High-performance CT features supporting accurate pre-operative tumor staging in colon cancer
Background and aimsAccurate pre-treatment tumor staging is essential for treatment decision-making. Multi-slice spiral computed tomography (CT) is currently the standard method for pre-operative clinical tumor staging, but accurately applying the CT findings in tumor staging remains a challenge due...
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Frontiers Media S.A.
2025-02-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2025.1549075/full |
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| author | Jianhua Yuan Cangzheng Jin Jianrong Si Baobao Liu Xiaohan Si Jianzhi Chen |
| author_facet | Jianhua Yuan Cangzheng Jin Jianrong Si Baobao Liu Xiaohan Si Jianzhi Chen |
| author_sort | Jianhua Yuan |
| collection | DOAJ |
| description | Background and aimsAccurate pre-treatment tumor staging is essential for treatment decision-making. Multi-slice spiral computed tomography (CT) is currently the standard method for pre-operative clinical tumor staging, but accurately applying the CT findings in tumor staging remains a challenge due to the poor pathological understanding of the CT signs. We aimed to pathologically interpret the key CT findings in order to identify reliable markers for pre-treatment staging of colon cancer.Patients and methodsThe following CT features from 136 colon adenocarcinomas were analyzed: colon wall pliability, outline contour, pericolic fat attenuations and vascularity, tumor fusion with adjacent organs, ascites, tumor size, and relevance between tumor and retroperitoneal fascia. These CT features were corroborated with histopathological findings. The diagnostic performance of these was further analyzed.ResultsBased on the postoperative pathological tumor staging (pT), 136 colon adenocarcinomas were classified into four stages: pT1 (n = 5), pT2 (n = 7), pT3 (n = 96), and pT4 (n = 28). Key findings include the following: (1) soft colon wall is a characteristic of the pT1 tumors, whereas stiff colon wall is a characteristic of the pT2~pT4 tumors; pathologically, stiff colon wall reflects the infiltration of tumor cells with desmoplastic reaction (DR) in muscularis propria; (2) small protuberances may help exclude the pT2 tumors. Histopathologically, small protuberances in pT2 cancer represent the pure DR on the surface of lamina propria, whereas the small protuberances in pT3~pT4 cancers represent the sub-serosal or extra-serosal cancer cell foci enwrapped by DR; (3) the presence of large protuberances, extensive reticulonodular fat stranding, and fusion with surrounding organs and ascites are diagnostic of pT4 tumors; and (4) the presence of extra-fascial nodules/streaks on CT scan could accurately diagnose the ascending/descending colon cancer of pT4 stage. Histologically, the presence of the above five CT features (large protuberances, extensive reticulonodular fat stranding, fusion with surrounding organs, ascites, and extra-fascial nodules/streaks) reflect the farther and deeper infiltration of tumor cells in serosa or retroperitoneal fascia involvement.ConclusionOur studies have identified multiple CT features that are practically useful in identifying and differentiating different stages of colon cancer prior to surgical procedures. These high-performance markers will provide valuable insights to the clinicians in making appropriate decisions in the management of patients with colon cancer. |
| format | Article |
| id | doaj-art-9085bf3944894c82ae41284437aa4e1e |
| institution | Kabale University |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj-art-9085bf3944894c82ae41284437aa4e1e2025-02-10T05:16:04ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-02-011510.3389/fonc.2025.15490751549075High-performance CT features supporting accurate pre-operative tumor staging in colon cancerJianhua Yuan0Cangzheng Jin1Jianrong Si2Baobao Liu3Xiaohan Si4Jianzhi Chen5Department of Radiology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, ChinaDepartment of Radiology, The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, ChinaDepartment of Radiology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, ChinaDepartment of Pathology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (affiliated to Guangzhou Kingmed Diagnostics Group Co. Ltd.), Foshan, ChinaEcosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, AustraliaDepartment of Pathology, The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, ChinaBackground and aimsAccurate pre-treatment tumor staging is essential for treatment decision-making. Multi-slice spiral computed tomography (CT) is currently the standard method for pre-operative clinical tumor staging, but accurately applying the CT findings in tumor staging remains a challenge due to the poor pathological understanding of the CT signs. We aimed to pathologically interpret the key CT findings in order to identify reliable markers for pre-treatment staging of colon cancer.Patients and methodsThe following CT features from 136 colon adenocarcinomas were analyzed: colon wall pliability, outline contour, pericolic fat attenuations and vascularity, tumor fusion with adjacent organs, ascites, tumor size, and relevance between tumor and retroperitoneal fascia. These CT features were corroborated with histopathological findings. The diagnostic performance of these was further analyzed.ResultsBased on the postoperative pathological tumor staging (pT), 136 colon adenocarcinomas were classified into four stages: pT1 (n = 5), pT2 (n = 7), pT3 (n = 96), and pT4 (n = 28). Key findings include the following: (1) soft colon wall is a characteristic of the pT1 tumors, whereas stiff colon wall is a characteristic of the pT2~pT4 tumors; pathologically, stiff colon wall reflects the infiltration of tumor cells with desmoplastic reaction (DR) in muscularis propria; (2) small protuberances may help exclude the pT2 tumors. Histopathologically, small protuberances in pT2 cancer represent the pure DR on the surface of lamina propria, whereas the small protuberances in pT3~pT4 cancers represent the sub-serosal or extra-serosal cancer cell foci enwrapped by DR; (3) the presence of large protuberances, extensive reticulonodular fat stranding, and fusion with surrounding organs and ascites are diagnostic of pT4 tumors; and (4) the presence of extra-fascial nodules/streaks on CT scan could accurately diagnose the ascending/descending colon cancer of pT4 stage. Histologically, the presence of the above five CT features (large protuberances, extensive reticulonodular fat stranding, fusion with surrounding organs, ascites, and extra-fascial nodules/streaks) reflect the farther and deeper infiltration of tumor cells in serosa or retroperitoneal fascia involvement.ConclusionOur studies have identified multiple CT features that are practically useful in identifying and differentiating different stages of colon cancer prior to surgical procedures. These high-performance markers will provide valuable insights to the clinicians in making appropriate decisions in the management of patients with colon cancer.https://www.frontiersin.org/articles/10.3389/fonc.2025.1549075/fullcolon cancerCT featureserosal sidepathological T stagingclinical T staging |
| spellingShingle | Jianhua Yuan Cangzheng Jin Jianrong Si Baobao Liu Xiaohan Si Jianzhi Chen High-performance CT features supporting accurate pre-operative tumor staging in colon cancer Frontiers in Oncology colon cancer CT feature serosal side pathological T staging clinical T staging |
| title | High-performance CT features supporting accurate pre-operative tumor staging in colon cancer |
| title_full | High-performance CT features supporting accurate pre-operative tumor staging in colon cancer |
| title_fullStr | High-performance CT features supporting accurate pre-operative tumor staging in colon cancer |
| title_full_unstemmed | High-performance CT features supporting accurate pre-operative tumor staging in colon cancer |
| title_short | High-performance CT features supporting accurate pre-operative tumor staging in colon cancer |
| title_sort | high performance ct features supporting accurate pre operative tumor staging in colon cancer |
| topic | colon cancer CT feature serosal side pathological T staging clinical T staging |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2025.1549075/full |
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