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Guimarães RB, Pacheco EO, Ueda SN, Tiferes DA, Mazzucato FL, Talans A, Torres US, D'Ippolito G. Evaluation of colon cancer prognostic factors by CT and MRI: an up-to-date review. Abdom Radiol (NY) 2024:10.1007/s00261-024-04373-x. [PMID: 38831072 DOI: 10.1007/s00261-024-04373-x] [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: 03/25/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 06/05/2024]
Abstract
Colorectal cancer (CRC) is a significant global health concern. Prognostication of CRC traditionally relies on the Union for International Cancer Control (UICC) and American Joint Committee on Cancer (AJCC) TNM staging classifications, yet clinical outcomes often vary independently of stage. Despite similarities, rectal and colon cancers are distinct in their diagnostic methodologies and treatments, with MRI and CT scans primarily used for staging rectal and colon cancers, respectively. This paper examines the challenges in accurately assessing prognostic factors of colon cancer such as primary tumor extramural extension, retroperitoneal surgical margin (RSM) involvement, extramural vessel invasion (EMVI), and lymph node metastases through preoperative CT and MRI. It highlights the importance of these factors in risk stratification, treatment decisions, and surgical planning for colon cancer patients. Advancements in imaging techniques are crucial for improving clinical management and optimizing patient outcomes, underscoring the necessity for ongoing research to refine diagnostic methods and incorporate novel findings into practice.
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Affiliation(s)
| | - Eduardo O Pacheco
- Grupo Fleury, R. Cincinato Braga 282, São Paulo, SP, 01333-910, Brazil.
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), R. Botucatu, 740, São Paulo, SP, 04023-062, Brazil.
| | - Serli N Ueda
- Grupo Fleury, R. Cincinato Braga 282, São Paulo, SP, 01333-910, Brazil
| | - Dario A Tiferes
- Grupo Fleury, R. Cincinato Braga 282, São Paulo, SP, 01333-910, Brazil
| | | | - Aley Talans
- Grupo Fleury, R. Cincinato Braga 282, São Paulo, SP, 01333-910, Brazil
| | - Ulysses S Torres
- Grupo Fleury, R. Cincinato Braga 282, São Paulo, SP, 01333-910, Brazil
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), R. Botucatu, 740, São Paulo, SP, 04023-062, Brazil
| | - Giuseppe D'Ippolito
- Grupo Fleury, R. Cincinato Braga 282, São Paulo, SP, 01333-910, Brazil
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), R. Botucatu, 740, São Paulo, SP, 04023-062, Brazil
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Shekleton F, Courtney E, Andreou A, Bunni J. Can Cross-Sectional Imaging Reliably Determine Pathological Staging of Right-Sided Colon Cancers and Select Patients for More Radical Surgery or Neo-Adjuvant Treatment? Cureus 2022; 14:e28827. [PMID: 36225504 PMCID: PMC9535614 DOI: 10.7759/cureus.28827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/05/2022] Open
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Mainenti PP, Stanzione A, Guarino S, Romeo V, Ugga L, Romano F, Storto G, Maurea S, Brunetti A. Colorectal cancer: Parametric evaluation of morphological, functional and molecular tomographic imaging. World J Gastroenterol 2019; 25:5233-5256. [PMID: 31558870 PMCID: PMC6761241 DOI: 10.3748/wjg.v25.i35.5233] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/06/2019] [Accepted: 08/24/2019] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) represents one of the leading causes of tumor-related deaths worldwide. Among the various tools at physicians’ disposal for the diagnostic management of the disease, tomographic imaging (e.g., CT, MRI, and hybrid PET imaging) is considered essential. The qualitative and subjective evaluation of tomographic images is the main approach used to obtain valuable clinical information, although this strategy suffers from both intrinsic and operator-dependent limitations. More recently, advanced imaging techniques have been developed with the aim of overcoming these issues. Such techniques, such as diffusion-weighted MRI and perfusion imaging, were designed for the “in vivo” evaluation of specific biological tissue features in order to describe them in terms of quantitative parameters, which could answer questions difficult to address with conventional imaging alone (e.g., questions related to tissue characterization and prognosis). Furthermore, it has been observed that a large amount of numerical and statistical information is buried inside tomographic images, resulting in their invisibility during conventional assessment. This information can be extracted and represented in terms of quantitative parameters through different processes (e.g., texture analysis). Numerous researchers have focused their work on the significance of these quantitative imaging parameters for the management of CRC patients. In this review, we aimed to focus on evidence reported in the academic literature regarding the application of parametric imaging to the diagnosis, staging and prognosis of CRC while discussing future perspectives and present limitations. While the transition from purely anatomical to quantitative tomographic imaging appears achievable for CRC diagnostics, some essential milestones, such as scanning and analysis standardization and the definition of robust cut-off values, must be achieved before quantitative tomographic imaging can be incorporated into daily clinical practice.
