Preoperative Staging of Gastric Adenocarcinoma: Comparison of Helical CT and Endoscopic US

Habermann, Christian R.; Weiß, Florian; Riecken, Rasmus; Honarpisheh, Human; Bohnacker, Sabine; Staedtler, Carsten; Dieckmann, Christoph; Schoder, Volker; Adam, Gerhard

doi:10.1148/radiol.2302020828

Cited by 234 publications

(176 citation statements)

References 28 publications

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“…One of the most useful methods for gastric cancer staging is computed tomography, which accepts as a positive lymph node those up to 10 mm size (5,6). Therefore, we have considered 10 mm lymph node size as differentiation criteria of each study group.…”

Section: Discussionmentioning

confidence: 99%

Large lymph node size harvested as prognostic factor in gastric cancer?

Espín¹,

Bianchi²,

Llorca³

et al. 2010

Rev. esp. enferm. dig.

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Objective: knowledge regarding prognostic factors in gastric cancer is essential to decide on single patient management. We aim to establish the value of large lymph node size in order to improve perioperative approach.Material and methods: charts of one hundred and twentyeight consecutive patients undergoing gastrectomy for resectable gastric cancer were reviewed between January 1996 and December 2005. Patients were split in two groups according to large lymph node size harvested, group I, lymph node size ≤ 10 mm and group II, lymph node size > 10 mm. Overall five-year survival related to cancer were analyzed as a main endpoint. Prognostic factors as TNM classification and degree of differentiation have been considered.Results: there were no differences regarding age and gender (67.4 vs. 64; p = 0.34 and 66,1 vs. 68,1%; p = 0.27, respectively). Nevertheless, a significant difference has been found according to T1-T2 of TNM stage (78.1 vs. 39.1% p = < 0.001), for N grade staging, has statistical signification for grade N0 (62.7 vs. 30.5%; p < 0.001), and for Ia and Ib stages (57.6 vs. 17.4%). Five years overall survival has a great statistical signification (p logrank = 0.0003), however, overall survival between groups with positive lymph nodes according to lymph node size was close to signification, (p log-rank = 0.0636).Conclusions: our data indicates that large lymph node size could be a powerful predictor for overall survival in gastric cancer, when it could be evaluated in preoperative period. In our opinion lymph node size should be considered for perioperative chemotherapy schemas. Detection and staging techniques for lymph node affection acquire much more importance.Key words: Gastric cancer. Lymphadenectomy. TNM staging. Postoperative survival. INTRODUCTIONAs it is well known, in order to face multidisciplinary treatment in many digestive neoplasms, it is basic to consider all of prognostic factors which can benefit patients undergoing perioperative therapy, trying to optimize long term results (1).Main prognostic factors are based on histological assessment as type and degree of tumor differentiation, depth invasion and macroscopic appearance. Complete preoperative staging will be provided by image or endoscopic techniques that will allow us to evaluate tumor extension and affection of neighbour tissues, as well as, the presence of suspicious lymph nodes. To pursue an extended assessment sophisticated data based on genetics or tumoral markers could be done (2,3).On the other hand, prognosis staging in gastric cancer is based on TNM classification, published by the International Union Against Cancer in 1997 (4). Lymph node affection is considered, for resectable patients, the most important prognosis-related factor which will also make the difference in patients' survival.Lymph node size is directly related to metastatic affection, and with its detection in complementary explorations, like CT-scans or endoscopic ultrasound. Otherwise, lymph nodes size could take us directly to the hypothesis of having b...

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Section: Discussionmentioning

confidence: 99%

Large lymph node size harvested as prognostic factor in gastric cancer?

Espín¹,

Bianchi²,

Llorca³

et al. 2010

Rev. esp. enferm. dig.

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“…It is possible to get high quality images of the gastric wall and anatomical perigastric structures by means of endoscopic ultrasonography, therefore, it is being used with high diagnostic yield in the loco-regional staging of the gastric cancer (3)(4)(5)(6). However, the importance that these have for everyday medical practice has been cause for debate.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of endoscopic ultrasonography in preoperative gastric cancer staging: diagnostic yield and therapeutic impact

Repiso

Gómez-Rodríguez

López-Pardo

et al. 2010

Rev. esp. enferm. dig.

