NAC. Little benefit from NAC was seen in mismatch repair-deficient tumors. |
1 |
| 2. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Annals of Surgical Oncology. 17(6):1471-4, 2010 Jun. |
Review/Other-Tx |
N/A |
An editorial to summarize the background of the current revision and outlines the major issues on TNM. |
No results stated in abstract. |
4 |
| 3. Hanna N, Hanna AN, Hanna DN. AJCC Cancer Staging System Version 9: Appendiceal Adenocarcinoma. Ann Surg Oncol 2024;31:2177-80. |
Review/Other-Dx |
N/A |
No abstract available |
No abstract available |
4 |
| 4. Khan F, Vogel RI, Diep GK, Tuttle TM, Lou E. Prognostic factors for survival in advanced appendiceal cancers. Cancer Biomark 2016;17:457-62. |
Observational-Dx |
49 patients with stage III and IV appendiceal carcinomas |
To determine prognostic factors, including markers of systemic inflammation, for survival in a cohort of patients with advanced appendiceal adenocarcinomas. |
Female gender and low-grade adenocarcinoma were associated with increased OS. These data suggest that the use of HIPEC treatment may also be associated with improved OS, but the difference was not statistically significant (HR = 0.37 [0.12-1.18], p = 0.09). We found no evidence of an association between markers of inflammation at diagnosis and OS. |
3 |
| 5. Glasgow SC, Gaertner W, Stewart D, et al. The American Society of Colon and Rectal Surgeons, Clinical Practice Guidelines for the Management of Appendiceal Neoplasms. Dis Colon Rectum 2019;62:1425-38. |
Review/Other-Dx |
N/A |
To provide information to support decision-making rather than to dictate a specific form of treatment. |
No abstract available |
4 |
| 6. Govaerts K, Chandrakumaran K, Carr NJ, et al. Single centre guidelines for radiological follow-up based on 775 patients treated by cytoreductive surgery and HIPEC for appendiceal pseudomyxoma peritonei. Eur J Surg Oncol. 44(9):1371-1377, 2018 09. |
Observational-Dx |
1070 patients that underwent surgery for a perforated epithelial tumour of the appendix, predominantly with PMP |
To analyze a long-term follow-up experience on a large number of patients with perforated mucinous appendix tumours, with some early patients with pseudomyxoma peritonei (PMP) undergoing treatment more than 20 years ago.To modify recommendations on appropriate duration and intensity of follow-up. |
Overall, 775/1070 (72%) had complete cytoreductive surgery (CCRS) and HIPEC. Histological classification was low grade PMP in 615 (79.4%), high grade PMP in 134 (17.3%) and adenocarcinoma in 26 (3.4%). DFS and OS were significantly worse for high grade disease, with the steepest decline for both in the first three years. DFS curves, for low as well as high grade PMP, levelled off at year 6 at approximately 60% and 20% respectively. Thereafter there were few recurrences in either group. |
4 |
| 7. Smeenk RM, van Velthuysen ML, Verwaal VJ, Zoetmulder FA. Appendiceal neoplasms and pseudomyxoma peritonei: a population based study. Eur J Surg Oncol 2008;34:196-201. |
Review/Other-Dx |
1482 specimens |
The aim of this study is to investigate the incidence of both lesions and their relation. |
The nationwide pathology database of the Netherlands (PALGA) was searched for the incidence of all appendectomies, the incidence of primary epithelial appendiceal lesions and the incidence and pathology history of patients with PMP. All regarded the 10-year period of 1995e2005. Results: In the 10-year period 167,744 appendectomies were performed in the Netherlands. An appendiceal lesion was found in 1482 appendiceal specimens (0.9%). Nine percent of these patients developed PMP. Coincidentally, an additional epithelial colonic neoplasm was found in 13% of patients with an appendiceal epithelial lesion. A mucinous epithelial neoplasm was identified in 0.3% (73% benign, 27% malignant) of appendiceal specimens and 20% of these patients developed PMP. For mucocele and non-mucinous neoplasm the association with PMP was only 2% and 3%, respectively. From the nationwide database 267 patients (62 men and 205 women) with PMP were identified, which demonstrates an incidence of PMP in the Netherlands approaching 2 per million per year. The primary site was identified in 68% and dominated by the appendix (82%). |
4 |
| 8. Kulemann V, Schima W, Tamandl D, et al. Preoperative detection of colorectal liver metastases in fatty liver: MDCT or MRI? Eur J Radiol 2011;79:e1-6. |
Observational-Dx |
20 patients |
To compare the diagnostic value of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the preoperative detection of colorectal liver metastases in diffuse fatty infiltration of the liver, associated with neoadjuvant chemotherapy. |
Overall, 51 metastases were found by histopathology of the resected liver segments/lobes. The size of the metastases ranged from 0.4 to 13 cm, with 18 (35%) being up to 1cm in diameter. In the overall rating, MDCT detected 33/51 lesions (65%), and MRI 45/51 (88%). For lesions up to 1cm, MDCT detected only 2/18 (11%) and MRI 12/18 (66%). One false positive lesion was detected by MDCT. Statistical analysis showed that MRI is markedly superior to MDCT, with a statistically significant difference (p<.001), particularly for the detection of small lesions (</= 1 cm; p<.004). There was no significant difference between the two modalities in the detection of lesions>1cm. |
2 |
| 9. van Kessel CS, van Leeuwen MS, van den Bosch MA, et al. Accuracy of multislice liver CT and MRI for preoperative assessment of colorectal liver metastases after neoadjuvant chemotherapy. Dig Surg. 2011; 28(1):36-43. |
Observational-Dx |
79 lesions in 15 patients |
To determine the best imaging modality for preoperative detection, characterization and measurement of colorectal liver metastases after neoadjuvant chemotherapy. |
Lesion detection rate was similar for multislice-CT and MRI (76% and 80%, respectively, P=0.648). Lesion characterization was significantly superior (P=0.021) at MRI (89%, kappa 0.747, P=0.001) compared to multislice-CT (77%, kappa 0.235, P=0.005). Interobserver variability for diameter measurement was not significant at MRI (P=0.909 [95% confidence interval; -1.245 to 1.395]), but significant at multislice-CT (P=0.028 [95% confidence interval; -3.349 to -2.007]). Differences in diameter measurement were independent of observer (P=0.131), and no statistical effect from imaging modality on diameter measurement was observed (P=0.095). |
3 |
| 10. Cance WG, Cohen AM, Enker WE, Sigurdson ER. Predictive value of a negative computed tomographic scan in 100 patients with rectal carcinoma. Dis Colon Rectum. 1991;34(9):748-751. |
Observational-Dx |
100 patients |
To evaluate the ability of a computed tomographic (CT) scan to predict accurately the absence of either periaortic nodal metastases or liver metastases in a group of patients with rectal carcinoma. |
Sixty-four patients (64 percent) had stage T3 or T4 tumors. Ten patients had unsuspected distant metastases for an overall negative predictive value of 90 percent. Seven patients had small liver metastases, and three had periaortic nodal metastases. Six of the patients with liver metastases had them completely resected at the original laparotomy. The predictive value of the CT scan diminished in the patients who were selected to receive full-dose preoperative radiation therapy and had a mean delay of 12 weeks between CT scan and laparotomy. The preoperative carcinoembryonic antigen levels were of no value in predicting the presence of distant metastases. |
3 |
| 11. Valls C, Andia E, Sanchez A, et al. Hepatic metastases from colorectal cancer: preoperative detection and assessment of resectability with helical CT. Radiology 2001;218:55-60. |
Experimental-Dx |
157 patients |
To prospectively evaluate helical computed tomography (CT) in the preoperative detection of hepatic metastases and assessment of resectability with surgical, intraoperative ultrasonographic (US), and histopathologic correlation. |
Intraoperative US, palpation, and histopathologic examination revealed 290 liver metastases; helical CT correctly depicted 247. Helical CT results were the following: overall detection rate, 85.1% (95% CI: 80.8%, 89.3%); positive predictive value, 96.1% (95% CI: 92.9%, 98.1%); and false-positive rate, 3.9% (10 of 257 findings; 95% CI: 1.9%, 7.1%). False-positive findings were related to hemangioendothelioma, hemangioma, hepatic peliosis, biliary adenoma, centrilobar hemorrhage, biliary hamartoma, periportal fibrosis, and normal liver parenchyma. Curative resection was performed in 112 instances with a resectability rate of 94.1%. Four-year patient survival rate was 58.6%. |
2 |
| 12. Numminen K, Isoniemi H, Halavaara J, et al. Preoperative assessment of focal liver lesions: multidetector computed tomography challenges magnetic resonance imaging. Acta Radiol 2005;46:9-15. |
Observational-Dx |
31 patients |
To investigate prospectively multidetector computed tomography (CT) (MDCT) and magnetic resonance (MR) imaging (MRI) in the preoperative assessment of focal liver lesions. |
At surgery, IOUS and palpation revealed 45 solid liver lesions. From these, preoperative MDCT detected 43 (96%) and MRI 35 (78%) deposits. MDCT performed statistically better than MRI in lesion detection (P=0.008). Assessment of lesion vascular proximity was correctly determined by MDCT in 98% of patients and by MRI in 87%. Statistical difference was found (P=0.002). IOUS and palpation changed the preoperative surgical plan as a result of extrahepatic disease in 8/31 (26%) cases. In MDCT as well in MRI extrahepatic involvement was suspected in two cases. |
3 |
| 13. Onishi H, Murakami T, Kim T, et al. Hepatic metastases: detection with multi-detector row CT, SPIO-enhanced MR imaging, and both techniques combined. Radiology 2006;239:131-8. |
Observational-Dx |
38 patients |
To retrospectively compare the accuracy in detection of hepatic metastases among contrast material-enhanced multi-detector row computed tomography (CT) alone, superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging alone, and a combination of contrast-enhanced CT and SPIO-enhanced MR imaging. |
The mean area under the AFROC curve for the combined approach (0.70) was significantly higher than that for SPIO-enhanced MR imaging alone (0.58, P < .05, Fisher protected least significant difference test), and there was no significant difference between each of them and that for contrast-enhanced CT alone (0.66). For all lesions, the mean sensitivity of combined imaging (0.59) was significantly higher than that of CT (0.48) or MR imaging (0.43) alone (P < .05, Fisher protected least significant difference test and generalized estimating equations). For all lesions, the mean positive predictive values were 0.82, 0.89, and 0.81, for combined MR and CT, CT alone, and MR alone, respectively. |
2 |
| 14. Soyer P, Poccard M, Boudiaf M, et al. Detection of hypovascular hepatic metastases at triple-phase helical CT: sensitivity of phases and comparison with surgical and histopathologic findings. Radiology 2004;231:413-20. |
Experimental-Dx |
32 patients with 59 hepatic metastases |
To compare the respective sensitivities of unenhanced, arterial-dominant, and portal-dominant phase helical computed tomography (CT) in the preoperative depiction of hypovascular hepatic metastases by using intraoperative ultrasonographic (US) and histopathologic findings as the standard of reference. |
Among 59 hepatic metastases, unenhanced, arterial-dominant, and portal-dominant phase helical CT imaging depicted 39 (66.1%; 95% CI: 53.3%, 76.8%), 44 (74.5%; 95% CI: 62.2%, 83.9%), and 54 (91.5%; 95% CI: 81.6%, 96.3%) metastases, respectively. Portal-dominant phase imaging depicted significantly more hypovascular hepatic metastases than did unenhanced (P <.001) or arterial-dominant (P <.01) phase imaging (Wilcoxon test). |
2 |
| 15. Brouquet A, Abdalla EK, Kopetz S, et al. High survival rate after two-stage resection of advanced colorectal liver metastases: response-based selection and complete resection define outcome. J Clin Oncol. 2011;29(8):1083-1090. |
Observational-Tx |
127 patients |
A retrospective study to compare outcomes of patients undergoing at least the first stage of two-stage resection with those of selected nonsurgically treated patients responding to modern chemotherapy. |
65 patients underwent the first stage of two-stage resection; 62 patients fulfilled the inclusion criteria for the medical group. Two-stage resection patients had a mean of 6.7 +/- 3.4 colorectal liver metastases with mean size of 4.5 +/- 3.1 cm. Nonsurgical patients had a mean of 5.9 +/- 2.9 colorectal liver metastases with mean size of 5.4 +/- 3.4 cm (not significant). 47 two-stage resection patients (72%) completed the second stage. Progression between stages was the main cause of noncompletion of the second stage (61%). After 50 months median follow-up, the 5-year survival rate was 51% in the two-stage resection group and 15% in the medical group (P=.005). In patients who underwent two-stage resection, noncompletion of two-stage resection and major postoperative complications were independently associated with worse survival. |
2 |
| 16. Shindoh J, Loyer EM, Kopetz S, et al. Optimal morphologic response to preoperative chemotherapy: an alternate outcome end point before resection of hepatic colorectal metastases. J Clin Oncol 2012;30:4566-72. |