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Affiliation(s)
- Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging of the National Council of Research (CNR), Naples 80145, Italy
| | - Arnaldo Stanzione
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Salvatore Guarino
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Valeria Romeo
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Lorenzo Ugga
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Federica Romano
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Giovanni Storto
- IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture 85028, Italy
| | - Simone Maurea
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
| | - Arturo Brunetti
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples 80131, Italy
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Kawashima K, Kato K, Tomabechi M, Matsuo M, Otsuka K, Ishida K, Nakamura R, Ehara S. Clinical evaluation of (18)F-fludeoxyglucose positron emission tomography/CT using point spread function reconstruction for nodal staging of colorectal cancer. Br J Radiol 2016; 89:20150938. [PMID: 27146065 DOI: 10.1259/bjr.20150938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE For patients with colorectal cancer, lymph node metastasis is a very important factor for prognostic and treatment determinations. Fluorine-18 fludeoxyglucose positron emission tomography/CT ((18)F-FDG-PET/CT) is among the useful tools for detecting lymph node metastasis. Recently, a new (18)F-FDG-PET/CT reconstruction technique for improving spatial resolution and signal-to-noise ratios, point spread function (PSF), has become available. We assessed the effect of PSF reconstruction on standardized uptake values and its diagnostic accuracy for lymph node staging in patients with colorectal cancer. METHODS We retrospectively analysed records from patients with colorectal cancer who underwent (18)F-FDG-PET/CT for pre-operative staging. All positron emission tomography CT (PET/CT) examinations were reconstructed using ordered subset expectation maximization (OSEM) and OSEM + PSF. We compared sensitivities, specificities, positive-predictive values (PPVs), negative-predictive values (NPVs) and accuracies of conventional PET/CT (reconstructed with OSEM) and PSF-PET/CT (reconstructed with OSEM + PSF) for identifying lymph node metastases. We also analysed the diagnostic confidence level on a 5-point scale. RESULTS With conventional PET/CT, the sensitivity, specificity, PPV, NPV and accuracy were 53.1%, 99.1%, 94.4%, 88.3% and 89.1%, respectively. With PSF PET/CT, the corresponding values were 65.6%, 99.1%, 95.4%, 91.2% and 91.8%, respectively. Conventional PET/CT and PSF PET/CT did not differ significantly in terms of N-stage definition (p = 0.125). However, the diagnostic confidence level of PSF PET/CT was significantly higher than that of conventional PET/CT (p < 0.01). CONCLUSION PSF reconstruction might slightly increase sensitivity without impairing specificity. Moreover, this technique is expected to facilitate more confident radiological decisions when compared with conventional PET/CT. Advance in knowledge: This study demonstrates the clinical effectiveness of PSF PET/CT for lymph node staging in colorectal cancer.
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Affiliation(s)
- Kazuya Kawashima
- 1 Department of Radiology, Iwate Medical University, Morioka, Japan
| | - Kenichi Kato
- 1 Department of Radiology, Iwate Medical University, Morioka, Japan
| | - Makiko Tomabechi
- 1 Department of Radiology, Iwate Medical University, Morioka, Japan
| | - Mikaru Matsuo
- 1 Department of Radiology, Iwate Medical University, Morioka, Japan
| | - Koki Otsuka
- 2 Department of Surgery, Iwate Medical University, Morioka, Japan
| | - Kazuyuki Ishida
- 3 Department of Pathology, Iwate Medical University, Morioka, Japan
| | - Ryuji Nakamura
- 4 PET Linac Center, Iwate Medical University, Morioka, Japan
| | - Shigeru Ehara
- 1 Department of Radiology, Iwate Medical University, Morioka, Japan
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Kim IY, Kim BR, Choi EH, Kim YW. Short-term and oncologic outcomes of laparoscopic and open complete mesocolic excision and central ligation. Int J Surg 2016; 27:151-157. [PMID: 26850326 DOI: 10.1016/j.ijsu.2016.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/21/2016] [Accepted: 02/01/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the pathologic, short-term and oncologic outcomes of laparoscopic and open complete mesocolic excision (CME) and central ligation for right-sided colon cancer. METHODS All patients (n = 215) underwent elective CME either by open surgery (n = 99) or laparoscopy (n = 116). RESULTS Mean number of retrieved lymph nodes (31 vs. 27, p = 0.012) was greater in the open CME group. Between the open and laparoscopic CME groups, there were no differences of length of the specimen (44.3 cm and 43.2 cm), ileum (14 cm and 13.3 cm), or colon (30.3 cm and 29.8 cm), respectively. Proximal and distal margins were similar. Mean operative time was similar between the open and laparoscopic CME groups (175 min vs. 178 min). The rate of 30-day postoperative complications (36.4% vs. 23.3%, p = 0.036) was higher in the open CME group. There were no differences in 3-year overall survival rates (86.9% vs. 95.5% in stage II disease and 70.2% vs. 90.7% in stage III disease) or recurrence-free survival rates (84.5% vs. 84.8% in stage II disease and 64.2% vs. 68.9% in stage III disease) between the open and laparoscopic CME groups. CONCLUSIONS Pathologic (specimen lengths, resection margin lengths, number of lymph nodes, and R0 resection) and oncologic outcomes of the laparoscopic CME group were comparable. Moreover, laparoscopic CME conferred short-term benefits in terms of lower rates of postoperative complications, reduced time to soft diet, and reduced length of hospital stay. Based on these results, laparoscopic CME can be considered as a routine elective approach for right-sided colon cancer.
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Affiliation(s)
- Ik Yong Kim
- Department of Surgery, Division of Gastrointestinal Surgery, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Bo Ra Kim
- Department of Internal Medicine, Division of Gastroenterology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Eun Hee Choi
- Institute of Lifestyle Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Young Wan Kim
- Department of Surgery, Division of Gastrointestinal Surgery, Yonsei University Wonju College of Medicine, Wonju, South Korea.
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Kim YW, Kim IY. Preoperative staging with positron emission tomography in patients with colorectal cancer. Ann Coloproctol 2015; 30:247. [PMID: 25580408 PMCID: PMC4286768 DOI: 10.3393/ac.2014.30.6.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Young Wan Kim
- Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ik Yong Kim
- Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
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