Hydro-MDCT for Gastric Adenocarcinoma Staging. A Comparative Study With Surgical and Histopathological Findings for Selecting Patients for Echo-endoscopy

Abstract

Background/Aim: In local staging of gastric adenocarcinoma CT is the modality of choice. Less frequently used in a few selected patients is echo-endoscopy. Aim of this study was to evaluate the accuracy of hydro-multidetectorcomputed tomography (hydro-MDCT) in the evaluation of gastric adenocarcinomas with subsequent surgical and histopathological correlation to select cases for echo-endoscopy. Patients and Methods: A total of 65 patients with gastric adenocarcinomas, diagnosed by endoscopy and biopsy, underwent contrast-enhanced hydro-MDCT with subsequent tumor, nodes, metastases (TNM) classification. The distension of the gastric lumen was obtained after the oral administration of 500 ml of water. Results: Hydro-MDCT always detected gastric cancer and in 49/65 patients the assessment of Tparameter was identical to the histopathological results (accuracy: 75%). We found overstaging in 12 and understaging in 4 cases. N-parameter with MDCT was in agreement with histo-pathology in 69%of patients; in metastatic disease hydro-MDCT had an accuracy of 99%. Hydro-MDCT has proven to be a reliable diagnostic technique in evaluating gastric cancer T3-T4 stages in comparison to T1 and T2: in defining T2-stage we found the highest number of errors (37%). Conclusion: Hydro-MDCT is a reliable technique in the preoperative staging of gastric adenocarcinoma. Echo-endoscopy could be particularly useful in doubtful cases to evaluate the muscularis propria infiltration (T2 vs. T3) and characterize the perigastric lymph nodes.

Global progress and future prospects of early gastric cancer screening

“…Its diagnostic value for gastric cancer, particularly for early gastric cancer and precancerous lesions, remains somewhat restricted. For instance, MDCT's utilization for diagnosing gastric cancer is based on the principle that a gastric wall thickness of greater than 1 mm may manifest as white bands or lines in the wall, while early-stage gastric cancer typically does not exhibit evident wall thickening 27 . Moreover, the soft tissue contrast of CT images is relatively low.…”