The accuracy of CT staging of small bowel adenocarcinoma: CT/pathologic correlation

Purpose: Several studies have documented the use of CT in the evaluation of small bowel neoplasms, but few have addressed the CT staging of adenocarcinoma. We retrospectively correlated CT and pathologic staging to evaluate the accuracy of CT for staging small bowel adenocarcinoma using American Joint Committee on Cancer criteria. Method: The preoperative CT scans of 15 patients with pathologically proven small bowel adenocarcinoma were analyzed. Two blinded readers separately interpreted extent of invasion, presence of lymphadenopathy, and distant metastases. Pathologic and CT staging were compared. Results: The overall accuracy of CT staging was 47% (14/30). The sensitivity of detection of mesenteric infiltration was 88%. The sensitivity and specificity for detection of distant metastases were 58 and 63% and for lymphadenopathy 75 and 20%, respectively. Errors occurred in patients with Crohn disease, adenomas, Peutz-Jegher syndrome, small bowel obstruction, and perforation and on suboptimal studies. Conclusion: The accuracy of CT staging of small bowel adenocarcinoma is 47%. CT is highly sensitive but not specific for the detection of mesenteric infiltration and regional lymphadenopathy. Since spiral CT may offer improved detection of distant metastases and increased accuracy in the evaluation of patients with concomitant bowel disease, further research is needed to determine the maximal utility of CT in the staging of adenocarcinoma of the small bowel.