MSCT For Preoperative Staging Of Colon Cancer

BACKGROUND:Cancer of the colon is the most common cancer in men and women. The selection of treatment and the prognosis of colon cancer are relevant to the clinical stages. While the accuracy of diagnosis related inti-mately with the depth of tumor invasion (T) , local lymph node metastasis (N) and metastasis to neighboring or remote organs (M). Accurate preoperative assessment of tumour extent is essential for choosing the appropriate therapeutic strategy, and thus for patient prognosis.Multi-spiral CT (MSCT) is a recent method for preoperative staging of the colon cancer. It provides an accurate evaluation about the depth of tumor invasion,lymph node or distant metastases.So MSCT could be a new method for staging of colon cancer.Objective: To assess MSCT diagnostic value in the staging of colonic carcinoma.MATERIAL AND METHODS: 40 patients at our general surgery center undergoing primary resection for colon cancer during 2008–2009 were included.The patients were underwent MSCT volume scan after hypotonic pneumocolon.After the scanning all the precontrast,enhancement and reconstruction MSCT images were analyzed and estimated independently by two radiologists blinded to histological stage and outcome. Images of the primary tumour were evaluated as CT-based TNM staging according to the tumor site, direct invasion of an adjacent organ,colic fat, involvement of lymph node and mesenteric surface of the colon and distant metastases.RESULT: The overall sensitivity of MSCT for T-stage is 100% and 91.43% for invasion of mesenteric surface.The overall accuracy is 90.25%,positive predictive value (PPV)94.12% and negative predictive value(NPV) 83.33%. For lymph node metastases the sensitivity of MSCT staging is 88.23%,accuracy 80%,PPV 71.42% and NPV 89.47%.The accuracy of MSCT for M-stage is 100%. CONCLUSION: Our results suggest that it is therefore a robust method for preoperative TNM staging of colon cancer.We have demonstrated that preoperative MSCT staging can predict the clinical outcome for'good'and'poor'prognosis tumours with the same accuracy as histopathology.It is significant for choosing the appropriate therapeutic strategy.