Diagnostic precision of CT in local staging of colon cancers: a meta-analysis
Received 21 September 2009; received in revised form 22 December 2009; accepted 7 January 2010. published online 12 July 2010.
Aim
To determine the accuracy of computed tomography (CT) in detecting disease with invasion beyond the muscularis propria (MP) and malignant lymph nodes.
Materials and methods
A literature search of Ovid, Embase, the Cochrane database, and Medline using Pubmed, Google™ Scholar and Vivisimo™ search engines was performed to identify studies reporting on the accuracy of CT to predict the staging of colonic tumours. Publication bias was demonstrated by Funnel plots. The sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated using a bivariate random effects model and hierarchical summary operating curves (HSROC) were generated.
Results
Nineteen studies fulfilled all the necessary inclusion criteria. The pooled sensitivity, specificity, DOR for detection of tumour invasion were 86% (95% CI: 78–92%); 78% (95% CI: 71–84%); 22.4 (95% CI: 11.9–42.4). Similarly, the values for nodal detection were 70% (95% CI: 63–73%); 78% (95% CI: 73–82%); 8.1(95% CI: 4.7–14.1). In the subgroup analysis, the best results were obtained in studies utilizing multidetector CT (MDCT).
Conclusion
Preoperative staging CT accurately distinguishes between tumours confined to the bowel wall and those invading beyond the MP; however, it is significantly poorer at identifying nodal status. MDCT provides the best results.
aDepartment of Radiology, Royal Marsden Hospital, Sutton, UK
cDepartment of Bio Surgery and Surgical Technology, Imperial College, London, UK
dDepartment of Surgery, Mayday Hospital, Croydon, UK
eDepartment of Computing and Statistics, Institute of Cancer Research, London, UK
Guarantor and correspondent: G. Brown, Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK. Tel.: +442086613964; fax: +442089156721.
ABSTRACT