Observational-Tx |
209 patients |
To confirm the prognostic value of an optimal morphologic response to preoperative chemotherapy in patients undergoing chemotherapy with or without bevacizumab before resection of colorectal liver metastases (CLM) and to identify predictors of the optimal morphologic response. |
An optimal morphologic response was observed in 47% of patients treated with bevacizumab and 12% of patients treated without bevacizumab (P < .001). The 3- and 5-year OS rates were higher in the optimal response group (82% and 74%, respectively) compared with the suboptimal response group (60% and 45%, respectively; P < .001). On multivariate analysis, suboptimal morphologic response was an independent predictor of worse OS (hazard ratio, 2.09; P = .007). Receipt of bevacizumab (odds ratio, 6.71; P < .001) and largest metastasis before chemotherapy of </= 3 cm (odds ratio, 2.12; P = .025) were significantly associated with optimal morphologic response. The morphologic response showed no specific correlation with conventional size-based RECIST criteria, and it was superior to RECIST in predicting major pathologic response. |
2 |
| 17. Malmstrom ML, Brisling S, Klausen TW, et al. Staging with computed tomography of patients with colon cancer. Int J Colorectal Dis. 33(1):9-17, 2018 Jan. |
Observational-Dx |
615 Patients |
Accurate staging of colonic cancer is important for patient stratification. We aimed to correlate the diagnostic accuracy of preoperative computed tomography (CT) with final histopathology as reference standard. |
Data was collected retrospectively on 615 consecutive patients operated for colonic cancer. Evaluation was based upon T-stage. Patients were stratified into high-risk and low-risk groups, based on the extent of tumor invasion beyond the proper muscle layer of more or less than 5 mm. The Kendall tau correlation coefficient was used to calculate concordance between radiological (r)T-stage obtained at CT imaging and pathological (p)T-stage from the final pathology. Results In total, 501 patients were included. We found no significant differences in the Kendall tau values for diagnostic measures between the groups at the 95% confidence interval (CI) level: 49% (95% CI, 43–55) for all individuals, 48% (95% CI, 40–56) for screened individuals, and 47% (95% CI, 37-56) for non-screened individuals. The overall sensitivity and specificity for all individuals in identifying high-risk tumors on CT was 65% (95% CI, 56–73) and 89% (95% CI, 85–92). The risk of ending up in the high-risk group due to overstaging among all individuals was calculated as the number needed to harm 11.7 (95% CI, 9–16). |
3 |
| 18. Rollven E, Blomqvist L, Oistamo E, Hjern F, Csanaky G, Abraham-Nordling M. Morphological predictors for lymph node metastases on computed tomography in colon cancer. Abdom Radiol. 44(5):1712-1721, 2019 05. |
Observational-Dx |
94 Patients |
The aim of the study was to assess morphological predictors for lymph node metastases (Stage III disease) in colon cancer on computed tomography. |
According to histopathology, 59 patients were staged as I–II disease and 35 patients were staged as stage III disease. The presence of internal heterogeneity in a lymph node on CT resulted in moderate sensitivity (66–77%) but high specifcity (95–95%) for prediction of Stage III disease by both observers. The presence of irregular outer border also resulted in poor sensitivity (49–54%) but high specifcity (97–97%). The combination of either internal heterogeneity and/or irregular outer border per patient resulted in a moderate sensitivity (67–77%) and high specifcity (95–95%), PPV (89–96%), and NPV (84–88%). Inter-observer agreement (Cohens Kappa) was 0.72. Consensus reading for the combined criteria resulted in sensitivity and specifcity of 69% and 100%, respectively. |
2 |
| 19. Fernandez LM, Parlade AJ, Wasser EJ, et al. How Reliable Is CT Scan in Staging Right Colon Cancer?. Dis Colon Rectum. 62(8):960-964, 2019 08. |
Observational-Dx |
150 CT scans |
To determine the accuracy of CT staging in proximal colon cancer in detecting unfavorable pathologic features that may aid in the selection of ideal candidates alternative treatment strategies, including extended lymph node dissection and/or neoadjuvant chemotherapy. |
Of 150 CT scans reviewed, CT failed to identify primary cancer in 18%. Overall accuracy of CT to identify unfavorable pathologic features was 63% with sensitivity, specificity, positive predictive value, and negative predictive value of 63% (95% CI, 54%-71%), 63% (95% CI, 46%-81%), 87% (95% CI, 80%-94%) and 30% (95% CI, 18%-41%). Only cT3/4 (55% vs 45%; p = 0.001) and cN+ (42% vs 58%; p = 0.02) were significantly associated with correct identification of unfavorable features at final pathology. CT scans overstaged and understaged cT in 23.7% and 48.3% and cN in 28.7% and 53.0% of cases. |
2 |
| 20. Olsen ASF, Gundestrup AK, Kleif J, Thanon T, Bertelsen CA. Accuracy of preoperative staging with multidetector computed tomography in colon cancer. Colorectal Dis. 23(3):680-688, 2021 Mar. |
Observational-Dx |
3465 patients |
To validate the accuracy of multidetector computed tomography (MDCT) in a national cohort with neoadjuvant chemotherapy for patients with preoperatively assessed locally advanced cancer and the emergence of other personalized treatments. |
A total 3465 patients were included in the analyses regarding locally advanced colon cancer. The sensitivity and specificity were 0.61 (0.58-0.64) and 0.85 (0.83-0.86), respectively, for CT to predict locally advanced disease. The sensitivity and specificity were 0.63 (0.59-0.66) and 0.80 (0.78-0.81), respectively, for predicting UICC Stage I in 4496 patients. Thirty six per cent of the patients assessed as having locally advanced disease and 58% assessed as Stage I were misclassified by MDCT. |
3 |
| 21. Hong EK, Landolfi F, Castagnoli F, et al. CT for lymph node staging of Colon cancer: not only size but also location and number of lymph node count. Abdom Radiol. 46(9):4096-4105, 2021 09. |
Observational-Dx |
317 patients |
To evaluate the diagnostic accuracy of imaging features to predict lymph node status of colon cancer using CT. |
The largest short diameter of lymph node and presence of internal heterogeneity of lymph node showed significant association with malignant lymph node status (P < 0.001 and P = 0.041, respectively). The ROC curve analysis revealed AUC of 0.703 for the largest short diameter of lymph node (P < 0.001), and AUC of the presence of internal heterogeneity was 0.630 (P < 0.001). In addition, our study showed that a total number of lymph nodes, regardless of size, (P = 0.022) and number of lymph nodes in peritumoral area (P < 0.001) and along the mesenteric vessels (P < 0.001) on CT demonstrated significant association with malignant status of lymph nodes in colon cancer. |
3 |
| 22. Komono A, Kajitani R, Matsumoto Y, et al. Preoperative T staging of advanced colorectal cancer by computed tomography colonography. Int J Colorectal Dis. 36(11):2489-2496, 2021 Nov. |
Observational-Dx |
110 patients |
To evaluate the external validity of this method and to determine whether there is a difference in the accuracy of T staging between the mesenteric and antimesenteric sides. |
Sensitivity, specificity, accuracy, positive, and negative predictive values were respectively, 65%, 91%, 83%, 76%, and 85% for T2 (n = 34); 76%, 82%, 81%, 50%, and 94% for T3 (n = 23); and 77%, 93%, 87%, 86%, and 88% for T4a disease (n = 39). Overall right answer rate was 83.3% (15/18) for the mesenteric side and 65% (39/60) for the antimesenteric side (n = 0.14). |
3 |
| 23. Kim S, Huh JW, Lee WY, et al. Oncologic outcomes of pathologic T4 and T3 colon cancer patients diagnosed with clinical T4 stage disease using preoperative computed tomography scan. Surg Oncol. 41:101749, 2022 May. |
Observational-Tx |
216 patients |
To evaluate the correlation between preoperative CT scan findings and oncologic outcomes and to identify risk factors associated with locally advanced colon cancer. |
The disease-free survival rate was significantly different between the pT3 and pT4 groups (88.6% vs. 68.6%, p < 0.001). The overall survival rate of the pT3 group was significantly higher than that of the pT4 group (91.2% vs. 76.5%, p = 0.002). Perineural invasion and tumor budding were identified as preoperative risk factors predisposing to pT4 staging (p = 0.044, p = 0.001). |
2 |
| 24. Wetterholm E, Rosen R, Rahman M, Ronnow CF. CT is unreliable in locoregional staging of early colon cancer: A nationwide registry-based study. Scand J Surg. 112(1):33-40, 2023 Mar. |
Observational-Dx |
4849 patients |
To investigate CT-staging accuracy in early CC by evaluating pT and pN stages in patients staged as cT1-2, and cT and cN stages in patients with pT1 tumors. |
Computed tomography (CT) staged 4849 patients as cT1-2, whereas 2445 (50%) were pT3 and 453 (9%) pT4. Positive predictive value of the cT1-2 stage was 40%. Of 1401 pT1 patients, 624 (45%) were staged as cT1-2, 139 (10%) as cT3, 15 (1%) as cT4 and 623 (44%) as cTx. In all, 1474 (30%) of the cT1-2 patients were pN+, whereas CT staged 1062 (72%) as cN0. A total of 771 patients were staged as cN+, whereas 403 (52%) were pN0. Overall accuracy in determining N+ was 67%, with 26% sensitivity and 88% specificity. Positive and negative predictive values in determining N+ were 48% and 73%, respectively. |
3 |
| 25. Kim YT, Min JH, Choi KH, Kim H. Colon cancer microsatellite instability influences computed tomography assessment of regional lymph node morphology and diagnostic performance. Eur J Radiol. 154:110396, 2022 Sep. |
Observational-Dx |
507 patients with cecal/proximal ascending colon cancer who underwent right hemicolectomy |
To elucidate whether a high level of microsatellite instability (MSI-high) in colon cancer influences the CT assessment of regional lymph node (rLN) morphology and diagnostic performance on predicting pathological node-negative (pN0) patients. |
A study population of 507 patients (mean age ± standard deviation, 63.0 ± 11.6; 264 women) were evaluated. In patients with rLN metastasis, the rLN long axis (pN1: P = 0.013, pN2: P = 0.039) and short axis (pN1: P = 0.001, pN2: P = 0.009) were both longer in MSI-high tumors compared with MSI-stable tumors. High specificity for predicting pN0 was only achieved in MSI-high tumors [sensitivityMSI-stable = 58.3% (n = 137/235), specificityMSI-stable = 71.2% (n = 116/163); sensitivityMSI-high = 38.4% (n = 33/86), specificityMSI-high = 91.3% (n = 21/23)]. Multivariable logistic regression indicated MSI-high (P < 0.001, odds ratio = 3.701), smaller LN long axis (P = 0.023, odds ratio = 0.905), and lower CT LN grade (CTN0: P = 0.009, odds ratio = 2.987; CTN1: P = 0.014, odds ratio = 2.195) as significant parameters in predicting pN0. |
3 |
| 26. Hong EK, Chalabi M, Landolfi F, et al. Colon cancer CT staging according to mismatch repair status: Comparison and suggestion of imaging features for high-risk colon cancer. Eur J Cancer. 174:165-175, 2022 10. |
Observational-Dx |
266 patients who underwent primary surgical resection of a colon tumour |
To assess and compare CT imaging features of CC between mismatch repair-proficient (pMMR) and MMR-deficient (dMMR) tumours and identify CT features that can distinguish high-risk (pT3-4, N+) CC according to MMR status. |
Among pT3 tumours only, dMMR CC were significantly larger than pMMR CC in both length and thickness (length 59.39 ± 26.28 mm versus 48.70 ± 23.72, respectively, p = 0.031; thickness 20.54 mm ± 11.17 versus 16.34 ± 8.73, respectively, p = 0.027). For pMMR tumours, nodal internal heterogeneity on CT was significantly associated with a positive lymph node status (odds ratio (OR) = 2.66, p = 0.027), while for dMMR tumours, the largest short diameter of the nodes was associated with lymph node status (OR = 2.01, p = 0.049). The best cut-off value of the largest short diameter of involved nodes was 10.4 mm for dMMR and 7.95 mm for pMMR. In the external validation cohort, AUCs for predicting involved nodes based on the largest short diameter was 0.764 for dMMR tumours using 10 mm size cut-off and 0.624 for pMMR tumours using 7 mm cut-off. |
2 |
| 27. Horvat N, Raj A, Liu S, et al. CT Colonography in Preoperative Staging of Colon Cancer: Evaluation of FOxTROT Inclusion Criteria for Neoadjuvant Therapy. AJR Am J Roentgenol. 212(1):94-102, 2019 01. |
Observational-Dx |
89 patients (with 93 tumors) who had colon cancer and underwent presurgical CTC |
To evaluate the diagnostic performance of and interreader agreement for CT colonography (CTC) in the local staging of colon cancer, with emphasis given to the FOxTROT (Fluoropyrimidine, Oxaliplatin, and Targeted-Receptor pre-Operative Therapy [Panitumumab]) trial inclusion criteria, which propose a new tailored treatment paradigm for colon cancer that uses neoadjuvant therapy for patients with a high-risk of locoregional disease as determined by imaging. |
