Preoperative N stage evaluation in advanced gastric cancer patients using multidetector CT: can the sum of the diameters of metastatic LNs be used for N stage evaluation?

You, J.M.; Kim, T.U.; Kim, S.; Lee, N.K.; Lee, J.W.; Ryu, Hojun; Kim, J.H.; Hong, Seung Baek; Jeon, Tae Yong; Park, D.Y.

doi:10.1016/j.crad.2019.06.030

Cited by 8 publications

(8 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Only a few studies considered the sum of the diameters of LNs. You et al demonstrated the correlation between the sum of the SA diameters of LNs and the number of metastatic LNs in GC [ 21 ], and we confirmed their finding.…”

Section: Discussionsupporting

confidence: 89%

“…CT has already proved an accurate and feasible method for detecting LN metastases in GC [ 17 , 30 , 31 ]. Many different features have been investigated as radiological markers of metastatic LNs, such as short- or long-axis diameters [ 22 , 32 , 33 ], or the sum of LN diameters [ 21 ], attenuation greater than 100 HU in the postcontrast portal venous phase, a round shape [ 23 ], and iodine concentration in the arterial and venous phases [ 34 ]. We chose to consider and compare several parameters that are easy to measure and objectify: the SA of the largest LN; the SA/LA ratio of the largest LN; the mean of the SA/LA ratios of all LNs in a nodal group; the sum of the SAs of all LNs in the nodal group; and the volume of the largest LN.…”

Section: Discussionmentioning

confidence: 99%

“…The radiological criteria for defining LN metastases are still a matter of debate, however. Previous studies were based on various radiological benchmarks, such as long-axis (LA) or short-axis (SA) diameters, enhancement pattern, or nodal volume [ 20 , 21 , 22 , 23 ], but no studies have compared all these parameters.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Predictors of Metastatic Lymph Nodes at Preoperative Staging CT in Gastric Adenocarcinoma

et al. 2022

View full text Add to dashboard Cite

Background. The aim of this study was to identify the most accurate computed-tomography (CT) dimensional criteria of loco-regional lymph nodes (LNs) for detecting nodal metastases in gastric cancer (GC) patients. Methods. Staging CTs of surgically resected GC were jointly reviewed by two radiologists, considering only loco-regional LNs with a long axis (LA) ≥ 5 mm. For each nodal group, the short axis (SA), volume and SA/LA ratio of the largest LN, the sum of the SAs of all LNs, and the mean of the SA/LA ratios were plotted in ROC curves, taking the presence/absence of metastases at histopathology for reference. On a per-patient basis, the sums of the SAs of all LNs, and the sums of the SAs, volumes, and SA/LA ratios of the largest LNs in all nodal groups were also plotted, taking the presence/absence of metastatic LNs in each patient for reference. Results. Four hundred and forty-three nodal groups were harvested during surgery from 107 patients with GC, and 173 (39.1%) were metastatic at histopathology. By nodal group, the sum of the SAs showed the best Area Under the Curve (AUC), with a sensitivity/specificity of 62.4/72.6% using Youden’s index with a >8 mm cutoff. In the per-patient analysis, the sum of the SAs of all LNs in the loco-regional nodal groups showed the best AUC with a sensitivity/specificity of 65.6%/83.7%, using Youden’s index with a >39 mm cutoff. Conclusion. In patients with GC, the sum of the SAs of all the LNs at staging CT is the best predictor among dimensional LNs criteria of both metastatic invasion of the nodal group and the presence of metastatic LNs.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Predictors of Metastatic Lymph Nodes at Preoperative Staging CT in Gastric Adenocarcinoma

et al. 2022

View full text Add to dashboard Cite

show abstract

“…First, with the increase of tumor invasion depth, the probability of lymph node metastasis greatly increases. Studies indicated that the probability of lymph node metastasis is about 3% when the tumor is in the mucosa, this probability can be increased to 20% when the tumor invades the submucosa, and the presence of metastatic lymph nodes then reduces the accuracy of N staging [19]. Second, as the depth of infiltration increases, the thickness of the gastric wall increases accordingly, which makes acoustic waves need to travel a longer distance to reach the metastatic lymph nodes, affecting the judgment of metastatic lymph nodes by EUS [20].…”

