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Objectives <p>To conduct a meta-analysis evaluating the diagnostic accuracy of computed tomography (CT) for identifying T3–T4 colon cancer using histopathology as the reference standard. Secondary objectives included assessing CT’s performance for detecting extramural vascular invasion (EMVI) and nodal involvement.</p> Materials and methods <p>This diagnostic accuracy meta-analysis followed PRISMA-DTA guidelines and searched MEDLINE, EMBASE, and Cochrane Library for studies published up to September 2024. Eligible studies evaluated CT for preoperative T staging (T3 or higher), EMVI, and/or nodal status in primary colon cancer, reporting sensitivity and specificity. Studies on rectal cancer, using specialized CT techniques, or not in English, were excluded. Pooled sensitivity and specificity for T staging, EMVI, and nodal status were calculated using a random-effects model. Subgroup analyses explored sources of heterogeneity.</p> Results <p>Thirty-two studies, including 222,948 patients (mean age 69 years; 50.5% female), were analyzed. For pT3–T4 staging, pooled sensitivity and specificity were 0.81 (95% CI: 0.76–0.85) and 0.75 (95% CI: 0.66–0.83). For pT3c–T4, sensitivity was 0.71 (95% CI: 0.62–0.79) and specificity was 0.83 (95% CI: 0.74–0.89). EMVI detection showed sensitivity of 0.40 (95% CI: 0.30–0.52) and specificity of 0.80 (95% CI: 0.71–0.87). A reliable pooled estimate for nodal status could not be determined.</p> Conclusion <p>CT shows good diagnostic performance for identifying T3–T4 colon cancer and can detect high-risk features like EMVI. These findings support its role in selecting candidates for neoadjuvant therapies, although EMVI sensitivity remains limited.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>How accurate is CT for identifying T3–T4 colon cancer and detecting key prognostic factors like EMVI to support neoadjuvant treatment planning</i>?</p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>CT shows good accuracy for T3–T4 staging (sensitivity 0.81; specificity 0.75) and high specificity (0.80) but low sensitivity (0.40) for EMVI</i>.</p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>CT enables reliable identification of locally advanced colon cancer and high-risk features such as EMVI, supporting better patient selection and personalized neoadjuvant treatment planning</i>.</p> Graphical Abstract <p></p>

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CT diagnostic performance for preoperative staging of colon cancer: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年8月6日

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  • Joao Miranda,
  • Giovanni B Torri,
  • Meiri Andreia Maria da Silva,
  • Gustavo Monjardim,
  • Miriana Mariussi,
  • Luiza G. Schmitt,
  • Camila Piovesan Wiethan,
  • Tiago Leal Ghezzi,
  • Caroline Lorenzoni Almeida Ghezzi,
  • Stephan Altmayer,
  • Adriano Basso Dias,
  • Natally Horvat

摘要

Objectives

To conduct a meta-analysis evaluating the diagnostic accuracy of computed tomography (CT) for identifying T3–T4 colon cancer using histopathology as the reference standard. Secondary objectives included assessing CT’s performance for detecting extramural vascular invasion (EMVI) and nodal involvement.

Materials and methods

This diagnostic accuracy meta-analysis followed PRISMA-DTA guidelines and searched MEDLINE, EMBASE, and Cochrane Library for studies published up to September 2024. Eligible studies evaluated CT for preoperative T staging (T3 or higher), EMVI, and/or nodal status in primary colon cancer, reporting sensitivity and specificity. Studies on rectal cancer, using specialized CT techniques, or not in English, were excluded. Pooled sensitivity and specificity for T staging, EMVI, and nodal status were calculated using a random-effects model. Subgroup analyses explored sources of heterogeneity.

Results

Thirty-two studies, including 222,948 patients (mean age 69 years; 50.5% female), were analyzed. For pT3–T4 staging, pooled sensitivity and specificity were 0.81 (95% CI: 0.76–0.85) and 0.75 (95% CI: 0.66–0.83). For pT3c–T4, sensitivity was 0.71 (95% CI: 0.62–0.79) and specificity was 0.83 (95% CI: 0.74–0.89). EMVI detection showed sensitivity of 0.40 (95% CI: 0.30–0.52) and specificity of 0.80 (95% CI: 0.71–0.87). A reliable pooled estimate for nodal status could not be determined.

Conclusion

CT shows good diagnostic performance for identifying T3–T4 colon cancer and can detect high-risk features like EMVI. These findings support its role in selecting candidates for neoadjuvant therapies, although EMVI sensitivity remains limited.

Key Points

Question How accurate is CT for identifying T3–T4 colon cancer and detecting key prognostic factors like EMVI to support neoadjuvant treatment planning?

Findings CT shows good accuracy for T3–T4 staging (sensitivity 0.81; specificity 0.75) and high specificity (0.80) but low sensitivity (0.40) for EMVI.

Clinical relevance CT enables reliable identification of locally advanced colon cancer and high-risk features such as EMVI, supporting better patient selection and personalized neoadjuvant treatment planning.

Graphical Abstract