CT diagnostic performance for preoperative staging of colon cancer: a systematic review and meta-analysis

To conduct a meta-analysis evaluating the diagnostic accuracy of computed tomography (CT) for identifying T3-T4 colon cancer using histopathology as the reference standard. Secondary objectives included assessing CT's performance for detecting extramural vascular invasion (EMVI) and nodal involvement.

This diagnostic accuracy meta-analysis followed PRISMA-DTA guidelines and searched MEDLINE, EMBASE, and Cochrane Library for studies published up to September 2024. Eligible studies evaluated CT for preoperative T staging (T3 or higher), EMVI, and/or nodal status in primary colon cancer, reporting sensitivity and specificity. Studies on rectal cancer, using specialized CT techniques, or not in English, were excluded. Pooled sensitivity and specificity for T staging, EMVI, and nodal status were calculated using a random-effects model. Subgroup analyses explored sources of heterogeneity.

Thirty-two studies, including 222,948 patients (mean age 69 years; 50.5% female), were analyzed. For pT3-T4 staging, pooled sensitivity and specificity were 0.81 (95% CI: 0.76-0.85) and 0.75 (95% CI: 0.66-0.83). For pT3c-T4, sensitivity was 0.71 (95% CI: 0.62-0.79) and specificity was 0.83 (95% CI: 0.74-0.89). EMVI detection showed sensitivity of 0.40 (95% CI: 0.30-0.52) and specificity of 0.80 (95% CI: 0.71-0.87). A reliable pooled estimate for nodal status could not be determined.

CT shows good diagnostic performance for identifying T3-T4 colon cancer and can detect high-risk features like EMVI. These findings support its role in selecting candidates for neoadjuvant therapies, although EMVI sensitivity remains limited.

Question How accurate is CT for identifying T3-T4 colon cancer and detecting key prognostic factors like EMVI to support neoadjuvant treatment planning? Findings CT shows good accuracy for T3-T4 staging (sensitivity 0.81; specificity 0.75) and high specificity (0.80) but low sensitivity (0.40) for EMVI. Clinical relevance CT enables reliable identification of locally advanced colon cancer and high-risk features such as EMVI, supporting better patient selection and personalized neoadjuvant treatment planning.