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CT Staging of Colon Cancer: Reproducibility and Pathology Association in a Multicenter Study.

Jona Shkurti1, Kevin B W Groot Lipman2, Renaud L M Tissier3

  • 1GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Diagnostic Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.

Academic Radiology
|March 1, 2026
PubMed
Summary

Radiologists showed moderate agreement on computed tomography (CT) features for colon cancer staging. Reliable CT indicators for treatment decisions include tumor length and largest node diameter, requiring standardized protocols.

Keywords:
Colonic neoplasmsNeoadjuvant therapyNeoplasm stagingX-ray computed tomography

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Area of Science:

  • Radiology
  • Oncology
  • Gastroenterology

Background:

  • Computed tomography (CT) is crucial for colon cancer staging.
  • Accurate staging guides treatment decisions and prognosis.
  • Interobserver agreement in CT interpretation can impact clinical practice.

Purpose of the Study:

  • To evaluate interobserver agreement for CT features in colon cancer.
  • To assess the association between CT findings and pathological staging.
  • To determine how baseline characteristics influence clinical-pathological agreement.

Main Methods:

  • Retrospective analysis of CT scans from 2011-2020.
  • Eleven radiologists independently reviewed scans using a structured template.
  • Interobserver agreement assessed using Krippendorff's alpha and ICC; associations analyzed with mixed-effects logistic regression.

Main Results:

  • Moderate agreement observed for T stage (α=0.55), N stage (α=0.57), and bowel obstruction (α=0.59).
  • Lower agreement for extramural vascular invasion (α=0.27) and tumor deposits (α=0.22).
  • High agreement for tumor length (ICC=0.72) and largest node diameter (ICC=0.62). Clinical features correlated significantly with pathological stages.

Conclusions:

  • CT features show significant associations with pathological staging.
  • Inconsistent interpretation limits reliability for individualized treatment.
  • Focus on reproducible features like tumor length and node diameter within standardized protocols is recommended.