Thirty-five of 93 tumors (37.6%) were histologically classified as high-risk tumors (T3c, T3d, or T4 tumors). The interreader agreement was substantial (? = 0.68) for classifying high-risk tumors with the use of CTC, moderate for differentiating N0 from N1 and N2 (? = 0.44), and slight for detecting EMVI (? = 0.15). The diagnostic statistics for CTC for the two readers were as follows: for detection of high-risk tumors, sensitivity was 65.7% and 82.9%, and specificity was 81.0% and 87.9%; for detection of N category-positive disease, sensitivity was 50.9% and 69.8%, and specificity was 50.0% and 72.5%; and for detection of EMVI, sensitivity was 18.2% and 66.7%, and specificity was 60.0% and 91.7%. |
2 |
| 28. Ao T, Kajiwara Y, Yamada K, et al. Cancer-induced spiculation on computed tomography: a significant preoperative prognostic factor for colorectal cancer. SURG. TODAY. 49(7):629-636, 2019 Jul. |
Observational-Dx |
335 patients |
To examine the correlation between CIS and clinicopathological findings to establish its prognostic value. |
The level of interobserver agreement in the evaluation of CIS was substantial (83%; kappa value, 0.65). The presence of CIS was specific for T3/T4 disease (positive predictive value, 88.3%), and was significantly associated with tumor size and venous invasion. The 5-year relapse-free survival rate was significantly lower in patients with CIS than in those without CIS (68.6% and 84.0%, respectively, p = 0.001). Subgroup analysis revealed remarkable prognostic differences in patients with stage III and T3 disease. Multivariate analysis revealed that CIS was a significant independent prognostic factor. |
2 |
| 29. Guan Z, Zhang XY, Li XT, et al. Correlation and prognostic value of CT-detected extramural venous invasion and pathological lymph-vascular invasion in colon cancer. Abdom Radiol. 47(4):1232-1243, 2022 04. |
Observational-Dx |
448 colon cancer patients |
To explore the association between CT-detected extramural vascular invasion (ctEMVI) and lymph-vascular invasion (LVI) in colon cancer, and analyze the prognostic value of ctEMVI in different conditions of LVI. |
Among the 448 patients, there were 261 men and 187 women, with an average age of 63 ± 12 years. The coincidence rate of ctEMVI and LVI was 73.9%. The k coefficient for identifying ctEMVI was 0.84. ctEMVI and LVI were both independent risk factors for overall survival (ctEMVI: HR 2.8, 95% CI 1.5-5.5; LVI: HR 2.2, 95% CI 1.2-4.1) and metastasis-free survival (ctEMVI: HR 3.3, 95% CI 1.7-6.4; LVI: HR 2.4, 95% CI 1.3-4.5) adjusted with PS. In the LVI(+) subgroup, the prognosis of ctEMVI(+) was significantly worse than that of ctEMVI(-); in the LVI(-) subgroup, the prognosis of different ctEMVI states was similar. |
2 |
| 30. Seo N, Lim JS, Chung T, Lee JM, Min BS, Kim MJ. Preoperative computed tomography assessment of circumferential resection margin in retroperitonealized colon cancer predicts disease-free survival. Eur Radiol. 33(4):2757-2767, 2023 Apr. |
Observational-Dx |
274 patients with retroperitonealized colon cancer |
To predict circumferential resection margin (CRM) involvement on preoperative CT, and prognostic impact of CRM assessment by CT (ctCRM) in patients with retroperitonealized colon cancer. |
A total of 274 patients (mean age, 64.0 years ± 11.0 [standard deviation]; 157 men) with retroperitonealized colon cancer were evaluated. Of 274 patients, 67 patients (24.5%) had positive CRM on surgical pathology. The accuracy of preoperative CT in predicting pCRM was 79.6% (218/274). Among preoperative factors, only CRM assessment on CT was independently associated with pCRM (p < 0.001). Positive ctCRM by primary tumor was an independent factor for DFS (HR, 3.362 [1.714-6.593]) and systemic recurrence (HR, 3.715 [1.787-7.724], but not for local recurrence on multivariable analyses. |
3 |
| 31. O'Leary MP, Parrish AB, Tom CM, MacLaughlin BW, Petrie BA. Staging Rectal Cancer: The Utility of Chest Radiograph and Chest Computed Tomography. Am Surg. 82(10):1005-1008, 2016 Oct. |
Observational-Dx |
74 patients |
To evaluate whether patients who are newly diagnosed with rectal cancer can undergo posteroanterior and lateral chest radiography (X-ray) for adequate staging. |
Sixty-three (85%) had a normal chest X-ray and 11 (15%) had an abnormal chest X-ray. Of the 63 patients with a normal chest X-ray, 40 (63%) had a corresponding normal chest CT and 23 (37%) had a lesion only noted on chest CT. Four patients (17%) in the latter group had metastatic cancer to the lung at the time of workup and four out of five of the tumors found to metastasize were within 5 cm from the anal verge. Our data suggest that a staging chest X-ray is unlikely to diagnose metastatic lungs lesions from a primary rectal cancer. |
3 |
| 32. Kronawitter U, Kemeny NE, Heelan R, Fata F, Fong Y. Evaluation of chest computed tomography in the staging of patients with potentially resectable liver metastases from colorectal carcinoma. Cancer 1999;86:229-35. |
Observational-Dx |
202 patients |
Retrospective analysis to determine whether CT of the chest was necessary in patients with negative chest radiograph. |
For routine preoperative workup, majority of lesions appearing on chest CT scans of patients with negative chest radiographs were not malignant. The positive yield of CT-guided workup was 10/202 patients (5%). |
3 |
| 33. Grossmann I, Avenarius JK, Mastboom WJ, Klaase JM. Preoperative staging with chest CT in patients with colorectal carcinoma: not as a routine procedure. Ann Surg Oncol 2010;17:2045-50. |
Review/Other-Dx |
200 patients |
To analyze the outcome and clinical benefit of routine staging with chest CT after inclusion of a consecutive series of 200 patients with colorectal cancer. |
Synchronous metastases were present in 60 patients (30%). Staging chest CT revealed pulmonary metastases in 6 patients, with 1 false positive finding. In 50 patients indeterminate lesions were seen on chest CT (25%). These were diagnosed during follow-up as true metastases (n = 8), bronchus carcinoma (n = 2), benign lesions (n = 25), and remaining unknown (n = 15). Ultimately, synchronous pulmonary metastases were diagnosed in 13 patients (7%), in 6 patients confined to the lung (3%). In none of the patients the treatment plan for the primary tumor was changed based on the staging chest CT. |
4 |
| 34. van den Broek JJ, van Gestel T, Kol SQ, van Geel AM, Geenen RWF, Schreurs WH. Dealing with indeterminate pulmonary nodules in colorectal cancer patients; a systematic review. Eur J Surg Oncol. 47(11):2749-2756, 2021 Nov. |
Review/Other-Dx |
18 studies (8637 patients) |
To estimate the incidence and risk of malignancy of IPNs and provide an overview of the existing literature on indeterminate pulmonary nodules (IPNs) in colorectal cancer (CRC) patients. |
Pooled analysis revealed IPNs on staging chest CT in 1327 (15%) of the CRC patients. IPNs appeared to be metastatic disease during follow up in 16% of these patients. Regional lymph node metastases, liver metastases, location of the primary tumour in the rectum, larger IPN size and multiple IPNs are the five most frequently reported parameters predicting the risk of malignancy of IPNs. |
4 |
| 35. Christoffersen MW, Bulut O, Jess P. The diagnostic value of indeterminate lung lesions on staging chest computed tomographies in patients with colorectal cancer. Dan Med Bull 2010;57:A4093. |
Observational-Dx |
131 consecutive patients |
To evaluate the significance of such indeterminate lung findings in staging CT scans. |
In eight of the 22 patients (36%) lesions progressed. In one patient, the lesion turned out to be a primary lung cancer, in another a lymphoma. In the last six patients (27%), the lesions developed into colorectal cancer lung metastases within a median period of 15 months. These results were significantly different from those obtained in patients who had a normal CT, among whom only 6% developed lung malignancies in the follow-up period (p < 0.0001). The development of lung metastases was significantly related to positive nodal status at operation and elevated carcinoembryonic antigen (CEA) level at follow-up (p < 0.05). |
4 |
| 36. Choi DJ, Kwak JM, Kim J, Woo SU, Kim SH. Preoperative chest computerized tomography in patients with locally advanced mid or lower rectal cancer: its role in staging and impact on treatment strategy. J Surg Oncol 2010;102:588-92. |
Review/Other-Dx |
103 patients |
To evaluate the role of chest CT on preoperative staging in rectal cancer patients and to assess the impact on treatment strategy. |
Nine patients (8.7%) had pulmonary metastases detected on CT. CXR did not reveal any pulmonary metastatic lesions in four of the nine patients. Of these four, treatment was changed in three patients because of these findings. Forty (38.8%) patients had indeterminate nodules on chest CT. Of these, 37 patients had follow-up CTs and four patients (10.8%) showed interval changes that were confirmed as pulmonary metastasis. |
4 |
| 37. McQueen AS, Scott J. CT staging of colorectal cancer: what do you find in the chest? Clin Radiol 2012;67:352-8. |
Review/Other-Dx |
514 patients |
To clarify the chest computed tomography (CT) findings in patients with a new diagnosis of colorectal adenocarcinoma. |
Five hundred and fourteen out of 568 (90.5%) CRC patients underwent complete CT staging. Thirty-one patients (6%) had lung metastases, of which four (0.8%) were isolated. Three hundred and fifty-three (68.7%) had no evidence of pulmonary metastases, but 130 (25.3%) had indeterminate lung nodules (ILNs). The ILNs of 12 patients were subsequently confirmed as metastases on follow-up. A major non-metastatic finding (pulmonary embolism or synchronous primary malignancy) was found in 15/514 patients (3%). |
4 |
| 38. Ramos E, Valls C, Martinez L, et al. Preoperative staging of patients with liver metastases of colorectal carcinoma. Does PET/CT really add something to multidetector CT? Ann Surg Oncol 2011;18:2654-61. |
Observational-Dx |
97 patients |
To determine prospectively whether the systematic use of PET/CT associated with conventional techniques could improve the accuracy of staging in patients with liver metastases of colorectal carcinoma. |
In a lesion-by-lesion analysis of the hepatic staging, the sensitivity of MDCT/RM was superior to PET/CT (89.2 vs. 55%, p < 0.001). On the extrahepatic staging, PET/CT was superior to MDCT/MR only for the detection of locoregional recurrence (p = 0.03) and recurrence in uncommon sites (p = 0.016). New findings in PET/CT resulted in a change in therapeutic strategy in 17 patients. However, additional information was correct only in eight cases and wrong in nine patients. |
2 |
| 39. Shin SS, Jeong YY, Min JJ, Kim HR, Chung TW, Kang HK. Preoperative staging of colorectal cancer: CT vs. integrated FDG PET/CT. [Review] [41 refs]. Abdom Imaging. 33(3):270-7, 2008 May-Jun. |
Review/Other-Dx |
N/A |
To discuss the role, relative advantages and limitations of CT and PET/CT in the preoperative staging of colorectal cancer. |
With the advance of CT technology, CT has still relative advantages over PET/CT with respect to local extent of primary tumor and regional lymph node metastases. The most significant additional information provided by PET/CT relates to the accurate detection of distant metastases. At present, routine evaluation of patients with suspicious colorectal cancer by PET/CT seems not to be necessary. But, it should be performed on selected patients who have suggestive but inconclusive metastatic lesions with CT. In addition, PET/CT with dedicated CT protocols, such as contrastenhanced PET/CT and PET/CT colonography, mayreplace the diagnostic CT for the preoperative staging of colorectal cancer. |
4 |
| 40. Wong GYM, Kumar R, Beeke C, et al. Survival Outcomes for Patients With Indeterminate 18FDG-PET Scan for Extrahepatic Disease Before Liver Resection for Metastatic Colorectal Cancer: A Retrospective Cohort Study Using a Prospectively Maintained Database to Analyze Survival Outcomes for Patients With Indeterminate Extrahepatic Disease on 18FDG-PET Scan Before Liver Resection for Metastatic Colorectal Cancer. Annals of Surgery. 267(5):929-935, 2018 05. |
Observational-Dx |
267 patients with PET scans before LR |
To evaluate overall survival (OS) and cancer recurrence for patients with indeterminate positron emission tomography (PET) scan for extrahepatic disease (EHD) before liver resection (LR) for colorectal liver metastases (CLMs). |
Of 267 patients with PET scans before LR, 197 patients had no EHD and 70 patients had indeterminate EHD. Median follow-up was 33 months. The estimated 5-year OS was 60.8% versus 59.4% for indeterminate and absent EHD, respectively (P = 0.625). Disease-free survival was comparable between both groups (P = 0.975) and overall recurrence was 57.1% and 59.5% for indeterminate and absent EHD, respectively (P = 0.742). About 16.9% of recurrence was associated with the site of indeterminate EHD, with 80% of associated recurrence occurring in the thorax. |
3 |
| 41. Briggs RH, Chowdhury FU, Lodge JP, Scarsbrook AF. Clinical impact of FDG PET-CT in patients with potentially operable metastatic colorectal cancer. Clin Radiol. 66(12):1167-74, 2011 Dec. |
Observational-Dx |
102 patients |
To assess the clinical impact of 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography-computed tomography (PET-CT) in patients with potentially resectable metastatic colorectal cancer. |
