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ESMO GI 2025 | Evaluating the reliability of CT-based staging in non-metastatic colon cancer
Giovanni Randon, MD, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy, discusses an analysis from the ALFAOMEGA Master Observational Trial (NCT04120935) evaluating radiologist concordance and correlation with pathology in staging non-metastatic colon cancer. CT-based assessment demonstrated only moderate agreement among radiologists and limited accuracy compared with pathological staging, particularly in detecting high-risk features such as pT4 disease and nodal status. This interview took place at the European Society for Medical Oncology (ESMO) Gastrointestinal Cancer 2025 Congress in Barcelona, Spain.
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Transcript
So we evaluated over 100 patients with localized mismatch-proficient colon cancer and had their preoperative CT scans evaluated by four different radiologist groups established at four referral centers in Italy. Radiologists were asked to stage these tumors according to the Forster criteria giving us the T staging, the nodal staging and also the depth of pericolonic fat invasion of these tumors...
So we evaluated over 100 patients with localized mismatch-proficient colon cancer and had their preoperative CT scans evaluated by four different radiologist groups established at four referral centers in Italy. Radiologists were asked to stage these tumors according to the Forster criteria giving us the T staging, the nodal staging and also the depth of pericolonic fat invasion of these tumors. Radiologists were blinded to each other and to the pathology report. We found only a moderate inter-rater agreement regarding the T stage and even a lower agreement regarding the nodal stage. Moreover, even if the specificity for T2 staging was quite high, suggesting that the rate of false positives in this context was low, the sensitivity for T4 tumors was much lower. Overall, this data challenged the widespread use of preoperative CT scan as a valuable tool for correctly identifying patients for neoadjuvant strategies in clinical practice.
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