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Gangi-Burton A, Plumb AA, De Paepe KN, Godfrey EM, Halligan S, Higginson A, Khwaja S, Patel A, Taylor S. Paris classification of colonic polyps using CT colonography: prospective cohort study of interobserver variation. Eur Radiol 2024:10.1007/s00330-024-10631-9. [PMID: 38488970 DOI: 10.1007/s00330-024-10631-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/18/2023] [Accepted: 01/16/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The Paris classification categorises colorectal polyp morphology. Interobserver agreement for Paris classification has been assessed at optical colonoscopy (OC) but not CT colonography (CTC). We aimed to determine the following: (1) interobserver agreement for the Paris classification using CTC between radiologists; (2) if radiologist experience influenced classification, gross polyp morphology, or polyp size; and (3) the extent to which radiologist classifications agreed with (a) colonoscopy and (b) a combined reference standard. METHODS Following ethical approval for this non-randomised prospective cohort study, seven radiologists from three hospitals classified 52 colonic polyps using the Paris system. We calculated interobserver agreement using Fleiss kappa and mean pairwise agreement (MPA). Absolute agreement was calculated between radiologists; between CTC and OC; and between CTC and a combined reference standard using all available imaging, colonoscopic, and histopathological data. RESULTS Overall interobserver agreement between the seven readers was fair (Fleiss kappa 0.33; 95% CI 0.30-0.37; MPA 49.7%). Readers with < 1500 CTC experience had higher interobserver agreement (0.42 (95% CI 0.35-0.48) vs. 0.33 (95% CI 0.25-0.42)) and MPA (69.2% vs 50.6%) than readers with ≥ 1500 experience. There was substantial overall agreement for flat vs protuberant polyps (0.62 (95% CI 0.56-0.68)) with a MPA of 87.9%. Agreement between CTC and OC classifications was only 44%, and CTC agreement with the combined reference standard was 56%. CONCLUSION Radiologist agreement when using the Paris classification at CT colonography is low, and radiologist classification agrees poorly with colonoscopy. Using the full Paris classification in routine CTC reporting is of questionable value. CLINICAL RELEVANCE STATEMENT Interobserver agreement for radiologists using the Paris classification to categorise colorectal polyp morphology is only fair; routine use of the full Paris classification at CT colonography is questionable. KEY POINTS • Overall interobserver agreement for the Paris classification at CT colonography (CTC) was only fair, and lower than for colonoscopy. • Agreement was higher for radiologists with < 1500 CTC experience and for larger polyps. There was substantial agreement when classifying polyps as protuberant vs flat. • Agreement between CTC and colonoscopic polyp classification was low (44%).
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Affiliation(s)
| | - Andrew A Plumb
- University College London Hospitals NHS Foundation Trust, London, UK.
| | - Katja N De Paepe
- Addenbrooke's Hospital, Cambridge, UK
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | | | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | | | | | - Anisha Patel
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Stuart Taylor
- Centre for Medical Imaging, University College London, London, UK
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Caruso D, Polici M, Bellini D, Laghi A. ESR Essentials: Imaging in colorectal cancer-practice recommendations by ESGAR. Eur Radiol 2024:10.1007/s00330-024-10645-3. [PMID: 38418627 DOI: 10.1007/s00330-024-10645-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 03/02/2024]
Abstract
Colorectal cancer (CRC) is a significant global health concern. Diagnostic imaging, using different modalities, has a pivotal role in CRC, from early detection (i.e., screening) to follow-up. The role of imaging in CRC screening depends on each country's approach: if an organized screening program is in place, the role of CT colonography (CTC) is limited to the study of either individuals with a positive stool test unwilling/unable to undergo colonoscopy (CC) or in patients with incomplete CC. Although CC is the most common modality to diagnose CRC, CRC can be also incidentally detected during a routine abdominal imaging examination or at the emergency room in patients presenting with intestinal occlusion/subocclusion or perforation. Staging is a crucial aspect of CRC management, guiding treatment decisions and providing valuable prognostic information. An accurate local staging is mandatory in both rectal and colon cancer to drive the appropriate therapeutic workflow. Important limitations of US, CT, and MR in N-staging can be partially solved by FDG PET/CT. Distant staging is usually managed by CT, with MR and FDG PET/CT which can be used as problem-solving techniques. Follow-up is performed according to the general recommendations of the oncological societies. CLINICAL RELEVANCE STATEMENT: It is essential to summarize each phase of colorectal cancer workup, differentiating the management for colon and rectal cancer supported by the main international guidelines and literature data, with the aim to inform the community on the best practice imaging in colorectal cancer. KEY POINTS: • Colorectal cancer is a prevalent disease that lends itself to imaging at each stage of detection and management. • Various imaging modalities can be used as adjuncts to, or in place of, direct visualization methods of screening and are necessary for evaluating metastatic disease. • Reevaluation of follow-up strategies should be considered depending on patients' individual risk of recurrence.