Of 102 patients (mean age 67 years, range 27-85 years), 94 had liver, five had isolated lung, and three had limited peritoneal metastases. In 31 patients (30%) PET-CT had a major impact on subsequent management, by correctly clarifying indeterminate lesions on conventional imaging as inoperable metastatic disease in 16 patients, detecting previously unsuspected metastatic disease in nine patients, identifying occult second primary tumours in three patients, and correctly down-staging three patients. PET-CT had a minor impact in 12 patients (12%), no impact in 49 cases (48%), and a potentially negative impact in 10 cases (10%). Following PET-CT, 36 (35%) patients were no longer considered for surgery. Of those remaining operative 45 of 66 (68%) underwent potentially curative metastatic surgery. In this cohort PET-CT saved 16 futile laparotomies. |
3 |
| 42. Eglinton T, Luck A, Bartholomeusz D, Varghese R, Lawrence M. Positron-emission tomography/computed tomography (PET/CT) in the initial staging of primary rectal cancer. Colorectal Dis 2010;12:667-73. |
Observational-Dx |
20 patients |
To assess the role of (18)flourodeoxyglucose positron-emission tomography/computed tomography (PET/CT) in the initial staging of primary rectal adenocarcinoma. |
Positron-emission tomography/computed tomography correctly identified the primary tumour in all 20 patients. Comparing PET/CT with conventional staging modalities, there were 11 discordant or incidental findings in nine patients (45%). This resulted in a potential change in stage in 30% (four patients downstaged and two upstaged). PET/CT suggested additional neoplastic pathology in three patients and excluded the same in two patients. The incidental neoplastic findings were of minor clinical significance and one was eventually deemed false positive. While PET/CT resulted in potential management changes in five patients (25%), no changes in surgical management occurred. When tumours were grouped according to conventional stage, PET/CT resulted in fewer changes in stage in stage I (0%), compared with stages II to IV (43%) (P = 0.08). |
2 |
| 43. Llamas-Elvira JM, Rodriguez-Fernandez A, Gutierrez-Sainz J, et al. Fluorine-18 fluorodeoxyglucose PET in the preoperative staging of colorectal cancer. Eur J Nucl Med Mol Imaging 2007;34:859-67. |
Observational-Dx |
104 patients |
To evaluate the utility of FDG-PET in the initial staging of patients with CC in comparison with conventional staging methods and to determine its impact on therapeutic management. |
In 14 patients, surgery was contraindicated by FDG-PET owing to the extent of disease (only 6/14 suspected by CT). FDG-PET revealed four synchronous tumours. For N staging, both procedures showed a relatively high specificity but a low diagnostic accuracy (PET 56%, CT 60%) and sensitivity (PET 21%, CT 25%). For M assessment, diagnostic accuracy was 92% for FDG-PET and 87% for CT. FDG-PET results led to modification of the therapy approach in 50% of patients with unresectable disease. FDG-PET findings were important, revealing unknown disease in 19.2%, changing the staging in 13.46% and modifying the scope of surgery in 11.54% (with a change in the therapeutic approach in 17.85% of those patients with rectal cancer). |
2 |
| 44. Baik H, Lee SM, Seo SH, et al. Prognostic value of positron emission tomography/computed tomography for adjuvant chemotherapy of colon cancer. ANZ J Surg. 88(6):587-591, 2018 Jun. |
Observational-Dx |
166 patients with high-risk stage II or stage III colon cancer who received FOLFOX4 chemotherapy |
To assess the prognostic value of preoperative 18 F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with high-risk stage II or stage III colon cancer who underwent FOLFOX chemotherapy. |
There were recurrences in 29 of the 166 patients (17.4%). Measuring the area under the receiver operating characteristic curve, the cut-off value of SUVmax with maximum sensitivity and specificity was 10.95. Using the Kaplan-Meier method, the DFS of the patients categorized by SUVmax tended to differ (P = 0.055). In univariate analyses, the risk factors for DFS were age over 70 years, higher N stage and neural invasion. SUVmax = 10.95 showed a tendency, but was not significant (P = 0.0604). In multivariate analyses, the risk factors for DFS were age over 70 and neural invasion. |
3 |
| 45. Daza JF, Solis NM, Parpia S, et al. A meta-analysis exploring the role of PET and PET-CT in the management of potentially resectable colorectal cancer liver metastases. Eur J Surg Oncol. 45(8):1341-1348, 2019 Aug. |
Meta-analysis |
2 randomized trials (n = 554) and 11 non-randomized studies |
To evaluate the role of PET and PET-CT in the preoperative management of patients with colorectal cancer liver metastases that are deemed resectable on conventional imaging. To evaluate differences in overall survival (OS) and disease-free survival (DFS) when compared to conventional imaging alone.To evaluate changes in surgical management and rates of futile laparotomy with routine PET/PET-CT. |
Of 4034 articles, two randomized trials (n = 554), and 11 non-randomized studies (n = 2251) were included. PET/PET-CT did not improve OS (hazard ratio [HR] 0.94, 95% CI 0.69-1.26, moderate quality) or DFS (HR 1.01, 95% CI 0.82-1.26, moderate quality). In the two trials, PET/PET-CT changed surgical management in 8% of cases (95% CI 5-11%, high quality), and did not significantly reduce futile laparotomies (risk ratio 0.59, 95% CI 0.24-1.47, low quality). Among non-randomized studies, PET/PET-CT changed surgical management in 20% of cases (95% CI 17-22%, very low quality) and reduced futile laparotomies (odds ratio 0.51, 95% CI 0.32-0.81, very low quality). |
Good |
| 46. Serrano PE, Gu CS, Moulton CA, et al. Effect of PET-CT on disease recurrence and management in patients with potentially resectable colorectal cancer liver metastases. Long-term results of a randomized controlled trial. J Surg Oncol. 121(6):1001-1006, 2020 May. |
Observational-Dx |
404 patients |
To compare long-term outcomes (disease-free [DFS], overall survival [OS]). |
Among 404 patients randomized, there were no differences in DFS (hazard ratio [HR] = 1.13; 95% confidence interval [CI], 0.89 to 1.43) or OS (HR, 1.02; 95% CI, 0.78-1.32) between groups. For all patients randomized, median DFS (PET-CT vs no PET-CT) was 16 months (95% CI, 13-18) and 15 months (95% CI, 11-22), P = .33. For patients who underwent liver resection (n = 368), DFS (17 vs 16 months, P = .51) and OS (58 months vs 52 months, P = .90) were similar between groups, respectively. Risk factors for DFS and OS were age, tumor size, node-positive disease, extrahepatic metastases and disease-free duration. |
3 |
| 47. Vogel JD, Felder SI, Bhama AR, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer. Dis Colon Rectum 2022;65:148-77. |
Review/Other-Dx |
N/A |
To provide clinical practice guidelines in defining quality care for conditions related to the colon, rectum, and anus based on the best available evidence. |
No abstract available |
4 |
| 48. Guney IB, Teke Z, Kucuker KA, Yalav O. A prospective comparative study of contrast-enhanced CT, contrast-enhanced MRI and 18F-FDG PET/CT in the preoperative staging of colorectal cancer patients. Ann Ital Chir. 91:658-667, 2020. |
Observational-Dx |
72 colorectal cancer patients |
To evaluate the accuracy of computed tomography (CT), magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for detection of regional lymph node metastases (RLNMs) and the additional value of PET/CT in the preoperative staging of colorectal cancer. |
There were 44 male and 28 female in our study. The mean age was 61±11 years. Histopathologically, 27 patients (51%) were negative and 26 patients (49%) were positive for RLNMs. The sensitivity, specificity, PPV, NPV, and ACC of PET/CT were 88.5%, 59.3%, 67.6%, 84.2%, and 73.6%, respectively. PET/CT changed the patient management with diagnostic contribution to the suspicious lesions identified by radiological imaging modalities. |
3 |
| 49. Mirshahvalad SA, Hinzpeter R, Kohan A, et al. Diagnostic performance of [18F]-FDG PET/MR in evaluating colorectal cancer: a systematic review and meta-analysis. [Review]. Eur J Nucl Med Mol Imaging. 49(12):4205-4217, 2022 Oct. |
Meta-analysis |
52 studies (2289 patients) |
To calculate the diagnostic performance of [18F]-FDG PET/MR in colorectal cancer (CRC). |
The pooled sensitivities in CRC lesion detection (tumor, lymph nodes, and metastases) were 0.94 (95%CI: 0.89-0.97) and 0.93 (95%CI: 0.82-0.98) at patient-level and lesion-level, respectively. The pooled specificities were 0.89 (95%CI: 0.84-0.93) and 0.95 (95%CI: 0.90-0.98) at patient-level and lesion-level, respectively. In sub-groups, the highest sensitivity (0.97, 95%CI: 0.86-0.99) and specificity (0.99, 95%CI: 0.84-1.00) were calculated for "M staging" and "rectal cancer: lesion-level," respectively. The lowest sensitivity (0.81, 95%CI: 0.65-0.91) and specificity (0.79, 95%CI: 0.52-0.93) were calculated for "N staging" and "T staging," respectively. |
Good |
| 50. Ren Q, Chen Y, Shao X, Guo L, Xu X. Lymph nodes primary staging of colorectal cancer in 18F-FDG PET/MRI: a systematic review and meta-analysis. [Review]. Eur J Med Res. 28(1):162, 2023 May 04. |
Meta-analysis |
7 studies (184 patients) |
To assess the diagnostic efficacy of 18F-FDG PET/MRI for lymph node (LN) metastasis primary staging in patients with colorectal cancer (CRC). |
The Spearman rank correlation coefficient was 0.108 (P = 0.818), with no threshold-effect observed. The pooled SEN was 0.81 (95%CI 0.66-0.90) and the SPE was 0.89 (95% CI 0.73-0.96). In sub-groups, prospective groups demonstrated to have the highest SEN of 0.92 (95%CI 0.79-1.00). The studies conducted by Catalano et al. and Kang et al. were considered to be potential sources of heterogeneity. |
Good |
| 51. Kersjes W, Mayer E, Buchenroth M, Schunk K, Fouda N, Cagil H. Diagnosis of pulmonary metastases with turbo-SE MR imaging. Eur Radiol. 1997; 7(8):1190-1194. |
Observational-Dx |
23 patients |
To determine the diagnostic value of T2- weighted turbo-spin echo MRI sequences in patients with pulmonary metastasis. Spiral volumetric CT was the radiological standard. |
286 (84%) of 340 metastases were identified at MRI. Sensitivity of MRI was 36% for nodules <5 mm, 83% for nodules 5-10 mm, 92% for nodules 10-15 mm, and 100% for nodules >15 mm. MRI does not appear to have a role in screening for pulmonary metastases. |
3 |
| 52. de Galiza Barbosa F, Geismar JH, Delso G, et al. Pulmonary nodule detection in oncological patients - Value of respiratory-triggered, periodically rotated overlapping parallel T2-weighted imaging evaluated with PET/CT-MR. Eur J Radiol 2018;98:165-70. |
Review/Other-Dx |
149 patients |
To prospectively evaluate the detection and conspicuity of pulmonary nodules in an oncological population, using a tri-modality PET/CT-MR protocol including a respiration-gated T2-PROPELLER sequence for possible integration into a simultaneous PET/MR protocol. |
No results stated in abstract. |
4 |
| 53. Berger-Kulemann V, Schima W, Baroud S, et al. Gadoxetic acid-enhanced 3.0 T MR imaging versus multidetector-row CT in the detection of colorectal metastases in fatty liver using intraoperative ultrasound and histopathology as a standard of reference. Eur J Surg Oncol 2012;38:670-6. |
Observational-Dx |
23 patients |
To compare the diagnostic value of gadoxetic acid-enhanced MRI at 3.0 T with 64-row MDCT in the detection of colorectal liver metastases in diffuse fatty infiltration of the liver after neoadjuvant chemotherapy. |
Overall, 68 metastases (range, 0.4-6 cm; 31/68 metastases [46%] </= 1 cm) were found at histology. MDCT detected 49/68 lesions (72%), and MRI 66/68 (97%, p < 0.001). For lesions </= 1 cm, MDCT detected only 13/31 (41.9%) and MRI 29/31 (93%, p < 0.001). Eight false-positive lesions were detected by MDCT, seven small lesions by MRI. There was no statistically significant difference between the two modalities in the detection of lesions > 1 cm (p = 0.250). IOUS detected all metastases and revealed two false-positive diagnoses. |
2 |
| 54. Hammerstingl R, Huppertz A, Breuer J, et al. Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 2008;18:457-67. |
Experimental-Dx |
169 patients |
To evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) using the new liver-specific contrast agent gadoxetic acid (Gd-EOB-DTPA, Primovist), as opposed to contrast-enhanced biphasic spiral computed tomography (CT), in the diagnosis of focal liver lesions, compared with a standard of reference (SOR). |
Data sets were evaluated on-site (14 investigators) and off-site (three independent blinded readers). Gd-EOB-DTPA was well tolerated. Three hundred and two lesions were detected in 131 patients valid for analysis by SOR. The frequency of correctly detected lesions was significantly higher on Gd-EOB-DTPA-enhanced MRI compared with CT in the clinical evaluation [10.44%; 95% confidence interval (CI): 4.88, 16.0]. In the blinded reading there was a trend towards Gd-EOB-DTPA-enhanced MRI, not reaching statistical significance (2.14%; 95% CI: -4.32, 8.6). However, the highest rate of correctly detected lesions with a diameter below 1 cm was achieved by Gd-EOB-DTPA-enhanced MRI. Differential diagnosis was superior for Gd-EOB-DTPA-enhanced MRI (82.1%) versus CT (71.0%). A change in surgical therapy was documented in 19 of 131 patients (14.5%) post Gd-EOB-DTPA-enhanced MRI. Gd-EOB-DTPA-enhanced MRI was superior in the diagnosis and therapeutic management of focal liver lesions compared with CT. |
