What question did this study set out to answer?

This research aims to improve nodal staging in colorectal cancer using non-invasive imaging techniques.

July 4, 2026Cancers0 citationsOpen Access

Reimagining Nodal Staging in Colorectal Cancer: Toward a Novel Non-Invasive Imaging Approach

PMPerla MorenoInstitut de Chirurgie Guidée par l'Image MOMichela OrsiUniversity of Rome Tor Vergata KBKarl-Philippe BeaudetInstitut national de recherche en sciences et technologies du numérique

Key Points

This research aims to improve nodal staging in colorectal cancer using non-invasive imaging techniques.
Evaluation of advanced imaging methods including PET-MRI and high-frequency quantitative ultrasound (HF-QUS).
Assessment of lymph node metastasis and extranodal extension in colorectal cancer patients.
Integration of artificial intelligence and molecular profiling for biologically informed staging.
HF-QUS demonstrated sensitivity and specificity exceeding 85% for detecting metastatic nodes.
Improvements in imaging techniques may reduce unnecessary surgeries and enhance treatment precision.
Study suggests that tumor biology should guide staging rather than solely anatomical considerations.

Abstract

Colorectal cancer (CRC) remains the third most common malignancy worldwide and a leading cause of cancer mortality, largely driven by metastatic dissemination. Among metastatic routes, lymphatic spread is crucial to determine the prognosis and establish an adequate therapeutic strategy. Lymph node metastasis (LNM) defines stage III disease in the TNM classification, guiding adjuvant chemotherapy and surgical planning. However, nodal staging based on lymphadenectomy and histopathology is invasive, time-consuming, and may lead to overtreatment. Conventional imaging modalities, including computed tomography, magnetic resonance imaging, and endorectal ultrasound, show limited sensitivity and specificity for small or micro-metastatic nodes. Despite multimodal progress, no non-invasive technique reliably identifies malignant nodes in real time. PET–MRI, contrast-enhanced ultrasound, photoacoustic and fluorescence approaches, ICG mapping, and sentinel node biopsy improve detection but remain limited by specificity, cost, or availability. Extranodal extension (ENE) and tumor deposits (TDs) carry major prognostic value, reflecting aggressive biology and association with distant spread. Meanwhile, phylogenetic studies challenge linear dissemination models, indicating that some metastases arise directly from the primary tumor or TDs rather than LNMs. These data support refinement of staging and surgical strategies according to tumor biology rather than purely anatomical criteria. High-frequency quantitative ultrasound (HF-QUS) enables real-time, operator-independent, three-dimensional nodal assessment with reported sensitivity and specificity exceeding 85%. Combined with artificial intelligence and molecular profiling, it may support biologically informed staging, reduce unnecessary surgery, and foster precision oncology. Lymphatic dissemination in CRC offers a platform to merge tumor biology with technological innovation, where advanced imaging, molecular insight, and artificial intelligence may redefine nodal staging toward precision, non-invasive care.

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