Diagnostic Value of Clinical T Staging Assessed by Endoscopy and Stomach Protocol Computed Tomography in Gastric Cancer: The Experience of a Low-Volume Institute

Abstract

PurposeClinical staging of gastric cancer appears to be important more and more for tailored therapy. This study aimed to verify the accuracy of clinical T staging in a low-volume institute.Materials and MethodsWe retrospectively reviewed prospectively collected data of gastric cancer patients who underwent resection. A total of 268 patients of gastric cancer were enrolled from March 2004 to June 2012. These demographics, tumor characteristics, and clinical stages were analyzed for identification of diagnostic value of clinical T staging.ResultsThe predictive values for pT1 of endoscopy and computed tomography were 90.0% and 89.4%, respectively. In detail, the predictive values of endoscopy for pT1a, pT1b, and pT2 or more were 87%, 58.5%, and 90.6%, respectively. The predictive values of computed tomography for pT1a, pT1b, and pT2 or more were 68.8%, 73.9%, and 84.4%, respectively. The factors leading to underestimation of pT2 or more lesions by gastroscopy were the middle third location, the size greater than 2 cm, and younger age. Those for overestimation of pT1 lesion by computed tomography were male, age more than 70 years, elevated type, and size greater than 3 cm.ConclusionsDiagnostic accuracy of early gastric cancer was 90%, which is comparable to those of high volume center. In patients with early gastric cancer, limited gastrectomy or minimal invasive surgery can be safely introduced at a low volume center also. However, the surgeon of low-volume institute should consider the accuracy of clinical staging before extending the indication of limited treatment.

Preoperative N Staging of Gastric Cancer by Stomach Protocol Computed Tomography

“…S-CT had an overall accuracy of 56.5% for cT stage and 63.2% for cN stage in our institute 11. Differentiation between EGC and AGC is important in deciding the extent of surgery.…”

“…Differentiation between EGC and AGC is important in deciding the extent of surgery. CT images could diagnose EGC lesions with a sensitivity of 90.3%, a specificity of 83.1%, an accuracy 87.5%, and a positive predictive value of 89.4% 11. Therefore, S-CT is highly specific but relatively insensitive for detecting nodal metastases, but is more sensitive in predicting invasion depth beyond the gastric muscular layer in our institute.…”

“…S-CT was performed with a 16 row multi-detector row computed tomography (MDCT) scanner (Sensation 16, Siemens Medical Systems, Erlangen, Germany) after administration of 10 mg of butyl scopolamine (Buscopan, Boehringer Ingelheim, Seoul, Korea) and two packs of effervescent granules 11. The scanning protocol was: 16×0.75 mm detector configuration; rotation time 0.5 seconds; slice thickness 1 mm; pitch 1.25; and kVp and mAs of 120 and 160.…”