1 |
| 55. Kim YK, Park G, Kim CS, Yu HC, Han YM. Diagnostic efficacy of gadoxetic acid-enhanced MRI for the detection and characterisation of liver metastases: comparison with multidetector-row CT. Br J Radiol. 85(1013):539-47, 2012 May. |
Observational-Dx |
67 patients |
To compare the diagnostic performance of gadoxetic acid-enhanced MRI and 16-slice multidetector CT (MDCT) with respect to their abilities to detect hepatic metastases and differentiate hepatic metastases from hepatic cysts and haemangiomas. |
For both observers, the Az values of gadoxetic acid-enhanced MRI (mean, 0.982 and 0.981) were significantly higher than the Az values of MDCT (mean, 0.839 and 0.892) (p<0.05) for the detection of metastases and for the differentiation of metastases from haemangiomas and cysts. Sensitivities of gadoxetic acid-enhanced MRI with regard to the detection and characterisation of liver metastases (mean, 96.9% and 96.0%) were significantly higher than those of MDCT (mean, 78.7% and 75.0%) (p<0.05). |
2 |
| 56. Knowles B, Welsh FK, Chandrakumaran K, John TG, Rees M. Detailed liver-specific imaging prior to pre-operative chemotherapy for colorectal liver metastases reduces intra-hepatic recurrence and the need for a repeat hepatectomy. HPB (Oxford) 2012;14:298-309. |
Review/Other-Dx |
242 patients |
Retrospective review of a prospective database to determine whether liver-specific magnetic resonance imaging (MRI) prior to pre-operative chemotherapy affects intra-hepatic recurrence and long-term outcome after hepatectomy. |
A liver-specific MRI pre-chemotherapy changed the staging in 56% of patients. At a median (range) follow-up of 55 (6-94) months, there was a higher incidence of intra-hepatic recurrence at a new site in the non-PCI group (65% vs. 48% in the PCI group, P= 0.041) and an increased rate of recurrence in patients with the same number of lesions pre- and post-chemotherapy [hazard ratio (HR) 2.02, 1:10-3.37, P= 0.024]. The non-PCI group underwent more repeat hepatectomies than the PCI group (24.7% vs. 13%, P= 0.034), achieving similar long-term survival. |
4 |
| 57. Koh DM, Collins DJ, Wallace T, Chau I, Riddell AM. Combining diffusion-weighted MRI with Gd-EOB-DTPA-enhanced MRI improves the detection of colorectal liver metastases. Br J Radiol 2012;85:980-9. |
Observational-Dx |
72 patients |
To compare the diagnostic accuracy of gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MRI, diffusion-weighted MRI (DW-MRI) and a combination of both techniques for the detection of colorectal hepatic metastases. |
417 lesions (310 metastases, 107 benign) were found in 72 patients. For both readers, diagnostic accuracy using the combined image set was higher [area under the curve (Az)=0.96, 0.97] than Gd-EOB-DTPA image set (Az=0.86, 0.89) or DW-MRI image set (Az=0.93, 0.92). Using combined image set improved identification of liver metastases compared with Gd-EOB-DTPA image set (p<0.001) or DW-MRI image set (p<0.001). There was very good interobserver agreement for lesion classification (kappa=0.81-0.88). |
2 |
| 58. Macera A, Lario C, Petracchini M, et al. Staging of colorectal liver metastases after preoperative chemotherapy. Diffusion-weighted imaging in combination with Gd-EOB-DTPA MRI sequences increases sensitivity and diagnostic accuracy. Eur Radiol. 23(3):739-47, 2013 Mar. |
Observational-Dx |
32 patients |
To compare the diagnostic accuracy and sensitivity of Gd-EOB-DTPA MRI and diffusion-weighted (DWI) imaging alone and in combination for detecting colorectal liver metastases in patients who had undergone preoperative chemotherapy. |
Evaluation of image set 1 correctly identified 127/166 lesions (accuracy 76.5 %; 95 % CI 69.3-82.7) and 106/144 metastases (sensitivity 73.6 %, 95 % CI 65.6-80.6). Evaluation of image set 2 correctly identified 108/166 (accuracy 65.1 %, 95 % CI 57.3-72.3) and 87/144 metastases (sensitivity of 60.4 %, 95 % CI 51.9-68.5). Evaluation of image set 3 correctly identified 148/166 (accuracy 89.2 %, 95 % CI 83.4-93.4) and 131/144 metastases (sensitivity 91 %, 95 % CI 85.1-95.1). Differences were statistically significant (P < 0.001). Notably, similar results were obtained analysing only small lesions (<1 cm). |
2 |
| 59. Kim SH, Lee JM, Hong SH, et al. Locally advanced rectal cancer: added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo- and radiation therapy. Radiology 2009;253:116-25. |
Observational-Dx |
40 patients |
To investigate the added value of diffusion-weighted (DW) magnetic resonance (MR) imaging in the evaluation of complete response (CR) to neoadjuvant combined chemotherapy and radiation therapy (CRT) in patients with locally advanced rectal cancer. |
Diagnostic accuracy (area under the ROC curve [A(z)]) in the evaluation of CR was significantly improved after additional review of DW MR images for both reviewers: For reviewer 1, A(z) improved from 0.676 to 0.876 (P = .005), whereas for reviewer 2, A(z) improved from 0.658 to 0.815 (P = .036). Mean ADC ([1.62 +/- 0.36] x 10(-3) mm(2)/sec) (standard deviation) of the CR group (n = 11) was significantly higher than that ([1.04 +/- 0.24] x 10(-3) mm(2)/sec) of the non-CR group (n = 29) (P < .0001). |
2 |
| 60. Koh DM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 2007;188:1622-35. |
Review/Other-Dx |
N/A |
Review applications and challenges of DWI in the body. |
DWI derives its image contrast from differences in the motion of water molecules between tissues. Such imaging can be performed quickly without the need for the administration of exogenous contrast medium. The technique yields qualitative and quantitative information that reflects changes at a cellular level and provides unique insights about tumor cellularity and the integrity of cell membranes. Recent advances enable the technique to be widely applied for tumor evaluation in the abdomen and pelvis and have led to the development of whole-body DWI. |
4 |
| 61. Sugita R, Ito K, Fujita N, Takahashi S. Diffusion-weighted MRI in abdominal oncology: clinical applications. World J Gastroenterol 2010;16:832-6. |
Review/Other-Dx |
N/A |
Review clinical applications of DWI MRI in abdominal oncology. |
DWI can be used for pretreatment tumor detection, characterization including predicting tumor response to therapy, monitoring tumor response during therapy and follow-up study after treatment to detect possible tumor recurrence. |
4 |
| 62. Granata V, Fusco R, de Lutio di Castelguidone E, et al. Diagnostic performance of gadoxetic acid-enhanced liver MRI versus multidetector CT in the assessment of colorectal liver metastases compared to hepatic resection. BMC Gastroenterol. 19(1):129, 2019 Jul 24. |
Observational-Dx |
128 patients |
To compare the diagnostic performance of gadoxetic acid-(Gd-EOB) enhanced liver MRI and contrast-enhanced MDCT in the detection of liver metastasis from colorectal cancer (mCRC). |
MRI detected 489 liver metastases and MDCT 384. In terms of per-lesion sensitivity in the detection of liver metastasis, all three readers had higher diagnostic sensitivity with Gd-EOB MRI than with MDCT (95.5% vs. 72% reader 1; 90% vs. 72% reader 2; 96% vs. 75% reader 3). Each reader showed a statistical significant difference (p < <.001 at Chi square test). MR imaging showed a higher performance than MDCT in per-patient detection sensitivity (100% vs. 74.2% [p < <.001] reader 1, 98% vs. 73% [p < <.001] reader 2, and 100% vs. 78% [p < <.001] reader 3). In the control group, MRI and MDCT showed similar per-patient specificity (100% vs. 98% [p = 0.31] reader 1, 100% vs. 100% [p = 0.92] reader 2, and 100% vs. 96% [p = 0.047] reader 3). Inter-reader agreement of lesion detection between the three radiologists was moderate to excellent (k range, 0.56-0.86) for Gd-EOB MRI and substantial to excellent for MDCT (k range, 0.75-0.8). |
2 |
| 63. Koh FHX, Tan KK, Teo LLS, Ang BWL, Thian YL. Prospective comparison between magnetic resonance imaging and computed tomography in colorectal cancer staging. ANZ J Surg. 88(6):E498-E502, 2018 Jun. |
Observational-Dx |
30 patients |
To compare the accuracy of DW-MRI with multidetector computed tomography (MDCT) in staging of colorectal cancer. |
The primary cancers were located in the rectum (n = 16, 53.3%), sigmoid colon (n = 9, 30%) and right colon (n = 5, 16.6%). For nodal metastases, the sensitivity and specificity of DW-MRI were 84.6% (95% confidence interval (CI): 54.6-98.1%) and 20.0% (95% CI: 2.5-55.6%) compared with 84.6% (95% CI: 54.6-98.1%) and 40.0% (95% CI: 12.2-73.8%) for MDCT. For liver metastases, the sensitivity and specificity for DW-MRI were 100.0% (95% CI: 63.1-100.0%) and 100% (95% CI: 84.6-100%) compared with 87.5% (95% CI: 47.4-99.7%) and 95.5% (95% CI: 77.2-99.9%) for MDCT. DW imaging altered the clinical management in three (10.0%) patients by detecting missed hepatic metastases in two patients and accurately diagnosing another patient with a hepatic cyst, mistaken for metastasis on MDCT. |
3 |
| 64. Kim HJ, Lee SS, Byun JH, et al. Incremental value of liver MR imaging in patients with potentially curable colorectal hepatic metastasis detected at CT: a prospective comparison of diffusion-weighted imaging, gadoxetic acid-enhanced MR imaging, and a combination of both MR techniques. Radiology 2015;274:712-22. |
Observational-Dx |
51 patients with potentially resectable hepatic metastases detected with CT underwent liver MR, including DW imaging and gadoxetic acid-enhanced MR |
To prospectively compare diagnostic performance of diffusion-weighted (DW) imaging, gadoxetic acid-enhanced magnetic resonance (MR) imaging, both techniques combined (combined MR imaging), and computed tomography (CT) for detecting colorectal hepatic metastases and evaluate incremental value of MR for patients with potentially curable colorectal hepatic metastases detected with CT. |
There were 104 hepatic metastases in 47 patients. The pooled FOM values, sensitivities, and PPVs of combined MR (FOM value, 0.93; sensitivity, 98%; and PPV, 88%) and gadoxetic acid-enhanced MR (FOM value, 0.92; sensitivity, 95%; and PPV, 90%) were significantly higher than those of CT (FOM value, 0.82; sensitivity, 85%; and PPV, 73%) (P < .006). The pooled FOM value and sensitivity of combined MR (FOM value, 0.92; sensitivity, 95%) was also significantly higher than that of DW imaging (FOM value, 0.82; sensitivity, 79%) for metastases (=1-cm diameter) (P = .003). DW imaging showed significantly higher pooled sensitivity (79%) and PPV (60%) than CT (sensitivity, 50%; PPV, 33%) for the metastases (=1-cm diameter) (P = .004). In 47 patients with hepatic metastases, combined MR depicted more metastases than CT in 10 and 14 patients, respectively, according to both readers. |
1 |
| 65. Zhang H, Dai W, Fu C, et al. Diagnostic value of whole-body MRI with diffusion-weighted sequence for detection of peritoneal metastases in colorectal malignancy. Cancer Biol Med 2018;15:165-70. |
Observational-Dx |
27 patients that underwent preoperative WB-MRI, followed by cytoreductive surgery for primary tumors |
To assess the diagnostic accuracy of whole-body MRI using diffusion-weighted sequence (WB-DWI) to determine the peritoneal cancer index (PCI) in correlation with surgical and histopathological findings. |
No statistical difference was found between the WB-DWI PCI and surgical PCI (P = 0.574). WB-DWI correctly predicted the PCI type in 24 of 27 patients with high accuracy (88.9%), including 10 of 10 patients with small-volume tumor, 12 of 14 with moderate-volume tumor, and 2 of 3 with large-volume tumor. WB-DWI correctly depicted tumors in 163 of 203 regions, with 40 false-negative and 23 false-positive regions. The overall sensitivity, specificity, and accuracy of WB-DWI for the detection of peritoneal tumors were 80.3%, 84.5%, and 82.1%, respectively. For lesions < 0.5 cm in diameter, WB-DWI demonstrated good sensitivity (69.4%). |
3 |
| 66. van 't Sant I, van Eden WJ, Engbersen MP, et al. Diffusion-weighted MRI assessment of the peritoneal cancer index before cytoreductive surgery. Br J Surg. 106(4):491-498, 2019 03. |
Observational-Dx |
49 patients with confirmed or suspected colorectal peritoneal metastases scheduled for exploratory laparotomy or laparoscopy |
To investigate whether diffusion-weighted MRI (DW-MRI) can be used to select patients for CRS-HIPEC. |
Fifty-six patients were included in the study, of whom 49 could be evaluated. The mean(s.d.) PCI at surgery was 11·27(7·53). The mean MRI-PCI was 10·18(7·07) for reader 1 and 8·59(7·08) for reader 2. Readers 1 and 2 correctly staged 47 of 49 and 44 of 49 patients respectively (accuracy 96 and 90 per cent). Both readers detected all patients with resectable disease with a PCI below 21 at surgery (sensitivity 100 per cent). No patient was overstaged. The intraclass correlation (ICC) between readers was excellent (ICC 0·91, 95 per cent c.i. 0·77 to 0·96). MRI-PCI had a stronger correlation with surgical PCI (ICC 0·83-0·88) than did CT-PCI (ICC 0·39-0·44). |
1 |
| 67. Dresen RC, De Vuysere S, De Keyzer F, et al. Whole-body diffusion-weighted MRI for operability assessment in patients with colorectal cancer and peritoneal metastases. Cancer Imaging 2019;19:1. |
Observational-Dx |
