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Review
. 2025 Aug 16.
doi: 10.1007/s00330-025-11844-2. Online ahead of print.

Diagnostic accuracy of CT for identifying high-risk colon cancer: a systematic review and meta-analysis

Jona Shkurti  1   2 , Kim van den Berg  3 , Renaud L M Tissier  4 , Stevie van der Mierden  5 , Max J Lahaye  6 , Regina G H Beets-Tan  6   7   8 , Joost Nederend  9
Affiliations
Review

Diagnostic accuracy of CT for identifying high-risk colon cancer: a systematic review and meta-analysis

Jona Shkurti et al. Eur Radiol. .

Abstract

Objectives: This systematic review and meta-analysis aimed to assess the diagnostic accuracy of CT in differentiating high-risk from low-risk colon cancer, with a focus on staging parameters and the impact of CT slice thickness.

Materials and methods: A systematic search of Ovid MEDLINE and Embase.com was conducted from January 1, 2015, to September 24, 2024, to identify studies evaluating CT-based staging accuracy using histopathology as the reference standard. The QUADAS-2 tool assessed the risk of bias. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated using a bivariate random-effects model. Subgroup analyses explored the influence of CT techniques, slice thickness, and study design on diagnostic performance.

Results: The meta-analysis included forty-four studies. CT demonstrated 83% sensitivity (95% CI, 79-86%) and 70% specificity (95% CI, 66-74%) for detecting pT3-T4 tumors (DOR: 10.0). For pT3cd-T4 (> 5 mm muscularis propria invasion), sensitivity was 67% (61-73%), specificity 88% (83-92%) and DOR 13.7 (9.0-21.0). Detection of pN+ yielded 64% sensitivity (60-68%), 67% specificity (62-72%) and DOR of 3.5 (3.0-4.2). Sensitivity for extramural venous invasion (EMVI+) was 49% (41-56%), with 77% specificity (67-84%) and DOR 3.0 (2.0-4.4). Studies with < 5 mm slice thickness showed higher sensitivity but lower specificity. High I² values indicated substantial heterogeneity across studies.

Conclusion: CT demonstrates high sensitivity for detecting T3-T4 colon cancer but moderate sensitivity for nodal involvement and EMVI+. Diagnostic performance varies with technical factors, emphasizing the need for standardized imaging protocols and supplementary diagnostic tools to improve colon cancer staging.

Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42022374615.

Key points: Question Accurate CT staging is crucial for guiding neoadjuvant therapy in colon cancer, but its ability to distinguish high-risk from low-risk cases remains uncertain. Findings CT showed high sensitivity for distinguishing pT3-T4 tumors but only moderate sensitivity for pT3cd-T4, nodal involvement, and extramural venous invasion. Clinical relevance This systematic review critically evaluates CT diagnostic accuracy in colon cancer staging, revealing its strengths and limitations. The findings highlight the need for optimized imaging protocols and complementary tools to enhance risk stratification and guide clinical decisions.

Keywords: Colonic neoplasms; Neoadjuvant therapy; Neoplasm staging; X-ray computed tomography.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Jona Shkurti. Conflict of interest: R.G.H.B.T. is a member of the Scientific Editorial Board of European Radiology (Section: Oncology) and is a guest editor for European Radiology. As such, they have not participated in the selection or review processes for this article. The remaining 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: One of the authors has significant statistical expertise. Informed consent: Written informed consent was not required for this study because this study is a systematic review and meta-analysis and did not involve the collection of primary data from human participants, human tissue, or animals. As such, consent to participate was not applicable. Ethical approval: Institutional Review Board approval was not required because this study is a systematic review and meta-analysis and did not involve the collection of primary data from human participants, human tissue, or animals. As such, ethics approval was not applicable. Study subjects or cohorts overlap: The data used in this systematic review and meta-analysis were extracted from previously published studies. All data supporting the results reported in this article are available within the referenced publications. No new data were generated or collected specifically for this study. Methodology: Meta-analysis

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