Helical Hydro-CT for Diagnosis and Staging of Gastric Carcinoma

Düx, Markus; Richter, G. M.; Hansmann, J.; Kuntz, C.; Kauffmann, G. W.

doi:10.1097/00004728-199911000-00015

Cited by 65 publications

(11 citation statements)

References 27 publications

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“…CT has failed to accurately determine the depth of tumour infiltration in numerous studies which is in accordance with our results [13, 24, 25]. Nonetheless, the limited accuracy of CT in our study should be interpreted with caution as CT was performed in fewer patients than the other staging modalities, thus reducing the statistical power of the analysis.…”

Section: Discussionsupporting

confidence: 84%

“…However, visible or enlarged nodes are not necessarily malignant. At present, there are no accepted criteria for identifying metastatic lymph nodes in CT, size or contrast enhancement are not reliable criteria to discriminate benign from malignant nodes [13, 26]. The same applies to endosonographic staging, although there are somewhat more accepted criteria to distinguish malignant from benign lesions such as the echostructure and regularity of borders (hypoechoic lesion with regular borders suggestive of malignancy) [13].…”

Section: Discussionmentioning

confidence: 99%

“…Tumours contiguous with surrounding organs were classified as T4, even if definite infiltration was not demonstrable. All visible lymph nodes were classified as malignant, independent of size or contrast enhancement [13]. …”

Section: Methodsmentioning

confidence: 99%

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Prospective Comparison of Endoscopy, Endosonography and Computed Tomography for Staging of Tumours of the Oesophagus and Gastric Cardia

Kienle¹,

Buhl²,

Kuntz³

et al. 2002

Digestion

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Background: Local and multimodal therapeutic strategies for tumours of the oesophagus and gastric cardia, require precise preoperative staging. Endosonography is considered the most accurate staging method, while computed tomography (CT) has limitations especially in the evaluation of local infiltration. Macroscopic endoscopic evaluation was reported to be accurate in selected series, but no study has yet compared all three staging modalities. Methods: One hundred and seventeen unselected patients with tumours of the oesophagus and gastric cardia were prospectively staged first by the endoscopic macroscopic appearance and then by endosonography. All patients had preoperative CT scans, however, only the 36 patients receiving the scans at our institution were included in the study. The preoperative staging results were then compared to postoperative histology which was available as the gold standard in all included patients. Kappa statistics were used to exclude chance agreement of the clinical staging results with the pathohistological findings. Differences between the resulting ĸ values for the different staging modalities were analysed with a jack-knife test. Results: Endoscopic macroscopic staging and endosonography (accuracy 67 and 69%, weighted ĸ 0.78 and 0.84) were significantly more accurate than CT (accuracy 33%, weighted ĸ 0.44) for determination of the T category (p = 0.006 and p = 0.001). After exclusion of tumours of the cardia (n = 33), the accuracy of macroscopic and endosonographic staging (accuracy 72 and 75%, weighted ĸ 0.86 and 0.88) increased and remained more accurate than CT (accuracy 50%, weighted ĸ 0.62). The main pitfall in our series in staging the T category was the overestimation of T2 tumours in the cardia as T3 or even as T4 tumours due to the inability to visualise the serosa. The accuracy of predicting lymph node metastasis was 68% for macroscopic endoscopic, 79% for endosonographic, and 67% for CT staging. Only endosonographic staging was significantly different from chance agreement with histology (weighted ĸ = 0.56). Endosonographic staging was significantly more accurate than endoscopic macroscopic and CT staging (p = 0.03). Conclusions: Endosonography is the most accurate staging modality for overall preoperative staging of oesophageal and cardial tumours. Endoscopic macroscopic staging allows a reasonably accurate assessment of the T category.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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Prospective Comparison of Endoscopy, Endosonography and Computed Tomography for Staging of Tumours of the Oesophagus and Gastric Cardia

Kienle¹,

Buhl²,

Kuntz³

et al. 2002

Digestion

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“…A sharp tumour contour and a clear stomach fat plane, or a few small linear strands of soft tissue extending into the fat plane, are normally defined as a T2 tumour. Blurring and wide reticular strands surrounding the outer border of the tumour are criteria for T3 tumours; however, it is difficult to identify a clear demarcation [1,[14][15]. In our study, the outer layer corresponded to the submucosa and was represented on imaging as delayed enhancement for T2-stage tumours, while tumours with a blurred outer layer and that enhanced gradually were staged as T3.…”

Section: Discussionmentioning

confidence: 60%

Determining gastric cancer resectability by dynamic MDCT

et al. 2009

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“…However, it is often extremely difficult to make a decision regarding indications and timing in performing laparoscopy in preoperative diagnosis and during postoperative monitoring. Although computed tomography (CT) is a diagnostic modality for the detection of peritoneal metastasis in conventional imaging study, CT has a limited capacity for revealing peritoneal metastasis unless the disease has progressed sufficiently to cause obstruction of the intestinal, biliary or urinary tract (12)(13)(14). High-speed spiral CT showed a sensitivity of only 47.4% in patients with peritoneal dissemination of abdominal malignancies (15).…”

Section: Introductionmentioning

confidence: 99%

Type IV collagen levels are elevated in the serum of patients with peritoneal dissemination of gastric cancer

et al. 2010

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Abstract. Type III procollagen (amino-terminal propeptide of procollagen type III) and type IV collagen are considered to be reliable serum markers for monitoring the progression of liver fibrosis. The peritoneal dissemination of gastric cancer is also characterised by abundant collagen deposition in the peritoneum. The present study was performed to investigate the potential of serum type III procollagen and IV collagen as biomarkers for peritoneal dissemination in gastric cancer. The study population consisted of 117 patients with gastric cancer: 32 patients had peritoneal dissemination which was pathologically diagnosed by laparotomy or laparoscopic examination, while 85 patients (45/40, early/advanced gastric cancer) had no peritoneal dissemination. We measured the serum levels of type III procollagen and type IV collagen in comparison to the commonly accepted tumor markers carcinoembryonic (CEA), carbohydrate antigen (CA)19-9 and CA125. The median type III procollagen levels showed no significant differences between the two groups, whereas the median type IV collagen levels were significantly (201 ng/ml) higher in patients with than in those without peritoneal dissemination (early/advanced gastric cancer, 124/136 ng/ml) (P<0.05). In receiver operating characteristic (ROC) curve analysis, type IV collagen had the largest area under the curve (0.83), followed by CA125 (0.72), CA19-9 (0.64), CEA (0.59) and type III procollagen (0.48). Type IV collagen was an independent marker (P<0.0001, odds ratio 15.7) for predicting peritoneal dissemination along with CA125 (P=0.0086, odds ratio 9.4) based on multivariate logistic regression. In conclusion, serum type IV collagen levels may be significant in the early detection and management of patients with peritoneal dissemination of gastric cancer.

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Helical Hydro-CT for Diagnosis and Staging of Gastric Carcinoma

Cited by 65 publications

References 27 publications

Prospective Comparison of Endoscopy, Endosonography and Computed Tomography for Staging of Tumours of the Oesophagus and Gastric Cardia

Prospective Comparison of Endoscopy, Endosonography and Computed Tomography for Staging of Tumours of the Oesophagus and Gastric Cardia

Determining gastric cancer resectability by dynamic MDCT

Type IV collagen levels are elevated in the serum of patients with peritoneal dissemination of gastric cancer

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