Section: Discussionmentioning

confidence: 99%

The Value of Gastric Cancer Staging by Endoscopic Ultrasonography Features in the Diagnosis of Gastroenterology

Zhou

2022

Computational and Mathematical Methods in Medicine

View full text Add to dashboard Cite

This research was aimed at exploring the application value of endoscopic ultrasonography (EUS) in the diagnosis of gastric cancer staging and the correlation between staging and clinical features of gastric cancer. A total of 72 patients with gastric cancer were selected and randomly divided into two groups. The patients in the pathological group underwent postoperative pathological examination, while those in the EUS group received preoperative EUS examination. The results showed that the staging accuracy of EUS was 73.33% for T1, 78.57% for T2, 27% for T3, and 100% for T4, compared with the pathological staging. The accuracy of N- and N+ was 42.5% and 82.3% in EUS, respectively, and the total accuracy was 55.7%. There was no considerable difference in the accuracy of T staging between early gastric cancer and advanced gastric cancer ( P > 0.05 ), but there was a considerable difference in N staging ( P < 0.05 ). Lymph node metastasis affected the accuracy of N staging ( P < 0.05 ). The number and location of metastatic lymph nodes did not affect the judgment of metastatic lymph nodes ( P > 0.05 ). In addition, the proportion of understaging and overstaging was greatly different among different lesion sizes and histological types of gastric cancer ( P < 0.05 ). To sum up, the accuracy of EUS for T and N staging of gastric cancer needed to be improved. The location of gastric cancer lesions affected the accuracy of T staging, while the depth of invasion and lymph node metastasis affected the accuracy of N staging.

show abstract

“…A short axis diameter greater than 8mm is the most common criterion for CT diagnosis of specific metastatic LNs. 11 , 12 However, this size-dependent criterion has its inherent limitations. Since normal-size LNs may present microscopic tumor involvement, the size of metastatic LNs is not always greater than the size defined by the MDCT lower limit.…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study of Prognostic Value of Metastatic Lymph Node Count and Size in Patients with Different Stages of Gastric Carcinoma

Gao¹,

Wang²,

Tang³

et al. 2022

CMAR

View full text Add to dashboard Cite

Background The correlation between the preoperative lymph node count (LNC) on multidetector computed tomography (MDCT) and the prognosis of gastric carcinoma (GC) remains to be defined. This research aims to evaluate the prognostic value of LNC on MDCT in GC patients based on tumor-node-metastasis (TNM) staging, using different size criteria for counting. Methods The clinical data of 126 patients with gastric adenocarcinoma undergoing gastrectomy were retrospectively analyzed. Lymph nodes greater than 8mm and 5mm on MDCT were counted and recorded. The prognostic implications of LNC on MDCT for patient survival were analyzed according to different size criteria for counting and tumor TNM staging. Results When 8mm was used as the counting criterion, LNC on MDCT had no significant effect on the overall survival (OS) of the entire cohort. In addition, the OS of T1–T2 GC patients with LNC on MDCT ≥1 was significantly worse than that of patients with LNC on MDCT <1. When 5mm was used as the counting criterion, LNC on MDCT was found to be significantly associated with the OS of the entire cohort. In the subgroup analysis, patients with relatively advanced (T3-T4, N+ and III) GC with LNC on MDCT >7 showed a significantly worse OS than those with LNC on MDCT ≤7. LNC on MDCT >7 with 5mm as the counting criterion and Stage III were independent risk factors for adverse prognosis. Conclusion The prognostic value of LNC on MDCT based on different size criteria varies in patients with different stages of GC. LNC of a smaller size (5mm) on MDCT may be a prognostic factor for patients with relatively advanced GC.

show abstract

Preoperative N stage evaluation in advanced gastric cancer patients using multidetector CT: can the sum of the diameters of metastatic LNs be used for N stage evaluation?

Cited by 8 publications

References 42 publications

Predictors of Metastatic Lymph Nodes at Preoperative Staging CT in Gastric Adenocarcinoma

Predictors of Metastatic Lymph Nodes at Preoperative Staging CT in Gastric Adenocarcinoma

The Value of Gastric Cancer Staging by Endoscopic Ultrasonography Features in the Diagnosis of Gastroenterology

A Pilot Study of Prognostic Value of Metastatic Lymph Node Count and Size in Patients with Different Stages of Gastric Carcinoma

Contact Info

Product

Resources

About