Application value of multi-detector computed tomography examination in the preoperative assessment of adenocarcinoma of esophagogastric junction

Abstract

Objective To investigate the application value of multi-detector computed tomography (MDCT) examination in the preoperative assessment of adenocarcinoma of esophagogastric junction (AEG) . Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 91 AEG patients who were admitted to the Second Affiliated Hospital of Wenzhou Medical University between January 2011 and December 2015 were collected. All the patients received plain and enhanced scans of MDCT, and they underwent operation under the consent of patients and his family members after preoperative relevant examinations and then received postoperative pathological examination. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis up to December 2015. Observation indicators included: (1) imaging features of MDCT, (2) comparison between preoperative MDCT examination and postoperative pathological examination, (3) treatment and prognosis. Measurement data with normal distribution were represented as ±s. Consistency analysis between stage of MDCT examination and pathological stage was done using the chi-square test. Results (1) Imaging features of MDCT: MDCT findings in 91 AEG patients were heterogeneously thickened wall at esophagogastric junction and cauliflower-like local soft tissue mass, and enhanced scan findings were obviously heterogeneous enhancement, clear periphery fat gap and most of lymph nodes enlargement between liver and stomach. (2) Comparison between preoperative MDCT examination and postoperative pathological examination: preoperative MDCT examination in 91 AEG patients showed that invasion of the esophagus was found in 88 patients, with a infiltration length of (3.1±1.1)cm. Postoperative pathological examination in 91 AEG patients showed that invasion of the esophagus was found in 68 patients, with a infiltration length of (3.5±1.3)cm. The sensitivity, specificity and accuracy of invasion of the esophagus were respectively 95.6%, 85.0% and 92.0%, and these of invasion of the serosa were 96.8%, 84.2% and 95.5%, with a κ=0.9. Preoperative enhanced scans of MDCT of gastric wall showed that the single-layer structure was detected in 22 patients and multi-layer structure in 69 patients (double-layer structure in 34 patients and 3-layer structure in 35 patients). Detection rate of AEG through preoperative MDCT examination was 96.7%(88/91). One, 18, 53 and 16 patients was in T1, T2, T3 and T4 stages and 3 had false negative results. Postoperative pathological examination showed that 2, 17, 55 and 17 patients were in T1, T2, T3 and T4 stages. Accuracy of T stage through preoperative MDCT examination was 85.4%, with a κ=0.7. N0, N1, N2, and N3 stages were respectively detected in 25, 43, 18, 5 patients through preoperative enhanced scans of MDCT and in 29, 32, 22, 8 patients through postoperative pathological examination. Accuracy of N stage through preoperative MDCT examination was 58.0% and κ was 0.4. Preoperative Siewert type of 91 patients: Siewert type Ⅰ, Ⅱ and Ⅲ were detected in 5, 46 and 40 patients, respectively. Postoperative pathological examination: 4 and 87 patients were respectively in the early and advanced AEG by Borrmann type (4 in Borrmann type Ⅰ, 15 in Borrmann type Ⅱ, 54 in Borrmann type Ⅲ and 14 in Borrmann type Ⅳ). (3) Treatment and prognosis: of 91 AEG patients, 5 in Siewert type Ⅰ underwent the lower esophageal and proximal gastrectomy via chest wall approach, 46 in Siewert type Ⅱ underwent gastrectomy via transabdominal esophageal hiatus approach (28 using epigastric midline incision approach, 15 using left thoracic incision approach and 3 using thoracoabdominal incision approach), and 40 in Siewert type Ⅲ underwent transabdominal total gastrectomy. All the 91 patients were followed up for 5-6 months with a median time of 4 months. During the follow-up, there was no death, and lymph node metastases were respectively detected in 3 of 5 patients with Siewert type Ⅰ AEG, 6 of 46 patients with Siewert type Ⅱ AEG and 24 of 40 patients with Siewert type Ⅲ AEG. Conclusion Result of preoperative MDCT examination for AEG is highly consistent with postoperative pathological result, and MDCT examination can also improve the diagnostic rate of AEG and accuracy of T stage. Key words: Esophagogastric junction neoplasms, adenocarcinoma; Siewert classification; Multidetector computed tomography