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Affiliation(s)
- Damiano Caruso
- Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Sant'Andrea University Hospital, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Michela Polici
- Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Sant'Andrea University Hospital, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy
- PhD School in Traslational Medicine and Oncology, Department of Medical Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Davide Bellini
- Department of Radiological Sciences, Oncology and Pathology, "Sapienza" University of Rome, I.C.O.T. Hospital, Latina, Italy
| | - Andrea Laghi
- Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Sant'Andrea University Hospital, Via Di Grottarossa, 1035-1039, 00189, Rome, Italy.
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Chawla T, Hurrell C, Keough V, Lindquist CM, Mohammed MF, Samson C, Sugrue G, Walsh C. Canadian Association of Radiologists Practice Guidelines for Computed Tomography Colonography. Can Assoc Radiol J 2024; 75:54-68. [PMID: 37411043 DOI: 10.1177/08465371231182975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Colon cancer is the third most common malignancy in Canada. Computed tomography colonography (CTC) provides a creditable and validated option for colon screening and assessment of known pathology in patients for whom conventional colonoscopy is contraindicated or where patients self-select to use imaging as their primary modality for initial colonic assessment. This updated guideline aims to provide a toolkit for both experienced imagers (and technologists) and for those considering launching this examination in their practice. There is guidance for reporting, optimal exam preparation, tips for problem solving to attain high quality examinations in challenging scenarios as well as suggestions for ongoing maintenance of competence. We also provide insight into the role of artificial intelligence and the utility of CTC in tumour staging of colorectal cancer. The appendices provide more detailed guidance into bowel preparation and reporting templates as well as useful information on polyp stratification and management strategies. Reading this guideline should equip the reader with the knowledge base to perform colonography but also provide an unbiased overview of its role in colon screening compared with other screening options.
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Affiliation(s)
- Tanya Chawla
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Valerie Keough
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chris M Lindquist
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mohammed F Mohammed
- Abdominal Radiology Section, Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Caroline Samson
- Département de Radiologie, Radio-oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Quebec, Canada
| | - Gavin Sugrue
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Cynthia Walsh
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada
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Hsieh SS, Inoue A, Yalon M, Cook DA, Gong H, Sudhir Pillai P, Johnson MP, Fidler JL, Leng S, Yu L, Carter RE, Holmes DR, McCollough CH, Fletcher JG. Targeted Training Reduces Search Errors but Not Classification Errors for Hepatic Metastasis Detection at Contrast-Enhanced CT. Acad Radiol 2024; 31:448-456. [PMID: 37567818 PMCID: PMC10853479 DOI: 10.1016/j.acra.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 08/13/2023]
Abstract
RATIONALE AND OBJECTIVES Methods are needed to improve the detection of hepatic metastases. Errors occur in both lesion detection (search) and decisions of benign versus malignant (classification). Our purpose was to evaluate a training program to reduce search errors and classification errors in the detection of hepatic metastases in contrast-enhanced abdominal computed tomography (CT). MATERIALS AND METHODS After Institutional Review Board approval, we conducted a single-group prospective pretest-posttest study. Pretest and posttest were identical and consisted of interpreting 40 contrast-enhanced abdominal CT exams containing 91 liver metastases under eye tracking. Between pretest and posttest, readers completed search training with eye-tracker feedback and coaching to increase interpretation time, use liver windows, and use coronal reformations. They also completed classification training with part-task practice, rating lesions as benign or malignant. The primary outcome was metastases missed due to search errors (<2 seconds gaze under eye tracker) and classification errors (>2 seconds). Jackknife free-response receiver operator characteristic (JAFROC) analysis was also conducted. RESULTS A total of 31 radiologist readers (8 abdominal subspecialists, 8 nonabdominal subspecialists, 15 senior residents/fellows) participated. Search errors were reduced (pretest 11%, posttest 8%, difference 3% [95% confidence interval, 0.3%-5.1%], P = .01), but there was no difference in classification errors (difference 0%, P = .97) or in JAFROC figure of merit (difference -0.01, P = .36). In subgroup analysis, abdominal subspecialists demonstrated no evidence of change. CONCLUSION Targeted training reduced search errors but not classification errors for the detection of hepatic metastases at contrast-enhanced abdominal CT. Improvements were not seen in all subgroups.
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Affiliation(s)
- Scott S Hsieh
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.); Department of General Internal Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H.).
| | - Akitoshi Inoue
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
| | - Mariana Yalon
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
| | - David A Cook
- Quantitative Health Services - Clinical Trials and Biostatistics, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (D.A.C.)
| | - Hao Gong
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
| | - Parvathy Sudhir Pillai
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
| | - Matthew P Johnson
- Department of Physiology Biomedical Engineering, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (M.P.J., R.E.C.)
