Comparison of preoperative Borrmann classification in advanced gastric carcinoma with double contrast-enhanced ultrasound and multi-detector row CT: correlation with surgical and histologic results

Abstract

Objective To compare the accuracy of double contrast-enhanced ultrasound (DCEUS) and multi-detector row CT (MDCT) in determining the Borrmann classification in advanced gastric carcinoma (AGC) preoperatively. Methods Two hundred and nine patients with AGC proved by endoscopic biopsy were included. DCEUS (intravenous microbubbles combined with oral contrast-enhanced ultrasound) and MDCT were performed preoperatively. The diagnostic accuracy of DCEUS and MDCT in determining Borrmann classification was calculated and compared. Additionally, intra- and inter- observer reliability of DCEUS and MDCT were assessed using Kappa analysis and a well reliability was set as Kappa value large than 0.75. Results The overall accuracy of DCEUS in determining the Borrmann classification of AGC was 87.9%, the accuracy of DCEUS in determining Borrmann Ⅰ, Ⅱ, Ⅲ and Ⅳ was 90.3%, 86.5%, 87.1% and 88.2%, respectively. The overall accuracy of MDCT in determining the Borrmann classification of AGC was 80.9%, the accuracy of MDCT in determining Borrmann Ⅰ, Ⅱ, Ⅲ and Ⅳ was 87.1%, 78.4%, 78.6% and 85.3%, respectively.There was no significant difference in accuracy between DCEUS and MDCT for Borrmann Ⅰ and Ⅳ classification of AGC (chi-square test, P=0.349 for Borramnn Ⅰ type, P=0.094 for Borrmann Ⅳ type). The accuracy of DCEUS for Borrmann Ⅱ and Ⅲ classification of AGC was higher than the accuracy of MDCT (chi-square test, P=0.000 for Borrmann Ⅱ type, P=0.000 for Borrmann Ⅲ type). The intra- and inter-observe reproducibility were both almost perfect for assessing the Borrmann classification of AGC with a Kappa value of 0.891(P=0.000) for intra-observer and 0.860(P=0.000) for inter-observer by DCEUS. The intra- and inter-observe reproducibility were both almost perfect for assessing the Borrmann classification of AGC with a Kappa value of 0.884 (P=0.000) for intra-observer and 0.852 (P=0.000) for inter-observer by MDCT. Conclusions DCEUS could be considered as a new, reliable and noninvasive method for preoperative the Borrmann classification in AGC. Key words: Ultrasonography; Microbubbles; Tomography, X-ray computed; Stomach neoplasms; Borrmann classification