60 colorectal cancer patients who underwent WB-DWI/MRI in addition to CT for clinically suspected peritoneal metastases |
To evaluate the added value of whole-body diffusion-weighted MRI (WB-DWI/MRI) to CT for prediction of peritoneal cancer spread and operability assessment in colorectal cancer patients with clinically suspected peritoneal carcinomatosis (PC). |
For detection of PC, CT had 43.2% sensitivity, 95.6% specificity, 84.5% positive predictive value (PPV) and 75.2% negative predictive value (NPV). WB-DWI/MRI had 97.8% sensitivity, 93.2% specificity, 88.9% PPV and 98.7% NPV. WB-DWI/MRI enabled better detection of inoperable distant metastases (all 12 patients) than CT (2/12 patients) and significantly improved prediction of PCI category [WB-DWI/MRI PCI < 12: 37/39 patients (94.9%); PCI = 12-15: 4/4 patients (100%); PCI > 15: 16/17 patients (94.1%) versus CT PCI < 12: 38/39 patients (97.4%); PCI = 12-15: 0/4 patients (0%); PCI > 15: 2/17 patients (11.8%); p < 0.0001)]. WB-DWI/MRI improved prediction of inoperability over CT with 90.6% sensitivity compared to 25% (p < 0.0001). |
2 |
| 68. Engbersen MP, Aalbers AGJ, Van't Sant-Jansen I, et al. Extent of Peritoneal Metastases on Preoperative DW-MRI is Predictive of Disease-Free and Overall Survival for CRS/HIPEC Candidates with Colorectal Cancer. Ann Surg Oncol. 27(9):3516-3524, 2020 Sep. |
Observational-Dx |
78 patients with PMs considered for CRS/HIPEC who underwent DW-MRI for preoperative staging |
To determine whether the extent of peritoneal metastases (PMs) on preoperative diffusion-weighted magnetic resonance imaging (DW-MRI) can be used as a biomarker of disease-free and overall survival in patients with colorectal cancer who are considered for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). |
CRS/HIPEC was planned for 53 patients and completed in 50 patients (60.5%). Median follow-up after DW-MRI was 23 months (interquartile range 13-24). The MRI-PCI of both readers showed prognostic value for overall survival, independently of whether R1 resection was achieved (hazard ratio [HR] 1.06-1.08; p < 0.05). For the patients who received successful CRS/HIPEC, the MRI-PCI also showed independent prognostic value for disease-free survival for both readers (HR 1.09-1.10; p < 0.05). |
3 |
| 69. Engbersen MP, Rijsemus CJV, Nederend J, et al. Dedicated MRI staging versus surgical staging of peritoneal metastases in colorectal cancer patients considered for CRS-HIPEC; the DISCO randomized multicenter trial. BMC Cancer. 21(1):464, 2021 Apr 26. |
Observational-Dx |
272 patients suspected of synchronous or metachronous peritoneal metastases of colorectal origin who are considered for CRS-HIPEC after CT imaging |
To determine whether MRI can effectively reduce the need for surgical staging. |
Results not yet available. |
1 |
| 70. van 't Sant I, Nerad E, Rijsemus CJV, et al. Seeing the whole picture: Added value of MRI for extraperitoneal findings in CRS-HIPEC candidates. European Journal of Surgical Oncology. 48(2):462-469, 2022 Feb. |
Observational-Dx |
158 patients with 60 MR-EPFs |
To investigate the added value of MRI to depict abdominopelvic extraperitoneal findings in the staging of CRS-HIPEC candidates compared to the standard workup. |
In 158 included patients 60 MR-EPFs (in 58/158 patients) were noted: twenty-six (43%) were new findings and thirty-four (57%) were equivocal findings on CT. Of the 34 equivocal findings 27 were 'rejected/less likely malignant' and 7 'confirmed/more likely malignant' based on MRI. In 29 patients (18%) the MR-EPFs had direct influence on treatment planning. Three patients (2%), eligible for CRS-HIPEC on CT, were deemed inoperable due to MR-EPFs. |
2 |
| 71. Taylor SA, Mallett S, Beare S, et al. Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed colorectal cancer: the prospective Streamline C trial. Lancet Gastroenterol Hepatol. 4(7):529-537, 2019 07. |
Observational-Dx |
299 patients with newly diagnosed colorectal cancer |
To prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in colorectal cancer. |
Between March 26, 2013, and Aug 19, 2016, 1020 patients were screened for eligibility. 370 patients were recruited, 299 of whom completed the trial; 68 (23%) had metastasis at baseline. Pathway sensitivity was 67% (95% CI 56 to 78) for WB-MRI and 63% (51 to 74) for standard pathways, a difference in sensitivity of 4% (-5 to 13, p=0·51). No adverse events related to imaging were reported. Specificity did not differ between WB-MRI (95% [95% CI 92-97]) and standard pathways (93% [90-96], p=0·48). Agreement with the multidisciplinary team's final treatment decision was 96% for WB-MRI and 95% for the standard pathway. Time to complete staging was shorter for WB-MRI (median, 8 days [IQR 6-9]) than for the standard pathway (13 days [11-15]); a 5-day (3-7) difference. WB-MRI required fewer tests (median, one [95% CI 1 to 1]) than did standard pathways (two [2 to 2]), a difference of one (1 to 1). Mean per-patient staging costs were £216 (95% CI 211-221) for WB-MRI and £285 (260-310) for standard pathways. |
1 |
| 72. Taylor SA, Mallett S, Miles A, et al. Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies. Health Technol Assess. 23(66):1-270, 2019 12. |
Observational-Dx |
299 patients aged ≥ 18 years with histologically proven or suspected colorectal (Streamline C) or non-small-cell lung cancer (Streamline L) |
To compare diagnostic accuracy, efficiency, patient acceptability, observer variability and cost-effectiveness of whole-body magnetic resonance imaging and standard pathways in staging newly diagnosed non-small-cell lung cancer (Streamline L) and colorectal cancer (Streamline C). |
Streamline C - 299 participants were included. Per-patient sensitivity for metastatic disease was 67% (95% confidence interval 56% to 78%) and 63% (95% confidence interval 51% to 74%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -5% to 13%; p = 0.51). Specificity was 95% (95% confidence interval 92% to 97%) and 93% (95% confidence interval 90% to 96%) respectively, a difference of 2% (95% confidence interval -2% to 6%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 96% and 95% of cases, respectively, a difference of 1% (95% confidence interval -2% to 4%). Time for staging was 8 days (95% confidence interval 6 to 9 days) and 13 days (95% confidence interval 11 to 15 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 5 days (95% confidence interval 3 to 7 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £216 (95% confidence interval £211 to £221) versus £285 (95% confidence interval £260 to £310). Streamline L - 187 participants were included. Per-patient sensitivity for metastatic disease was 50% (95% confidence interval 37% to 63%) and 54% (95% confidence interval 41% to 67%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -7% to 15%; p = 0.73). Specificity was 93% (95% confidence interval 88% to 96%) and 95% (95% confidence interval 91% to 98%), respectively, a difference of 2% (95% confidence interval -2% to 7%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 98% and 99% of cases, respectively, a difference of 1% (95% confidence interval -2% to 4%). Time for staging was 13 days (95% confidence interval 12 to 14 days) and 19 days (95% confidence interval 17 to 21 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 6 days (95% confidence interval 4 to 8 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £317 (95% confidence interval £273 to £361) versus £620 (95% confidence interval £574 to £666). Participants generally found whole-body magnetic resonance imaging more burdensome than standard imaging but most participants preferred the whole-body magnetic resonance imaging staging pathway if it reduced time to staging and/or number of tests. |
1 |
| 73. Park SY, Cho SH, Lee MA, et al. Diagnostic performance of MRI- versus MDCT-categorized T3cd/T4 for identifying high-risk stage II or stage III colon cancers: a pilot study. Abdom Radiol. 44(5):1675-1685, 2019 05. |
Observational-Dx |
38 |
To determine the diagnostic performance of magnetic resonance imaging (MRI)-categorized T3cd/T4 tumors for identifying high-risk stage II or stage III cancer in patients with curatively resectable colon cancer in comparison to that of multidetector computed tomography (MDCT). |
Twenty-nine patients (76.3%) were histopathologically diagnosed with high-risk stage II or stage III colon cancer. The false-positive rate with MRI was lower than that with MDCT (0% vs. 7.9% for reader 1, 2.6% vs. 10.6% for reader 2). The diagnostic performance of MRI was better than that of MDCT across both readers (AUC: 0.707 vs. 0.506 [P = 0.032] for reader 1, 0.651 vs. 0.485 [P = 0.055] for reader 2). Moreover, MRI interreader agreement for the assessment of T3cd/T4 was significantly better than that of MDCT (? = 0.821 vs. 0.391 [P = 0.017]). |
1 |
| 74. Bonifacio C, Vigano L, Felisaz P, et al. Diffusion-weighted imaging and loco-regional N staging of patients with colorectal liver metastases. Eur J Surg Oncol. 45(3):347-352, 2019 03. |
Observational-Dx |
32 patients |
To evaluate quantitative ADC measurement as a tool to identify metastatic LNs in patients with liver metastases from colorectal cancer. |
Among 555 patients operated for CLM, 32 met the inclusion criteria. Fifty-six LNs were analyzed and 28 were metastatic. ADC and ADCratio in metastatic LNs were lower than in benign LNs (ADC=1.37 vs. 1.83×10-3mm2/s, p<0.001; ADCratio=1.26 vs. 1.73, p<0.001). The optimal cut-off value for ADC was 1.48 x 10-3mm2/s (AUC=0.85, p<0.001, sensitivity/specificity/accuracy 79%/93%/86% in per LN-analysis and 94%/86%/91% in per-patient analysis). The optimal cut-off for ADCratio was 1.15 (AUC=0.80, p<0.001, sensitivity/specificity/accuracy 69%/93%/81% and 76%,93%/84%). Excellent inter- and intra-operators’ agreements were observed. |
2 |
| 75. Liu LH, Lv H, Wang ZC, Rao SX, Zeng MS. Performance comparison between MRI and CT for local staging of sigmoid and descending colon cancer. Eur J Radiol. 121:108741, 2019 Dec. |
Observational-Dx |
116 patients with sigmoid or descending colon cancer who underwent both MRI and CT before surgery |
To compare the diagnostic performance of MRI and CT for local staging of sigmoid and descending colon cancer, with pathological results as the reference standard. |
MRI achieved correct T-stage in 81 of 116 patients (69.8 %) while CT in 66 (56.9 %). For detecting T3-4 disease, MRI showed better performance than CT with area under the curve (AUC) of 0.888 versus 0.712 (P = 0.002) and specificity of 81.82 % versus 54.6 % (P = 0.011). No significance was found in sensitivity between two modalities (89.2 % versus 83.1 %, P = 0.302). For detecting N+ disease, performance of MRI and CT were similar (AUC, 0.670 versus 0.650, P = 0.412). For detecting EMVI+, MRI showed better performance than CT (AUC, 0.780 versus 0.575, P = 0.012) with significantly higher sensitivity (68.6 % versus 40.0 %, P = 0.031) and similar specificity (both are 84.3 %). |
2 |
| 76. Song Y, Wang Y, An J, Fu P. Local Staging of Colon Cancer: A Cross-Sectional Analysis for Diagnostic Performance of Magnetic Resonance Imaging and by Experience. Cancer Invest. 39(5):379-389, 2021 May. |
Review/Other-Dx |
N/A |
Cross-sectional analysis for diagnostic performance of magnetic resonance imaging. |
Preoperative magnetic resonance imaging was analyzed by four radiologists regarding local tumor staging (T and N) and the presence of extramural vascular involvement. An astonishingly high sensitivity for the detection of T 3/4 tumors (? (quadratic weighted statistics constant) = 0.67), with considerably lower sensitivity for T 3 cd/4 tumors (? = 0.51), high sensitivity for serosal involvement 76-87% (? = 0.65) and extramural vascular involvement (87-98%, ? = 0.56). Sensitivity and specificity for lymph node involvement is lower (? = 0.57). Magnetic resonance imaging with adequate experience can accurately detect tumors with invasion through the bowel wall and their prognostic factors. |
4 |
| 77. Rafaelsen SR, Dam C, Vagn-Hansen C, et al. CT and 3 Tesla MRI in the TN Staging of Colon Cancer: A Prospective, Blind Study. Curr. oncol.. 29(2):1069-1079, 2022 02 13. |
Observational-Dx |
134 patients |
To investigate the sensitivity and specificity of magnetic resonance imaging (MRI) compared to CT in the T- and N-staging of colon cancer. |
From 2018 to 2021, 134 patients received CT and MRI scans. CT identified 118 of the 134 tumors, whereas MRI identified all tumors. For discriminating between stage T3ab and T3cd, the sensitivity of CT was 51.1% and of MRI 80.0% (p = 0.02). CT and MRI showed a sensitivity of 21.4% and 46.4% in detecting pT4 tumors and a specificity of 79.0% and 85.0%, respectively. |
1 |
| 78. Wille-Jorgensen P, Syk I, Smedh K, et al. Effect of More vs Less Frequent Follow-up Testing on Overall and Colorectal Cancer-Specific Mortality in Patients With Stage II or III Colorectal Cancer: The COLOFOL Randomized Clinical Trial. JAMA. 319(20):2095-2103, 2018 05 22. |
Observational-Dx |
2509 patients with stage II or III colorectal cancer |
To examine overall mortality, colorectal cancer-specific mortality, and colorectal cancer-specific recurrence rates among patients with stage II or III colorectal cancer who were randomized after curative surgery to 2 alternative schedules for follow-up testing with computed tomography and carcinoembryonic antigen. |
