Contrast-Enhanced Computed Tomography Colonography in Preoperative Distinction between T1-T2 and T3-T4 Staging of Colon Cancer

Rationale and Objectives To predict the T stage of nonrectal colon cancer using contrast-enhanced computed tomography colonography. Materials and Methods Sixty-one patients with 67 nonrectal colon cancers consecutively underwent contrast-enhanced computed tomography colonography after an incomplete colonoscopy. Two readers evaluated wall deformity and perilesional fat abnormality on three-dimensional double contrast enema-like views and multiplanar reconstructions. Pathology was used as the standard of reference. McNemar, Fisher, and Cohen κ statistics were used. Results At pathologic examination, we found the following stages: T1 ( n = 5), T2 ( n = 10), T3 ( n = 41), T4a ( n = 6), and T4b ( n = 5). Intraobserver and interobserver reproducibilities were almost perfect for wall deformity (κ = 1.00 and κ = 0.88, respectively), substantial for perilesional fat abnormality (κ = 0.79 and κ = 0.74, respectively). Using the results of the more experienced reader, accuracy of wall deformity ≥50% (apple-core) alone for T ≥ 3 was 62 of 67 (0.93, 95% confidence interval [CI] 0.83–0.97) and that of perilesional fat abnormality alone was 37 of 67 (0.55, 95% CI 0.43–0.67) ( P P = .148, Fisher exact test). Conclusions The presence of apple-core wall deformity, regardless of perilesional fat abnormality, is highly predictive of stage T3 or higher.