Preoperative N Staging of Gastric Cancer by Stomach Protocol Computed Tomography

Abstract

PurposeClinical stage of gastric cancer is currently assessed by computed tomography. Accurate clinical staging is important for the tailoring of therapy. This study evaluated the accuracy of clinical N staging using stomach protocol computed tomography.Materials and MethodsBetween March 2004 and November 2012, 171 patients with gastric cancer underwent preoperative stomach protocol computed tomography (Jeju National University Hospital; Jeju, Korea). Their demographic and clinical characteristics were reviewed retrospectively. Two radiologists evaluated cN staging using axial and coronal computed tomography images, and cN stage was matched with pathologic results. The diagnostic accuracy of stomach protocol computed tomography for clinical N staging and clinical characteristics associated with diagnostic accuracy were evaluated.ResultsThe overall accuracy of stomach protocol computed tomography for cN staging was 63.2%. Computed tomography images of slice thickness 3.0 mm had a sensitivity of 60.0%; a specificity of 89.6%; an accuracy of 78.4%; and a positive predictive value of 78.0% in detecting lymph node metastases. Underestimation of cN stage was associated with larger tumor size (P<0.001), undifferentiated type (P=0.003), diffuse type (P=0.020), more advanced pathologic stage (P<0.001), and larger numbers of harvested and metastatic lymph nodes (P<0.001 each). Tumor differentiation was an independent factor affecting underestimation by computed tomography (P=0.045).ConclusionsComputed tomography with a size criterion of 8 mm is highly specific but relatively insensitive in detecting nodal metastases. Physicians should keep in mind that computed tomography may not be an appropriate tool to detect nodal metastases for choosing appropriate treatment.

Accuracy of Multidetector Computed Tomography for N Staging of Gastric Cancer in Eastern Asia: A Meta-analysis and Systematic Review

“…A systematic search was conducted to initially identify 4333 articles for the rst review. 46 After deleting duplicates and screening related titles and abstracts, the remaining 233 articles were reviewed for full text, and a total of 14 studies [20][21][22][23][24][25][26][27][28][29][30][31][32][33] were nally adopted in accordance with the inclusion criteria (Fig. 1).…”

“…54 The calculated I² value for above results were almost all > 50% and the P value was often < 0.05, indicated that there was considerable heterogeneity among the included studies. 55 In terms of grouping, the pooled sensitivity for N0 and N + were 0.66 and 0.88 in 6 studies [20,22,26,28,32,33] which the reference diameter of LNM in MDCT was < 8 mm, and another group [21,23,25,27,30,31] of the reference was ≥ 8 mm, the pooled sensitivity for N0 and N + were 0.91 and 0.52 respectively. 56 The result may instruct that appropriate reduction of the reference diameter of LNM could increase MDCT sensitivity for LNM in Eastern Asia.…”

“…56 The result may instruct that appropriate reduction of the reference diameter of LNM could increase MDCT sensitivity for LNM in Eastern Asia. 57 The other grouping was about DTI, which was divided into two groups according to the proportion of T3 and T4 in T stage by pathological results, < 50% (the majority of patients with EGC) [23,25,27,31] or ≥ 50% ( the majority of patients with advanced gastric cancer(AGC)) [21,24,26,[28][29][30]. 58 The pooled sensitivity for N0 and N + were 0.92 and 0.49 in the proportion < 50%, and were 0.6 and 0.84 in the proportion ≥ 50% respectively.…”

“…26 MDCT has been used as a hot tool for continuous research to more accurately assess the preoperative staging of GC since its invention [10,11]. 27 With the development of the times and technological innovation, MDCT has been greatly improved and is currently considered as one of the most reliable preoperative staging techniques for GC [12][13][14][15]. 28 When using MDCT alone, its accuracy has been reported to reach 89% [16,17].…”

Usefulness of Two-Dimensional Values Measured Using Preoperative Multidetector Computed Tomography in Predicting Lymph Node Metastasis of Gastric Cancer

“…[3][4][5][6] The significance of MDCT is more emphasized in the N and M staging rather than in the T staging. [7][8][9][10][11] Although there are various diagnostic criteria for lymph node (LN) metastasis using MDCT, such as enhancement, clustering, and shape, LN size is considered the most important. 9,12,13 A short diameter greater than 10 mm is generally considered a metastatic LN with tumor infiltration.…”