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Multicenter Study
. 2023 Jul;11(6):551-563.
doi: 10.1002/ueg2.12403. Epub 2023 Jun 10.

Diagnostic value of radiological staging and surveillance for T1 colorectal carcinomas: A multicenter cohort study

Jelle F Huisman  1 , Hao Dang  2 , Leon M G Moons  3 , Yara Backes  3 , Vincent K Dik  4 , John N Groen  5 , Frank Ter Borg  6 , Jeroen D van Bergeijk  7 , Joost M J Geesing  8 , B W Marcel Spanier  9 , Joachim S Terhaar Sive Droste  10 , Anouk Overwater  11 , Niels van Lelyveld  11 , Koen Kessels  11 , Miangela M Lacle  12 , G Johan A Offerhaus  12 , Richard M Brohet  13 , Nikki Knijn  14 , Frank P Vleggaar  3 , Henderik L van Westreenen  15 , Wouter H de Vos Tot Nederveen Cappel  1 , Jurjen J Boonstra  2 ; Dutch T1 CRC working group
Affiliations
Multicenter Study

Diagnostic value of radiological staging and surveillance for T1 colorectal carcinomas: A multicenter cohort study

Jelle F Huisman et al. United European Gastroenterol J. 2023 Jul.

Abstract

Background: The role of radiological staging and surveillance imaging is under debate for T1 colorectal cancer (CRC) as the risk of distant metastases is low and imaging may lead to the detection of incidental findings.

Objective: The aim of this study was to evaluate the yield of radiological staging and surveillance imaging for T1 CRC.

Methods: In this retrospective multicenter cohort study, all patients of 10 Dutch hospitals with histologically proven T1 CRC who underwent radiological staging in the period 2000-2014 were included. Clinical characteristics, pathological, endoscopic, surgical and imaging reports at baseline and during follow-up were recorded and analyzed. Patients were classified as high-risk T1 CRC if at least one of the histological risk factors (lymphovascular invasion, poor tumor differentiation, deep submucosal invasion or positive resection margins) was present and as low-risk when all risk factors were absent.

Results: Of the 628 included patients, 3 (0.5%) had synchronous distant metastases, 13 (2.1%) malignant incidental findings and 129 (20.5%) benign incidental findings at baseline staging. Radiological surveillance was performed among 336 (53.5%) patients. The 5-year cumulative incidence of distant recurrence, malignant and benign incidental findings were 2.4% (95% confidence interval (CI): 1.1%-5.4%), 2.5% (95% CI: 0.6%-10.4%) and 18.3% (95% CI: 13.4%-24.7%), respectively. No distant metastatic events occurred among low-risk T1 CRC patients.

Conclusion: The risk of synchronous distant metastases and distant recurrence in T1 CRC is low, while there is a substantial risk of detecting incidental findings. Radiological staging seems unnecessary prior to local excision of suspected T1 CRC and after local excision of low-risk T1 CRC. Radiological surveillance should not be performed in patients with low-risk T1 CRC.

Keywords: T1 colorectal cancer; cohort study; metastasis; radiological follow-up; radiological staging.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Flowchart of the included patients.
FIGURE 2
FIGURE 2
Follow‐up recommendations after T1 colorectal cancer (CRC) therapy.
See this image and copyright information in PMC

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