Performances of preoperative CT scan to predict the pTN stage for MSI/dMMR localized colon cancers

Highlights•A large cohort of MSI/dMMR localized CCs (113) and CT scan reviewing by three expert blinded independent radiologists.•On preoperative CT scan, 33% of cT4 tumors were actually pT1-3 and 66% of the pT4 population were not identified as such.•On preoperative CT scan, 54% of cN-positive tumors were pN-negative and 30% of the pN-positive population were cN-negative.•Preoperative CT scan has limited performances to correctly identify TN stages for MSI/dMMR CC.•Other diagnostic/prognostic tools are needed to properly develop neoadjuvant strategies with immune checkpoint inhibitors.AbstractBackgroundNeoadjuvant immunotherapy emerges as a promising strategy for patients with localized colon cancer (CC) harboring microsatellite instability/mismatch repair deficiency (MSI/dMMR). The aim of this study is to evaluate the concordance between clinical cTN stage assessed by preoperative computed tomography (CT) scan and pTN stage of MSI/dMMR CC.Patients and methodsConsecutive patients diagnosed for localized MSI/dMMR CC and treated with upfront surgery between 2013 and 2022 in two French centers were eligible. Two independent radiologists, blinded to pathological findings, reviewed all preoperative CT scans and assessed cTN stage, with a third radiologist reviewing discordant cases. Radiological predictive diagnostic accuracy for pT4 and pN+ (N+ = N1 or N2) were calculated.ResultsOne hundred and thirteen patients were included (right CCs = 79%). CT scan diagnostic performances for pT4 were sensitivity (Se) = 33.3%; specificity (Sp) = 94.0%; positive predictive value (PPV) = 66.7%; and negative predictive value (NPV) = 79.6% and for pN+ were Se = 70.3%; Sp = 59.2%; PPV = 45.6%; and NPV = 80.4%. When pT-pN were combined, 37.5% of tumors identified as cT4 and/or cN+ were actually pT1-3 and pN0, and 23.1% of the pT4 and pN+ population was not identified as such radiologically.ConclusionThe ability of preoperative CT scan to predict pT and pN stages is limited for localized MSI/dMMR CCs. Reassessing neoadjuvant strategies' benefit–risk balance in this population is needed.