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. 2025 Aug 6.
doi: 10.1007/s00330-025-11850-4. Online ahead of print.

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

Joao Miranda #  1 , Giovanni B Torri #  2 , Meiri Andreia Maria da Silva  3 , Gustavo Monjardim  4 , Miriana Mariussi  5 , Luiza G Schmitt  6 , Camila Piovesan Wiethan  7 , Tiago Leal Ghezzi  8 , Caroline Lorenzoni Almeida Ghezzi  3   9 , Stephan Altmayer  10 , Adriano Basso Dias  11 , Natally Horvat  12
Affiliations

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

Joao Miranda et al. Eur Radiol. .

Abstract

Objectives: 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.

Materials and methods: 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.

Results: 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.

Conclusion: 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.

Key points: 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.

Keywords: Colonic neoplasms; Computed tomography; Lymphatic metastasis; Neoplasm staging.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Giovanni Brondani Torri. Conflict of interest: The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry: Stephan Altmayer and Giovanni Brondani Torri kindly provided statistical advice for this manuscript. Stephan Altmayer has significant statistical expertise. No complex statistical methods were necessary for this paper, as it is a systematic review and meta-analysis. Informed consent: Written informed consent was not required for this study because it is a systematic review and meta-analysis, which synthesizes data from previously published research and does not involve new human or animal subjects. Ethical approval: This systematic review and meta-analysis followed the PRISMA-DTA guidelines [6] and adhered to the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy [7]. The study is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42024527689. Institutional Review Board approval was not required because this study is a systematic review and meta-analysis, which does not involve direct participation of human or animal subjects. Study subjects or cohorts overlap: No study subjects or cohorts have been previously reported by the authors in relation to this manuscript. Methodology: Systematic review and meta-analysis

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