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Peer-reviewedCC BYCancers

Preoperative CT Nodal Staging Versus Pathology in Colon Cancer: A Retrospective Multicentre Diagnostic Accuracy Study

  • Tomasz Cwaliński1
  • Mateusz Jagielski2
  • Michał Kazanowski3,4
  • Jacek Piątkowski2
  • Maciej Ciesielski5,6
  • Marcin Januszkiewicz7
  • Zuzanna Bigus1
  • Patryk Kaczor2
  • Bartosz Kapturkiewicz3,4
  • Paweł Lesiak4
  • Sergii Girnyi1
  • Damian Nowiński7
5 more authors
  • Piotr Kurek5
  • Natale Calomino8
  • Marek Jackowski2
  • Marek Bębenek3,4
  • Luigi Marano1,9
9 affiliations
  1. 1Department of General Surgery and Surgical Oncology, Saint Wojciech Hospital, Nicolaus Copernicus Health Center, 80-462 Gdańsk, Poland
  2. 2Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland
  3. 3Department of Oncology and Haematology, Faculty of Medicine, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland
  4. 4First Department of Surgical Oncology, Lower Silesian Oncology, Pulmonology and Hematology Center, Pl. Hirszfelda 12, 53-413 Wroclaw, Poland
  5. 5Department of Oncological Surgery, Gdynia Oncology Centre, 81-519 Gdynia, Poland
  6. 6Department of Oncological Surgery, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland
  7. 7Department of Minimally Invasive and Oncological General Surgery, Voivodeship Hospital in Bialystok, 15-950 Bialystok, Poland
  8. 8Kidney Transplant Unit, Department of Medicine Surgery and Neuroscience, University Hospital of Siena, 53100 Siena, Italy
  9. 9Department of Medicine, Academy of Applied Medical and Social Sciences, AMiSNS, 82-300 Elblag, Poland
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Abstract

Background/Objectives: Computed tomography (CT) informs preoperative staging in colon cancer, yet its diagnostic accuracy for lymph node involvement relative to pathological staging remains uncertain. We examined nodal concordance and multicentre variation in Poland. Methods: This retrospective diagnostic accuracy study included adults who underwent upfront resection for nonmetastatic colon cancer at five centres between January 2022 and August 2025. All underwent preoperative CT; recorded cN categories were dichotomised as cN0 versus cN+ (any positive cN category), and pathological pN was the reference. We estimated accuracy, sensitivity, specificity, predictive values, and kappa with 95% confidence intervals. A centre-adjusted exploratory analysis examined the association between cT3–4 and occult pN+ among cN0 patients. Results: Of 662 otherwise eligible patients, 590 had evaluable cN and pN. CT and pathology agreed in 386 (65.4%; 95% CI, 61.5–69.2; κ = 0.276; 95% CI, 0.199–0.353). Occult pN+ occurred in 73 of 335 cN0 patients (21.8%; 95% CI, 17.7–26.5); 131 of 255 cN+ patients were pN0 (51.4%; 95% CI, 45.3–57.4). Sensitivity was 62.9% and specificity 66.7%. Centre-level cN/pN completeness ranged from 73.5% to 100%. cT3–4 was associated with occult pN+ after centre adjustment (OR, 3.10; 95% CI, 1.71–5.62). Sensitivity analyses were materially consistent. Conclusions: Routine CT nodal classification showed limited concordance with pathology. The cT3–4 association is exploratory and does not establish a prediction or treatment selection rule; cN alone should not determine treatment.

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Cite

BibTeXRIS
BibTeX
@article{cwalinski2026preoperative,
  title = {{Preoperative CT Nodal Staging Versus Pathology in Colon Cancer: A Retrospective Multicentre Diagnostic Accuracy Study}},
  author = {Tomasz Cwaliński and Mateusz Jagielski and Michał Kazanowski and Jacek Piątkowski and Maciej Ciesielski and Marcin Januszkiewicz and Zuzanna Bigus and Patryk Kaczor and Bartosz Kapturkiewicz and Paweł Lesiak and Sergii Girnyi and Damian Nowiński and Piotr Kurek and Natale Calomino and Marek Jackowski and Marek Bębenek and Luigi Marano},
  journal = {Cancers},
  year = {2026},
  month = oct,
  doi = {10.3390/cancers18193175},
  url = {https://europepmc.org/article/PMC/PMC13664425},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Preoperative CT Nodal Staging Versus Pathology in Colon Cancer: A Retrospective Multicentre Diagnostic Accuracy Study
AU  - Tomasz Cwaliński
AU  - Mateusz Jagielski
AU  - Michał Kazanowski
AU  - Jacek Piątkowski
AU  - Maciej Ciesielski
AU  - Marcin Januszkiewicz
AU  - Zuzanna Bigus
AU  - Patryk Kaczor
AU  - Bartosz Kapturkiewicz
AU  - Paweł Lesiak
AU  - Sergii Girnyi
AU  - Damian Nowiński
AU  - Piotr Kurek
AU  - Natale Calomino
AU  - Marek Jackowski
AU  - Marek Bębenek
AU  - Luigi Marano
PY  - 2026
DA  - 2026/10/01
JO  - Cancers
DO  - 10.3390/cancers18193175
UR  - https://europepmc.org/article/PMC/PMC13664425
AB  - Background/Objectives: Computed tomography (CT) informs preoperative staging in colon cancer, yet its diagnostic accuracy for lymph node involvement relative to pathological staging remains uncertain. We examined nodal concordance and multicentre variation in Poland. Methods: This retrospective diagnostic accuracy study included adults who underwent upfront resection for nonmetastatic colon cancer at five centres between January 2022 and August 2025. All underwent preoperative CT; recorded cN categories were dichotomised as cN0 versus cN+ (any positive cN category), and pathological pN was the reference. We estimated accuracy, sensitivity, specificity, predictive values, and kappa with 95% confidence intervals. A centre-adjusted exploratory analysis examined the association between cT3–4 and occult pN+ among cN0 patients. Results: Of 662 otherwise eligible patients, 590 had evaluable cN and pN. CT and pathology agreed in 386 (65.4%; 95% CI, 61.5–69.2; κ = 0.276; 95% CI, 0.199–0.353). Occult pN+ occurred in 73 of 335 cN0 patients (21.8%; 95% CI, 17.7–26.5); 131 of 255 cN+ patients were pN0 (51.4%; 95% CI, 45.3–57.4). Sensitivity was 62.9% and specificity 66.7%. Centre-level cN/pN completeness ranged from 73.5% to 100%. cT3–4 was associated with occult pN+ after centre adjustment (OR, 3.10; 95% CI, 1.71–5.62). Sensitivity analyses were materially consistent. Conclusions: Routine CT nodal classification showed limited concordance with pathology. The cT3–4 association is exploratory and does not establish a prediction or treatment selection rule; cN alone should not determine treatment.
SN  - 2072-6694
ER  -