Knoppers, Carlijn (2023) Poor Diagnostic Value of CT-Scan For Staging of Lymph Node Metastasis In T1-Colorectal Carcinoma. thesis, Medicine.
Full text available on request.Abstract
Introduction: An increasing proportion of colorectal carcinomas (CRC) is found at an early stage (T1). With this, a conservative approach without surgery is also growing attractive. Thus, radiological identification of lymph node metastasis (LNM) deserves more attention. To our best knowledge, research on LNM prediction in T1-CRC by either preoperative CT-scan or surveillance CT-scan is scarce. Objectives: The diagnostic value of CT-scan for LNM in patients with T1-CRC either preoperatively or during follow-up, along with characteristic lymph node (LN) features and LN-growth. Methods: This retrospective multicenter study has two cohorts of patients with an endoscopically removed T1-CRC. Cohort 1 is 100 patients with preoperative CT-staging (20 with LNM metastasis and 80 controls), cohort 2 is 40 patients initially not operated on, but with follow-up scans followed by surgery showing LNM in 10 cases (10 cases and 30 controls). CT-scans were assessed independently by three expert reviewers and compared to the LN-pathological outcome. Results: Assessments of preoperative CT-scan showed true positive rates (TPR) between 33,3% and 100,0% and false negative rates (FNR) between 22,0% and 25,0%. ROC analyses found AUC's no higher than 0,617. No LN-features had a significant predictive value (lowest p = 0,121). With odds ratios between 6 and 21 (p-values < 0,05), surveillance CT-scan assessments found TPR between 50,0% - 71,4% and FNR between 8,9% - 14,3%. LN-growth was recognized in a total of 3 cases (30,0%) and 2 controls (6.6%), with a significant Odds ratio. Conclusions: Preoperative CT-scans are not useful for identifying LNM in T1-CRC. The lymph node features had no prognostic value in relation to positive LN-pathology in our study. Despite the small sample size, our study offers suggestions regarding the diagnostic use of surveillance CT-scans for detecting LNM or LN-growth in T1-CRC cases.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | ter Borg, Dr. Frank |
| Faculty: | Medical Sciences |
| Date Deposited: | 18 Apr 2023 13:02 |
| Last Modified: | 18 Apr 2023 13:02 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3478 |
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