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
| | - Lifeng Yu
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
| | - Rickey E Carter
- Department of Physiology Biomedical Engineering, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (M.P.J., R.E.C.)
| | - David R Holmes
- Quantitative Health Services - Clinical Trials and Biostatistics, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 (D.R.H. III)
| | - Cynthia H McCollough
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 (S.S.H., A.I., M.Y., H.G., P.S.P., J.L.F., S.L., L.Y., C.H.McC., J.G.F.)
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Xie M, Liu G, Dong Y, Yu L, Song R, Zhang W, Zhang Y, Huang S, He J, Xiao Y, Long L. Effect of visceral fat area on the accuracy of preoperative CT-N staging of colorectal cancer. Eur J Radiol 2023; 168:111131. [PMID: 37804651 DOI: 10.1016/j.ejrad.2023.111131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To investigate the effect of visceral fat area (VFA) on the accuracy of preoperative CT-N staging of colorectal cancer. METHODS We retrospectively reviewed the clinical and imaging data of 385 CRC patients who underwent surgical resection for colorectal cancer between January 2018 and July 2021. Preoperative CT-N staging and imaging features were determined independently by two radiologists. Using postoperative pathology as the gold standard, patients were divided into accurately and incorrectly staged groups, and clinical and imaging characteristics were compared between the two groups. VFA and subcutaneous fat area (SFA) at the L3 vertebral level, sex, age, BMI, tumor location, size, and tumor circumference ratio (TCR) were included. Logistic regression analysis was used to evaluate the independent factors influencing the accuracy of preoperative N staging of colorectal cancer. RESULTS Of the 385 patients enrolled, 259 (67.27%) were in the preoperative N-stage accurate staging group, and 126 (32.73%) were in the incorrectly staged group. Univariate analysis showed that there were significant differences in BMI, tumor location, VFA, SFA, size and TCR between the two groups (P<0.05). Logistic regression analysis showed that VFA (95% CI: 1.277, 3.813; P=0.005) and TCR (95% CI: 1.649, 17.545; P=0.005) were independent factors affecting the accuracy of N staging. The optimal cutoff points for VFA and TCR in predicting incorrect staging were 110 cm2 and 0.675, respectively. CONCLUSIONS Colorectal cancer patients with lower VFA and higher TCR and preoperative CT-N staging had an increased risk for diagnostic errors.
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Affiliation(s)
- Meizhen Xie
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China; Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, Guangxi 545006, China
| | - Gangyi Liu
- Department of Laboratory, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China
| | - Yan Dong
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Lan Yu
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Rui Song
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Wei Zhang
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, Guangxi 545006, China
| | - Ying Zhang
- Department of Pathology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China
| | - Shafei Huang
- Department of Scientific Research, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China
| | - Jiaqian He
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China
| | - Yunping Xiao
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, Guangxi 545006, China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China.
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Single CT Appointment for Double Lung and Colorectal Cancer Screening: Is the Time Ripe? Diagnostics (Basel) 2022; 12:diagnostics12102326. [PMID: 36292015 PMCID: PMC9601268 DOI: 10.3390/diagnostics12102326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 12/24/2022] Open
Abstract
Annual screening of lung cancer (LC) with chest low-dose computed tomography (CT) and screening of colorectal cancer (CRC) with CT colonography every 5 years are recommended by the United States Prevention Service Task Force. We review epidemiological and pathological data on LC and CRC, and the features of screening chest low-dose CT and CT colonography comprising execution, reading, radiation exposure and harm, and the cost effectiveness of the two CT screening interventions. The possibility of combining chest low-dose CT and CT colonography examinations for double LC and CRC screening in a single CT appointment is then addressed. We demonstrate how this approach appears feasible and is already reasonable as an opportunistic screening intervention in 50–75-year-old subjects with smoking history and average CRC risk. In addition to the crucial role Computer Assisted Diagnosis systems play in decreasing the test reading times and the need to educate radiologists in screening chest LDCT and CT colonography, in view of a single CT appointment for double screening, the following uncertainties need to be solved: (1) the schedule of the screening CT; (2) the effectiveness of iterative reconstruction and deep learning algorithms affording an ultra-low-dose CT acquisition technique and (3) management of incidental findings. Resolving these issues will imply new cost-effectiveness analyses for LC screening with chest low dose CT and for CRC screening with CT colonography and, especially, for the double LC and CRC screening with a single-appointment CT.
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Obaro AE, McCoubrie P, Burling D, Plumb AA. Effectiveness of Training in CT Colonography Interpretation: Review of Current Literature. Semin Ultrasound CT MR 2022; 43:430-440. [DOI: 10.1053/j.sult.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Obaro AE, McCoubrie P, Burling D, Plumb AA. Training in Computed Tomographic Colonography Interpretation: Recommendations for Best Practice. Semin Ultrasound CT MR 2022; 43:422-429. [DOI: 10.1053/j.sult.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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