Preoperative staging of nodal status in gastric cancer

Abstract

An accurate preoperative staging of nodal status is crucial in gastric cancer, because it has a great impact on prognosis and therapeutic decision-making. Different staging methods have been evaluated for gastric cancer in order to predict nodal involvement. So far, no technique could meet the necessary requirements, which include a high detection rate of infiltrated lymph nodes and a low frequency of falsepositive results. This article summarizes different staging methods used to assess lymph node status in patients with gastric cancer, evaluates the evidence, and proposes to establish new methods.

Impact of neoadjuvant chemotherapy on surgical and pathological results of gastric cancer patients: A case‐control study

“…The cT and cN status was defined by clinical assessment with computerized tomography by an experienced radiologist. Lymph nodes more than 10 mm in the smallest axis were considered metastatic 15,16 . The T assessment was defined in accordance with the 8th edition of the UICC Staging System 17,18…”

“…Lymph nodes more than 10 mm in the smallest axis were considered metastatic. 15,16 The T assessment was defined in accordance with the 8th edition of the UICC Staging System. 17,18 The type of gastrectomy and lymphadenectomy were defined based on the Japanese Gastric Cancer Association criteria, 19 Complications were categorized based on the Clavien-Dindo classification system and major complications were defined as Clavien >II.…”

Lymph Node Involvement in Advanced Gastric Cancer in the Era of Multimodal Treatment—Oncological and Surgical Perspective

“…Computed tomography (CT) is widely recognized as the primary method for staging and detecting distant metastases, determining surgical treatment [21]. Accuracy of preoperative cN staging is strongly dependent on cT stage and histological type of GC [22].…”

“…A German study showed that even 55% of cancerous-infiltrated LN remain smaller than 5 mm [26], which implies high possibility of false-negative and false-positive results. Limitations are related to poor visualisation of nodal engagement [21,27], nodal location dependency and sensitivity rate of 44.4% [22]. Moreover, in up to 30% of negative CT scans, endoscopic ultrasound (EUS) reveals nodal involvement [27,28].…”

“…According to Gertsen et al, restaging CT prevents only 1% of unnecessary laparotomies, although preoperative assessment was performed before completing NAC [29]. High volume centres present contrasting numbers with negative prognostic value (NPV) of LN involvement at a level of 90.1% among patients with early GC [21,30]. However, in advanced GC Kagedan et al estimated NPV of LN metastases at 43.3%, emphasizing the issue of cN understaging [31].…”