Diagnostic precision of CT in local staging of colon cancers: a meta-analysis

Aim: To determine the accuracy of computed tomography (CT) in detecting disease with invasion beyond the muscularis propria (MP) and malignant lymph nodes. Materials and methods: A literature search of Ovid, Embase, the Cochrane database, and Medline using Pubmed, GoogleTM Scholar and VivisimoTM search engines was performed to identify studies reporting on the accuracy of CT to predict the staging of colonic tumours. Publication bias was demonstrated by Funnel plots. The sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated using a bivariate random effects model and hierarchical summary operating curves (HSROC) were generated. Results: Nineteen studies fulfilled all the necessary inclusion criteria. The pooled sensitivity, specificity, DOR for detection of tumour invasion were 86% (95% CI: 78-92%); 78% (95% CI: 71-84%); 22.4 (95% CI: 11.9-42.4). Similarly, the values for nodal detection were 70% (95% CI: 63-73%); 78% (95% CI: 73-82%); 8.1(95% CI: 4.7-14.1). In the subgroup analysis, the best results were obtained in studies utilizing multidetector CT (MDCT). Conclusion: Preoperative staging CT accurately distinguishes between tumours confined to the bowel wall and those invading beyond the MP; however, it is significantly poorer at identifying nodal status. MDCT provides the best results.