Among 2555 patients who were randomized, 2509 were included in the intention-to-treat analysis (mean age, 63.5 years; 1128 women [45%]) and 2365 (94.3%) completed the trial. The 5-year overall patient mortality rate in the high-frequency group was 13.0% (161/1253) compared with 14.1% (174/1256) in the low-frequency group (risk difference, 1.1% [95% CI, -1.6% to 3.8%]; P = .43). The 5-year colorectal cancer-specific mortality rate in the high-frequency group was 10.6% (128/1248) compared with 11.4% (137/1250) in the low-frequency group (risk difference, 0.8% [95% CI, -1.7% to 3.3%]; P = .52). The colorectal cancer-specific recurrence rate was 21.6% (265/1248) in the high-frequency group compared with 19.4% (238/1250) in the low-frequency group (risk difference, 2.2% [95% CI, -1.0% to 5.4%]; P = .15). |
3 |
| 79. Figueredo A, Rumble RB, Maroun J, et al. Follow-up of patients with curatively resected colorectal cancer: a practice guideline. BMC Cancer 2003;3:26. |
Review/Other-Dx |
NA |
A systematic review was conducted to evaluate the literature regarding the impact of follow-up on colorectal cancer patient survival and, in a second phase, recommendations were developed. |
Six randomized trials and two published meta-analyses of follow-up were obtained. Of six randomized trials comparing one follow-up program to a more intense program, only two individual trials detected a statistically significant survival benefit favouring the more intense follow-up program. Pooling of all six randomized trials demonstrated a significant improvement in survival favouring more intense follow-up (Relative Risk Ratio 0.80 (95%CI, 0.70 to 0.91; p = 0.0008). Although the rate of recurrence was similar in both of the follow-up groups compared, asymptomatic recurrences and re-operations for cure of recurrences were more common in patients with more intensive follow-up. Trials including CEA monitoring and liver imaging also had significant results, whereas trials not including these tests did not. |
4 |
| 80. Spatz J, Holl G, Sciuk J, Anthuber M, Arnholdt HM, Markl B. Neoadjuvant chemotherapy affects staging of colorectal liver metastasis--a comparison of PET, CT and intraoperative ultrasound. Int J Colorectal Dis 2011;26:165-71. |
Observational-Dx |
34 patients |
To evaluate the effects of neoadjuvant chemotherapy on the efficacy of positron emission tomography (PET), PET-computed tomography (CT), CT and intraoperative ultrasound (IUS) in the detection of liver metastasis. |
A total of 109 liver segments were resected, of which 50 showed no metastatic involvement (45.9%). For patients without systemic chemotherapy, sensitivities for PET, CT/MRI and IUS were 92%, 64% and 100% respectively as compared with 63%, 65% and 94% for patients after neoadjuvant chemotherapy in a segment-based analysis. For PET, standardised uptake values were decreased by 3.9 in 10 patients after chemotherapy whereas lesion diameters were similar (3.0 vs. 3.2 cm). Additional metastases were detected by IUS in seven patients resulting in a change of operative procedure in 20.6%. |
3 |
| 81. Moore A, Ulitsky O, Ben-Aharon I, et al. Early PET-CT in patients with pathological stage III colon cancer may improve their outcome: Results from a large retrospective study. Cancer Med. 7(11):5470-5477, 2018 11. |
Observational-Dx |
342 patients |
This study aimed to determine the role of the PET/CT in the general stage III colon cancer population. |
A total of 342 patients, 166 (48.5%) males, median age 66 years (range, 29-90), were included. Pathological stage was IIIA, IIIB, and IIIC in 18 (5.3%), 257 (75.1%), and 67 (19.6%) patients, respectively. Median number of positive lymph nodes was 2 (range, 0-32). PET-CT results modified the management of 46 patients (13.4%): 37 (10.8%) with overt metastatic disease and 9 (2.6%) with a second primary. The 5-year disease-free survival for true stage III patients was 81%. The median overall survival for the entire cohort and for true stage III patients was not reached and was 57.2 months for true stage IV. Of the 37 patients found to be metastatic, 14 (37.8%) underwent curative treatments and 9/14 (64.3%) remain disease-free, with a median follow-up of 83.8 months. Predictive factors for upstaging following PET-CT were identified. |
3 |
| 82. Capirci C, Rubello D, Pasini F, et al. The role of dual-time combined 18-fluorodeoxyglucose positron emission tomography and computed tomography in the staging and restaging workup of locally advanced rectal cancer, treated with preoperative chemoradiation therapy and radical surgery. Int J Radiat Oncol Biol Phys 2009;74:1461-9. |
Observational-Dx |
87 consecutive patients enrolled, 2 reviewers |
To evaluate the possible role of dual time sequential FDG-PET scans in the staging and restaging workup of locally advanced rectal cancer. |
Six of 87 patients were excluded due to protocol deviation. Following CRT, 40/81 patients (49%) were classified as responders according to Mandard's criteria (TRG1-2). The mean pre-CRT SUV(max) was significantly higher than post-CRT (15.8, vs 5.9; p < 0.001). The mean RI was significantly higher in responders than in nonresponder patients (71.3% vs 38%; p = 0.0038). Using a RI cut-off of 65% for defining response to therapy, the following parameters have been obtained: 84.5% sensitivity, 80% specificity, 81.4% positive predictive value, 84.2% negative predictive value, and 81% overall accuracy. |
2 |
| 83. Borello A, Russolillo N, Lo Tesoriere R, Langella S, Guerra M, Ferrero A. Diagnostic performance of the FDG-PET/CT in patients with resected mucinous colorectal liver metastases. Surgeon Journal of the Royal Colleges of Surgeons of Edinburgh & Ireland. 19(5):e140-e145, 2021 Oct. |
Review/Other-Dx |
831 patients |
The aim of this study was to evaluate the diagnostic performance of the FDG-PET/CT in patients with mucCRLM who underwent liver surgery. |
831 patients underwent liver resections for CRLM between 01/2005 and 11/2018. Of these patients 131 had mucinous CRLM (15.7%). Eight patients were excluded for incomplete data (2 patients for missing FDG-PET/CT reports, 1 patient for unreported number of liver metastases at intraoperative ultrasound and 3 at pathological reports) and 2 patients for follow-up time shorter than 6 months.FDG-PET/CT was performed in 58 (44.2%) patients (38 males, 79.2%) with a median age of 62 (23–80) years. |
4 |
| 84. Amorim BJ, Hong TS, Blaszkowsky LS, et al. Clinical impact of PET/MR in treated colorectal cancer patients. Eur J Nucl Med Mol Imaging. 46(11):2260-2269, 2019 Oct. |
Observational-Dx |
39 patients |
The primary aim of the present study was to evaluate if positron emission tomography (PET)/magnetic resonance imaging(MR) induced management changes versus standard of care imaging (SCI) in treated colorectal cancer patients. The secondary aim was to assess the staging performance of PET/MR and of SCI versus the final oncologic stage. |
A total of 39 patients who underwent 42 PET/MR studies were included, mean age 56.7 years (range 39–75 years), 26 males, and 13 females. PET/MR changed clinical management 15/42 times (35.7%, standard error ± 7.4%); these 15 changes in management were due to upstaging in 9/42 (21.5%) and downstaging in 6/42 (14.2%). The differences in management prompted by SCI versus PET/MR were statistically significant, and PET/MR outperformed SCI (P value <?0.001; odds ratio?=?2.8). In relation to the secondary outcome, PET/MR outperformed the SCI in accuracy of oncologic staging (P value?=?0.016; odds ratio?=?4.6). |
3 |
| 85. Kang SK, Reinhold C, Atri M, et al. ACR Appropriateness Criteria® Staging and Follow-Up of Ovarian Cancer. J Am Coll Radiol 2018;15:S198-S207. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for staging and follow-up of ovarian cancer. |
No results stated in abstract. |
4 |
| 86. Sugarbaker PH, Sardi A, Brown G, Dromain C, Rousset P, Jelinek JS. Concerning CT features used to select patients for treatment of peritoneal metastases, a pictoral essay. Int J Hyperthermia 2017;33:497-504. |
Review/Other-Dx |
15 images |
Pictoriaal essay of CT features used to select patients for treatment of peritoneal metastases. |
Radiographs of 15 CT images that cause concern when a patient is being evaluated for CRS were listed. The anatomic pathology these images define and possible surgical resections they require were reviewed. The surgical implications of the absence or presence of a single, or of multiple concerning CT features was extracted from the surgical and radiologic literature. |
4 |
| 87. Lim HK, Lee WJ, Kim SH, Kim B, Cho JM, Byun JY. Primary mucinous cystadenocarcinoma of the appendix: CT findings. AJR Am J Roentgenol 1999;173:1071-4. |
Review/Other-Dx |
NA |
The purpose of this study was to describe CT findings in six patients with primary mucinous cystadenocarcinoma of the appendix. |
No resuts listed in abstract. |
4 |
| 88. Wang H, Chen YQ, Wei R, et al. Appendiceal mucocele: A diagnostic dilemma in differentiating malignant from benign lesions with CT. AJR Am J Roentgenol 2013;201:W590-5. |
Observational-Dx |
18 patients |
The purpose of this study was to assess the feasibility of using CT to differentiate malignant from benign lesions in patients with pathologically confirmed appendiceal mucoceles. |
CT showed statistically significant differences in wall irregularity and soft-tissue thickening between malignant and benign cases (p < 0.05). Short diameter of mucoceles, attenuation of intraluminal contents, maximal wall thickness, calcifications, internal septations, periappendiceal fat stranding, intraperitoneal free fluid, and pseudomyxoma peritonei in the lesions did not differ significantly between the benign and malignant groups (p > 0.05). |
3 |
| 89. Koh JL, Yan TD, Glenn D, Morris DL. Evaluation of preoperative computed tomography in estimating peritoneal cancer index in colorectal peritoneal carcinomatosis. Ann Surg Oncol 2009;16:327-33. |
Observational-Dx |
19 patients |
The objective of this study was to evaluate the utility of preoperative CT in estimating PCI during the patient selection process. |
The sensitivity, specificity, positive predictive value, and negative predictive value were calculated in each abdominopelvic region. Overall, where CT identifies the presence of disease, it portrayed lesion size accurately in 60%, underestimated in 33%, and overestimated in 7% of cases. Analysis of individual abdominopelvic regions demonstrated a statistically significant difference between radiologically and intraoperatively visualized lesion sizes (P < 0.05) except in the epigastrium, left upper, and left flank regions. The sensitivity of CT in detecting peritoneal implants was influenced by lesion size. Small nodules (<0.5 cm) were visualized on CT with only a sensitivity of 11%, which is in contrast to 94% with nodules exceeding 5 cm. Radiological PCI scores significantly underestimated intraoperative PCI (P < 0.001). This study demonstrated that the sensitivity of CT in detecting peritoneal implants was influenced by lesion size and CT PCI significantly underestimated clinical PCI. |
3 |
| 90. Flicek K, Ashfaq A, Johnson CD, Menias C, Bagaria S, Wasif N. Correlation of Radiologic with Surgical Peritoneal Cancer Index Scores in Patients with Pseudomyxoma Peritonei and Peritoneal Carcinomatosis: How Well Can We Predict Resectability? J Gastrointest Surg 2016;20:307-12. |
Review/Other-Dx |
32 patients |
Compare preoperative imaging with surgical findings based on PCI. |
Forty-two patients had a mean surgical PCI?±?SEM score of 15.1 ± 1.3 and mean radiologic PCI of 15.5?±?1.5. The most common tumor histologies were appendiceal (60 %) and colon (33 %) adenocarcinoma and were of low tumor grade (67 %). Correlation between individual radiologists and surgical PCI was 0.59 and 0.62, respectively (all p?<?0.001). When mean radiologic PCI was used, this correlation with surgical PCI improved to 0.64 and to 0.65 when good quality studies only were considered (all p?<?0.001). Radiologic PCI score had a sensitivity of 76 %, a specificity of 69 %, positive predictive value of 85 %, and a negative predictive value of 56 % when compared with the surgical PCI. In patients with a radiologic PCI score?=?20, 6/13 (46 %) still achieved adequate cytoreduction. |
4 |
| 91. Lee RM, Zaidi MY, Gamboa AC, et al. What is the Optimal Preoperative Imaging Modality for Assessing Peritoneal Cancer Index? An Analysis From the United States HIPEC Collaborative. Clin Colorectal Cancer 2020;19:e1-e7. |
Review/Other-Tx |
488 patients |
To determine the correlation of computed tomography (CT)-predicted PCI (CT-PCI) and magnetic resonance imaging (MRI)-predicted PCI (MRI-PCI) with intraoperative-PCI, and if a preoperative-PCI cutoff is associated with incomplete cytoreduction. |
A total of 488 patients were included. Of these, 34% had noninvasive appendiceal, 30% invasive appendiceal, 28% colorectal, and 8% PM histology. CT-PCI was correlated with intraoperative-PCI for patients with noninvasive and invasive appendiceal and colorectal histologies (r = 0.689, 0.554, and 0.571; all P < .001), but not PM (r = 0.188; P = .295). MRI-PCI was correlated with intraoperative-PCI for all histologies (non-invasive appendiceal: r = 0.591; P = .002; invasive appendiceal: r = 0.848; P < .001; colorectal: r = 0.729; P < .001; PM: r = 0.890; P = .007). Comparing CT and MRI, correlations were similar in noninvasive appendiceal and colorectal histologies; MRI was better for invasive appendiceal and PM (P = .005 and P = .021, respectively). Twenty-eight (6%) patients underwent an incomplete cytoreduction (cytoreduction score, 2-3). PCI greater than 15 was associated with cytoreduction score of 2 to 3 for both CT and MRI (CT-PCI: odds ratio, 3.0; P = .033; MRI-PCI: odds ratio, 7.6; P = .071). |
