Abstract
Diagnosing the absence or presence of peritoneal carcinomatosis in patients with gastric cancer, including its extent and distribution, is an essential step in patients’ therapeutic management. Such diagnosis still remains a radiological challenge. In this article, we review the strengths and weaknesses of the different imaging techniques for the diagnosis of peritoneal carcinomatosis of gastric origin as well as the techniques’ imaging features. We also discuss the assessment of response to treatment and present recommendations for the follow-up of patients with complete surgical resection according to the presence of risk factors of recurrence, as well as discussing future directions for imaging improvement.
Highlights
Lin et al recommended the combination of thoraco-abdomino-pelvic Computed Tomography (CT) with abdomino-pelvic Magnetic Resonance Imaging (MRI) for pre-operative assessment of peritoneal metastases (PM) due to higher inter-reader agreement, true positive rate, and smaller error in Peritoneal Cancer Index (PCI) evaluation when compared with CT alone [6]
Imaging is key in identifying lesions that can limit or contraindicate potential surgery, such as: (1) lesions associated with an increased risk of incomplete tumour resection by identification of concerning radiologic features (Table 1); attention should be paid to the three more frequent sites for unresectable lesions—the small bowel and its mesentery (Figure 13), the porta hepatic, and the pelvis [33]; (2) lesions that require surgical subspecialty expertise because of their anatomic site—for example, diffuse spread of the liver capsule or of the diaphragm (Figure 14), multifocal lesions of the mesentery, involvement of the pelvic sidewall and vascular spaces, and abdominal wall involvement; and (3) occult peritoneal metastases—for example, lesions not visible during laparoscopy located in the Morrison pouch or posterior surface of the liver (Figure 10)
Both MRI and positron emission tomography (PET)/CT have been shown to be useful in the preoperative staging of peritoneal metastases
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. With the emergence of possible treatment strategies for patients with peritoneal metastases (PM) of gastric origin, the role of imaging for the accurate staging of these patients is becoming increasingly important. Compared with PM from other types of cancer, such as colonic or ovarian cancers, gastric carcinomatosis has specific issues to overcome: (1) the translymphatic process of peritoneal metastases at early stage, with implants location into milky spots [1] in the greater omentum, mesenterium, and pelvic floor; (2) the infiltrative pattern with small size implants of the diffuse-type of gastric cancer (GC); and (3) the low FDG avidity of the mucinous and diffuse-type of gastric cancer. Assessment of response and follow-up recommendations after complete surgical resection, including the specific situation of patients with positive peritoneal washing cytology during the surgery without gross PM, are discussed
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