Spiral computed tomography and operative staging of gastric carcinoma: a comparison with histopathological staging

Abstract

Background-Much controversy exists as to the value of computed tomography (CT) in the preoperative staging of gastric cancer, because of its limited ability to identify correctly lymph node (LN) metastases, invasion of adjacent organs, or hepatic and peritoneal metastases. Spiral CT scanners have a number of potential advantages over conventional scanners, including the absence of respiratory misregistration, image reconstruction smaller than scan collimation permitting overlapping slices and optimisation of intravenous contrast enhancement. Aim-To compare the performance of spiral CT and operative assessment against formal (TNM) pathological staging. Patients and methods-A study of 105 consecutive patients who underwent both spiral CT and operative staging was performed. All CT scans were reviewed by a radiologist who commented on tumour location and size, evidence of adjacent organ invasion, lymph node metastases to both N1 and N2 nodes, and evidence of hepatic and peritoneal metastases. All patients underwent careful operative assessment at the time of surgery, along the lines suggested by Rohde and colleagues. Results-Spiral CT remained poor at identifying LN metastases to both N1 and N2 lymph nodes, with sensitivity ranging from 24 to 43%; specificity, however, was 100%. Operative staging was superior, with sensitivities between 84 and 94%, but specificity was much lower (63-74%). Spiral CT correctly detected 13 of 17 cases of invasion of either the colon or the mesocolon (sensitivity 76%) compared with 16 of 17 cases at operative staging (sensitivity 94%). Spiral CT correctly identified three of six cases with invasion of the pancreas (sensitivity 50%) compared with six of six cases on operative staging (sensitivity 100%). Spiral CT correctly identified 12 of 17 cases of peritoneal metastases (sensitivity 71%) and four of seven cases of hepatic metastases (sensitivity 57%). Conclusion-Whilst spiral CT remains poor at identifying lymph node metastases, it correctly identified most cases with invasion of either the colon or the mesocolon and half the cases of pancreatic invasion. It was of value in detecting peritoneal metastases and some cases with hepatic metastases. At present, at Leeds General Infirmary spiral CT is performed routinely on all patients with gastric cancer and a selective staging laparoscopy policy is adopted in those patients in whom the status of the peritoneal cavity and liver is in doubt.

Predictors and survival of synchronous peritoneal carcinomatosis of colorectal origin: A population‐based study

“…In the remaining patients, the abdominal cavity was usually screened for peritoneal carcinomatosis by various imaging modalities such as CT scanning, but these studies are all known for their moderate 60-79% sensitivity in diagnosing peritoneal carcinomatosis. [16][17][18][19] Indeed, patients older than 80 years exhibited a smaller risk of presenting with peritoneal carcinomatosis. However, this does not explain the significant higher risk of presenting with peritoneal carcinomatosis at a younger age, especially younger than 60 years, for which we do not have a straightforward explanation.…”

“…Liver metastases only 8 (7-9) 12 (11)(12)(13)(14) Lung metastases only 22 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) 20 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) Other distant metastases at a single location Other distant metastases at multiple locations 7 (6-8) 8 (7)(8)(9)(10) Abbreviation: CI, confidence interval.…”

Prospective Comparative Study Between Cect Staging and Surgical Staging in Carcinoma of Stomach With Particular Reference to Pancreatic, Colonic Invasion and Secondaries in Liver

“…Much controversies as to efficacy of CECT in the preoperative evaluation of carcinoma of stomach exist because of its limited ability to identify correctly invasion of adjacent organs, lymph node metastases and metastases to liver and peritoneum. 6 This study was designed to assess the dependability of CECT in preoperative staging of carcinoma of stomach.…”

Multidetector Computerized Tomography -- Is It Indispensable In Management of Gastric Carcinoma?

“…2 Patients with advanced gastric cancer (AGC) have a 5-year survival rate of 7%-27%, whereas those with early gastric cancer (EGC) have a 5-year survival rate of 85%-100% 3,4,5,6 . A wide arena of therapeutic options is in practice, from endoscopic mucosal resection for selected mucosal cancers to more radical treatments for advanced cancers.…”