4 |
| 92. Guaglio M, Sinukumar S, Kusamura S, et al. Clinical Surveillance After Macroscopically Complete Surgery for Low-Grade Appendiceal Mucinous Neoplasms (LAMN) with or Without Limited Peritoneal Spread: Long-Term Results in a Prospective Series. Ann Surg Oncol 2018;25:878-84. |
Observational-Dx |
41 patients |
This study prospectively assessed a clinical surveillance strategy for LAMN with or without limited peritoneal spread. |
Appendectomy and five right colectomies were performed for 36 patients. Nine patients also underwent macroscopically complete cytoreduction of mucinous peritoneal disease, and four patients had hysterectomy plus bilateral salphingo-oophorectomy. Appendiceal rupture was evaluable in 38 of the 41 patients, being present in 21 patients (51.2%). Mucin, cells, or both outside the appendix were observed in 24 patients (58.5%). The median follow-up period was 58 months (range 9.3-162 months). The 5-year recurrence-free survival rate was 95.1%. Only two patients experienced peritoneal recurrences (4.9%), respectively 18 and 22 months after appendectomy. Their primary lesions were LAMNs with and without appendix wall rupture or extra-appendiceal mucin, respectively. No death occurred. |
3 |
| 93. Solomon D, Bekhor E, Leigh N, et al. Surveillance of Low-Grade Appendiceal Mucinous Neoplasms With Peritoneal Metastases After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Are 5 Years Enough? A Multisite Experience. Ann Surg Oncol 2020;27:147-53. |
Review/Other-Dx |
NA |
Multisite surveillance study to monitor patients over 5 years. |
The study enrolled 156 patients. The median peritoneal cancer index (PCI) was 18 (interquartile range IQR1-3, 12-23), and 125 patients (80.1%) had a CC0 cytoreduction. According to American Joint Committee on Cancer (AJCC) grading, 152 patients (97.4%) presented with acellular mucin or G1 implants, 2 patients (1.3%) presented with G2 disease, and 2 patients (1.3%) presented with G3 disease. During the follow-up period (median, 45 months; IQR1-3 23-76 months), 23 patients (14.7%) experienced recurrence. All the recurrences were peritoneal and occurred within 5 years. The 1-, 3-, and 5-year disease-free survival (DFS) rates were respectively 95.5%, 83.4%, and 78.3%. Univariate Cox regression analysis showed that higher PCI scores (p < 0.001), a CC1 cytoreduction (p = 0.005), and higher preoperative levels of carcinoembryonic antigen (CEA) (p = 0.012) and CA-125 (p = 0.032) correlated with a shorter DFS. Only higher PCI scores independently predicted earlier recurrences (p < 0.001). |
4 |
| 94. Rohani P, Scotti SD, Shen P, et al. Use of FDG-PET imaging for patients with disseminated cancer of the appendix. Am Surg 2010;76:1338-44. |
Observational-Dx |
33 patients |
The goal of this study is to evaluate the use of positron emission tomography (PET) in evaluation of patients with peritoneal dissemination of carcinoma of appendiceal origin (PDA). |
Thirty-three patients with PDA, who had preoperative PET or PET/CT imaging, were analyzed. Using operative, pathology, and PET +/- CT data, presence or absence of disease in each abdominal quadrant was noted and the use of 18fluoro-deoxy-glucose (FDG) PET for each quadrant was evaluated. The mean age was 52, and there were 17 males; 58 per cent had low-grade lesions. PET was positive in only 35 per cent of cases overall (30 and 41% sensitivity for low-grade and high-grade, respectively). PET without CT sensitivity for low-grade and high-grade lesions was 21 and 8 per cent, respectively. PET imaging has limited use for patients with PDA. We do not recommend the use of FDG-PET for patients with PDA from cancer of the appendix. |
3 |
| 95. Dromain C, Leboulleux S, Auperin A, et al. Staging of peritoneal carcinomatosis: enhanced CT vs. PET/CT. Abdom Imaging 2008;33:87-93. |
Observational-Dx |
30 |
To assess and compare the performance of CT and 18F-FDG-PET/CT in the evaluation of peritoneal carcinomatosis (PC). |
The presence of PC was correctly determined on CT and PET/CT in 23/28 and 16/28 patients, respectively. The extent of PC was understaged with CT and PET/CT in 27 patients and overstaged with CT and PET/CT in 1 and 2 patients, respectively. The interclass correlation was 0.53 (moderate) between CT and surgery and 0.12 (low) between PET/CT and surgery. The interclass correlation was higher for mucinous tumor (0.63) than for non-mucinous (0.16) on CT imaging whereas no difference was found in PET/CT. |
2 |
| 96. Sommariva A, Evangelista L, Pintacuda G, Cervino AR, Ramondo G, Rossi CR. Diagnostic value of contrast-enhanced CT combined with 18-FDG PET in patients selected for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Abdom Radiol (NY) 2018;43:1094-100. |
Observational-Dx |
27 patients |
Aim of the study is to assess the reliability and correlation with surgical peritoneal cancer index (PCI) of combined PET/CT and ceCT scans (PET/ceCT) performed in a session in patients with peritoneal carcinomatosis candidates for cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy (HIPEC). |
Surgical PCI was available in 21 patients. The coefficient of correlation between PCI of PET/CT and surgery was 0.528, while it resulted higher between PET/ceCT and surgery (r = 0.878), very similar to ceCT and surgery (r = 0.876). The r coefficient between surgical PCI and PET/CT was higher in patients with a non-mucinous cancer (n = 12) than the counterpart (0.601 vs. 0.303) and the addition of ceCT significantly increases the correlation (r = 0.863), which is anyway similar to ceCT alone (r = 0.856). |
2 |
| 97. Squires MH 3rd, Volkan Adsay N, Schuster DM, et al. Octreoscan Versus FDG-PET for Neuroendocrine Tumor Staging: A Biological Approach. Ann Surg Oncol. 22(7):2295-301, 2015 Jul. |
Observational-Dx |
153 patients |
Clinicians may order Octreoscan or positron emission tomography (PET) scan for staging patients with neuroendocrine tumors (NETs). (111)In-Octreoscan (Octreoscan) identifies tumors by radiolabeled targeting of somatostatin receptors, while 18F-fluorodeoxyglucose-positron emission tomography ((18)FDG-PET) measures differential tissue glucose transport. We assessed the sensitivity of both nuclear imaging modalities with pathologic correlation to define the best initial choice for NET staging after standard cross-sectional imaging. |
Imaging and pathology results were identified for 153 patients. Of these, 131 underwent Octreoscan, 43 underwent PET, and 21 patients had both performed. Overall sensitivity of Octreoscan and PET for NET detection was similar (77 vs. 72 %; p = not significant). For well-differentiated NETs, Octreoscan (n = 124) demonstrated sensitivity of 80 vs. 60 % (p = 0.28) for PET (n = 30). For poorly-differentiated NETs, Octreoscan (n = 7) proved significantly less sensitive than PET (n = 13) (57 vs. 100 %; p = 0.02). The sensitivity of Octreoscan versus PET varied similarly when analyzed by WHO tumor grade: Grade 1 (79 vs. 52 %; p = 0.16), Grade 2 (85 vs. 86 %; p = not significant), and Grade 3 (57 vs. 100 %; p = 0.02). |
2 |
| 98. Paspulati RM, Partovi S, Herrmann KA, Krishnamurthi S, Delaney CP, Nguyen NC. Comparison of hybrid FDG PET/MRI compared with PET/CT in colorectal cancer staging and restaging: a pilot study. Abdom Imaging 2015;40:1415-25. |
Observational-Dx |
12 patients |
We report our initial clinical experience from a pilot study to compare the diagnostic accuracy of hybrid PET/MRI with PET/CT in colorectal cancer and discuss potential PET/MRI workflow solutions for colorectal cancer. |
Of the 12 patients enrolled, two were for initial staging and ten for restaging. The median scan delay between the two modalities was 60 min. The initial imaging was PET/CT in nine patients and PET/MRI in three patients. When PET/CT was performed first, the SUV values of the 16 FDG avid lesions were greater at PET/MRI than at PET/CT. In contrast, when PET/MRI was performed first, the SUV values of the seven FDG avid lesions were greater at PET/CT than at PET/MRI. PET/MRI provided more detailed T staging than PET/CT. On a per-patient basis, with both patient groups combined for the evaluation of N and M staging/restaging, the true positive rate was 5/7 (71%) for PET/CT and 6/7 (86%) for PET/MRI, and true negative rate was 5/5 (100%) for both modalities. On a per-lesion basis, PET/CT identified 26 of 29 (90%) tumor lesions that were correctly detected by PET/MRI. Our proposed workflow allows for comprehensive cancer staging including integrated local and whole-body assessment. |
3 |
| 99. Kang B, Lee JM, Song YS, et al. Added Value of Integrated Whole-Body PET/MRI for Evaluation of Colorectal Cancer: Comparison With Contrast-Enhanced MDCT. AJR Am J Roentgenol 2016;206:W10-20. |
Observational-Dx |
51 patients |
The purpose of this study was to evaluate the added clinical value of PET/MRI compared with conventional contrast-enhanced MDCT (CECT) alone in the evaluation of patients with colorectal cancer. |
PET/MRI added value to CECT for 14 of 51 patients (27.5%) in terms of better characterization (12/51 [23.5%]) and additional detection (2/51 [3.9%]) of extracolonic lesions. The additional information from PET/MRI led to a change in treatment strategy for 11 of 51 (21.6%) patients. ROC analyses showed that PET/MRI was significantly superior to CT in depicting colorectal cancer (p < 0.05). The rate of detection of pulmonary metastatic nodules with PET/MRI was 52.9% (9/17). |
2 |
| 100. Low RN, Sebrechts CP, Barone RM, Muller W. Diffusion-weighted MRI of peritoneal tumors: comparison with conventional MRI and surgical and histopathologic findings--a feasibility study. AJR Am J Roentgenol 2009;193:461-70. |
Observational-Dx |
34 consecutive oncology patients; 2 independent observers |
To evaluate the utility of single-shot spin-echo echo-planar DWI using a b value of 400-500 s/mm(2) for depicting peritoneal tumors. |
255 sites of peritoneal tumor were proven by surgical and histopathologic findings. The combination of DWI and conventional MRI was most sensitive and accurate for peritoneal tumors, depicting 230 and 214 tumor sites for the two observers (sensitivity, 0.90, 0.84; and accuracy, 0.91, 0.88) compared with DWI alone, which depicted 182 and 182 tumor sites with sensitivity (0.71, 0.71; and accuracy, 0.81, 0.81), and conventional MRI alone, which depicted 185 and 132 tumor sites (sensitivity, 0.73, 0.52; and accuracy, 0.81, 0.72). Peritoneal tumor showed restricted diffusion on DWI and ascites was of low signal intensity, increasing tumor conspicuity. Adding DWI to routine MRI improves the sensitivity and specificity for depicting peritoneal metastases. |
2 |
| 101. Dohan A, Hoeffel C, Soyer P, et al. Evaluation of the peritoneal carcinomatosis index with CT and MRI. Br J Surg 2017;104:1244-49. |
Observational-Dx |
28 patients |
The aim was to determine the incremental value of MRI compared with CT in the preoperative estimation of the peritoneal carcinomatosis index (PCI). |
CT plus MRI was more accurate in predicting the surgical PCI than CT alone. The absolute difference between PCICT+MRI and PCIRef was lower than that between PCICT and PCIRef (mean(s.d.) 3·96(4·10) versus 4·89(4·73); P = 0·010). The number of true-positive findings increased from 106 to 125 for reader 1 and from 117 to 132 for reader 2 with the adjunct of MRI. For both readers, an increased sensitivity was obtained when both MRI and CT were used (from 63 to 81 per cent for reader 1; from 44 to 81 per cent for reader 2). The increase in sensitivity was greater for patients with a moderate volume of disease. |
3 |
| 102. Low RN, Barone RM, Lee MJ. Surveillance MR imaging is superior to serum tumor markers for detecting early tumor recurrence in patients with appendiceal cancer treated with surgical cytoreduction and HIPEC. Ann Surg Oncol. 20(4):1074-81, 2013 Apr. |
Meta-analysis |
50 patients |
The purpose of this study was to determine if MRI surveillance is better than serum tumor makers in detecting early recurrence in patients with mucinous appendiceal neoplasm. |
During surveillance tumor recurrence was documented in 30 patients (60 %) with median time to recurrence of 13 months (range 3-56 months). MRI detected recurrent tumor in 28 patients, including 11 patients with normal laboratory values (sensitivity 0.93, specificity 0.95, accuracy 0.94, PPV 0.97, and NPV 0.90). Serial laboratory values showed tumor recurrence in 14 patients (sensitivity 0.48, specificity 1.00, accuracy 0.69, PPV 1.0, and NPV 0.57). Median survival was 50 months for 11 patients with earlier MRI detection of recurrence vs 33 months for the other 19 patients with recurrence. |
Not Assessed |
| 103. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. |
Review/Other-Dx |
N/A |
Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. |
No abstract available. |
4 |
| 104. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