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Objectives: to evaluate the diagnostic yield of endoscopic ultrasonography in loco-regional staging of gastric cancer in our medium and to determine the impact of this technique on later therapeutic management.Material and methods: this is a retrospective study carried out on patients histologically diagnosed with gastric adenocarcinoma who had been referred for endoscopic ultrasonographic examination. The technique results were compared with those obtained from surgical samples and/or from exploratory laparoscopylaparotomy. We compared the initial therapeutic decision based on conventional diagnostic techniques with the final therapeutic management based on the endoscopic ultrasonography results.Results: forty-six patients with gastric adenocarcinoma were included in the study (a reference exploration was available in 36 cases). Diagnostic precision was 70% in stage T, while in stages T1, T2, T3 y T4 was 100, 38, 82, and 100%, respectively. The sensitivity and specificity to differentiate T1-2 from T3-4 was 94 and 85%, respectively. We could not identify factors associated with obtaining a correct diagnosis in staging T. Diagnostic precision was 72% for stage N (N0: 58%; Nx 88%). The presence of free perigastric fluid was identified in 7 cases; the presence of peritoneal carcinomatosis was later confirmed in 5 of these. The result of endoscopic ultrasonography led to a modification in the subsequent therapeutic management in 13 patients (28%).Conclusions: endoscopic ultrasonography is a useful technique for loco-regional staging of gastric adenocarcinoma, which may have important implications in the therapeutic management of these patients.Key words: Gastric cancer. Endoscopic ultrasonography. Treatment. RESUMENObjetivos: valorar la rentabilidad diagnóstica de la ecoendoscopia en la estadificación locorregional del cáncer gástrico en nuestro medio y determinar el impacto de la técnica sobre el manejo terapéutico posterior.Material y métodos: estudio retrospectivo realizado en pacientes diagnosticados histológicamente de adenocarcinoma gástri-co que habían sido remitidos para la realización de ecoendoscopia. Se comparó el resultado de la técnica con el estudio final obtenido en la pieza operatoria y/o laparoscopia-laparotomía exploradora. Se comparó la decisión terapéutica inicial basada en los resultados de las técnicas diagnósticas convencionales, con el manejo terapéu-tico final basado en el resultado de la ecoendoscopia.Resultados: se incluyeron en el estudio 46 pacientes con adenocarcinoma gástrico (en 36 de los cuales se disponía de exploración de referencia). La precisión diagnóstica fue del 70% para el estadIo T, y para T1, T2, T3 y T4 del 100, 38, 82 y 100%, respectivamente. La sensibilidad y especificidad para diferenciar el estadio T1-2 del T3-4 fue del 94 y 85% respectivamente. No se identificaron factores relacionados con la obtención de un diagnóstico correcto en la estadificación T. La precisión diagnóstica fue del 72% para el estadio N (N0: 58%; Nx 88%). En 7 pacientes se identificó la pr...

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“…Imaging findings vary depending on the type and grade of the tumor, including diffuse or segmental thickening with intravenous contrast enhancement, masses, ulceration, and loss of distensibility. 16,19 UGE is the method of choice for definitive diagnosis, because it is more sensitive and allows biopsies to be performed for histopathologic analysis. 16 Endoscopic ultrasonography is currently the best method for assessing the primary tumor as well as evaluating the local extent of the tumor and the presence of compromised regional lymph nodes.…”

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confidence: 99%

“…16 Endoscopic ultrasonography is currently the best method for assessing the primary tumor as well as evaluating the local extent of the tumor and the presence of compromised regional lymph nodes. 19 Recent studies have demonstrated the role of MRI in the diagnosis of early gastric carcinomas that are not seen on other imaging tests. 20 The rarity of gastric cancer in children makes this diagnosis a very remote possibility among pediatricians.…”

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confidence: 99%

Ménétrier’s disease associated with gastric adenocarcinoma in a child – imaging aspect

Silva

Rigo²,

Batista³

et al. 2016

Rev. Assoc. Med. Bras.

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Preoperative Staging of Gastric Adenocarcinoma: Comparison of Helical CT and Endoscopic US

Abstract: Compared with endoscopic US, helical CT focused on the stomach provides valuable results regarding T and N staging in patients with gastric cancer.

Cited by 234 publications

References 28 publications

Large lymph node size harvested as prognostic factor in gastric cancer?

Large lymph node size harvested as prognostic factor in gastric cancer?

Usefulness of endoscopic ultrasonography in preoperative gastric cancer staging: diagnostic yield and therapeutic impact

Ménétrier’s disease associated with gastric adenocarcinoma in a child – imaging aspect

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