Sjövall A, Blomqvist L, Egenvall M, Johansson H, Martling A
Department of Molecular Medicine and Surgery, Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Department of Radiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Colorectal Dis. 2016 Jan;18(1):73-9. doi: 10.1111/codi.13091.
AIM: To select patients for neoadjuvant therapy in colon cancer, there is a need to improve pre-therapeutic locoregional staging. There are now data showing that the TN stage can be adequately assessed by preoperative CT in dedicated centres. In Sweden the use of preoperative CT of the abdomen for staging of the primary tumour is increasing. The aim of this study was to determine to what extent the preoperatively reported radiological TN stage correlates with the histopathological TN stage in an entire population. METHOD: Data were collected on the preoperative cTN stage according to the radiologist and postoperative pTN stage according to the pathologist on all patients operated on for colon cancer in Sweden 2007-2010. The correlation between cTN stage and pTN stage was calculated using kappa statistics. RESULTS: T stage was compared in 4373 patients with cT and pT stage. The correlation coefficient was 0.44, indicating fair agreement. The cN and pN correlation coefficient was 0.28, indicating a slight correlation. There was no difference in correlation related to age, gender, tumour location, body mass index or emergent vs elective surgery. A slight difference was seen between different geographical regions. CONCLUSION: Preoperative CT in an unselected population does not result in an accurate cTN staging as previously reported from dedicated centres. To achieve adequate preoperative cTN staging nationally, the education of radiologists and optimization of the radiological method will be necessary.
目的：为了筛选出适合接受结肠癌新辅助治疗的患者，有必要改进治疗前的局部区域分期。目前有数据表明，在专业中心，术前CT能够充分评估TN分期。在瑞典，用于原发性肿瘤分期的腹部术前CT的使用正在增加。本研究的目的是确定术前报告的放射学TN分期在整个人口中与组织病理学TN分期的相关程度。 方法：收集了2007年至2010年在瑞典接受结肠癌手术的所有患者的术前放射科医生报告的cTN分期和术后病理科医生报告的pTN分期数据。使用kappa统计量计算cTN分期和pTN分期之间的相关性。 结果：对4373例患者的cT和pT分期进行了T分期比较。相关系数为0.44，表明一致性尚可。cN和pN的相关系数为0.28，表明相关性较弱。在年龄、性别、肿瘤位置、体重指数或急诊手术与择期手术方面，相关性没有差异。不同地理区域之间存在细微差异。 结论：在未经过筛选的人群中，术前CT并不能像专业中心先前报告的那样得出准确的cTN分期。为了在全国范围内实现充分的术前cTN分期，有必要对放射科医生进行培训并优化放射学方法。
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