1 Department of Radiology, Catharina Hospital Eindhoven, PO Box 1350, 5602 ZA, Eindhoven, The Netherlands.
2 GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands.
AJR Am J Roentgenol. 2016 Nov;207(5):984-995. doi: 10.2214/AJR.15.15785. Epub 2016 Aug 4.
The purpose of this article is to determine the accuracy of CT in the detection of tumor invasion beyond the bowel wall and nodal involvement of colon carcinomas. A literature search was performed to identify studies describing the accuracy of CT in the staging of colon carcinomas. Studies including rectal carcinomas that were inseparable from colon carcinomas were excluded. Publication bias was explored by using a Deeks funnel plot asymmetry test. A hierarchic summary ROC model was used to construct a summary ROC curve and to calculate summary estimates of sensitivity, specificity, and diagnostic odds ratios (ORs).
On the basis of a total of 13 studies, pooled sensitivity, specificity, and diagnostic ORs for detection of tumor invasion beyond the bowel wall (T3-T4) were 90% (95% CI, 83-95%), 69% (95% CI, 62-75%), and 20.6 (95% CI, 10.2-41.5), respectively. For detection of tumor invasion depth of 5 mm or greater (T3cd-T4), estimates from four studies were 77% (95% CI, 66-85%), 70% (95% CI, 53-83%), and 7.8 (95% CI, 4.2-14.2), respectively. For nodal involvement (N+), 16 studies were included with values of 71% (95% CI, 59-81%), 67% (95% CI, 46-83%), and 4.8 (95% CI, 2.5-9.4), respectively. Two studies using CT colonography were included with sensitivity and specificity of 97% (95% CI, 90-99%) and 81% (95% CI, 65-91%), respectively, for detecting T3-T4 tumors. CT has good sensitivity for the detection of T3-T4 tumors, and evidence suggests that CT colonography increases its accuracy. Discriminating between T1-T3ab and T3cd-T4 cancer is challenging, but data were limited. CT has a low accuracy in detecting nodal involvement.
本文旨在确定 CT 检测结肠癌肿瘤侵犯肠壁外和淋巴结受累的准确性。通过文献检索，确定了描述 CT 分期结肠癌准确性的研究。排除了与结肠癌无法区分的直肠癌研究。使用 Deeks 漏斗图不对称检验探索发表偏倚。使用层次汇总 ROC 模型构建汇总 ROC 曲线并计算汇总敏感性、特异性和诊断比值比 (OR) 的估计值。
基于 13 项研究的综合结果，对于检测肿瘤侵犯肠壁外（T3-T4），汇总敏感性、特异性和诊断 OR 分别为 90%（95%CI，83-95%）、69%（95%CI，62-75%）和 20.6（95%CI，10.2-41.5）。对于检测肿瘤侵犯深度为 5mm 或以上（T3cd-T4），四项研究的估计值分别为 77%（95%CI，66-85%）、70%（95%CI，53-83%）和 7.8（95%CI，4.2-14.2）。对于淋巴结受累（N+），纳入了 16 项研究，其值分别为 71%（95%CI，59-81%）、67%（95%CI，46-83%）和 4.8（95%CI，2.5-9.4）。两项使用 CT 结肠成像的研究分别显示出检测 T3-T4 肿瘤的敏感性和特异性为 97%（95%CI，90-99%）和 81%（95%CI，65-91%）。CT 对 T3-T4 肿瘤的检测具有良好的敏感性，有证据表明 CT 结肠成像提高了其准确性。区分 T1-T3ab 和 T3cd-T4 癌症具有挑战性，但数据有限。CT 在检测淋巴结受累方面准确性较低。
