Abstract
The aim of this study was to evaluate the accuracy of multiple detector computed tomography (MDCT) in the preoperative staging of gastric cancer, prospectively comparing CT findings with pathological findings at surgery, in a single-center study. A total of 19 consecutive patients with primary cancer recruited between March and July 2014 were submitted to preoperative MDCT staging according to a standard protocol. All diagnostic procedures were performed by dedicated radiologists who were unaware of the final pathological results. Subsequently, 16 patients underwent surgical treatment and 15 were finally included in the study. The primary tumor was detected at CT in all 15 cases. CT results for T staging were in agreement with pathological findings in 12 of 15 cases, with overall accuracy of 80%. Stage-specific sensibility was high for advanced stages (sensibility for T1, T3, and T4 resulted 60%, 85.7%, and 100%, respectively), while earlier stages showed higher specificity (specificity for T1, T3, and T4 resulted 100%, 75%, and 91.7%, respectively). Overall N staging accuracy was 86.7%, with 13 of 15 patients correctly staged. Stage-specific sensibility was 75% for N0 and 100% for N3, while specificity was 100% for N0 and lower for advanced stages. Accuracy for peritoneal involvement was 100%. Our findings show a good performance of the diagnostic protocol performed with MDCT tested in this study.
Highlights
The purpose of this study is to evaluate the diagnostic performance of contrast enhanced multiple detector CT (MDCT) in the exact TNM tumor staging before surgical treatment, compared with pathological staging after surgery
Wall thickening was more evident in advanced gastric cancers than in EGC
Overall accuracy in T staging was, in our study, 80%, in agreement with the results obtained by Kim et al (77% - 82%), even though stage-specific accuracy, sensibility and specificity were slightly different, probably because of the small number of the considered sample and as a result of the different composition of the two populations: in the Korean sample, EGC were almost 60%, while in our study they resulted around 30%
Summary
Despite a decline in the incidence of gastric cancer (GC), this tumor remains the third cause of cancer-related death in both sexes, the second if we only consider the digestive tract.In western world, the majority of GC cases are diagnosed in an advanced stage, when clinical evidence of the disease (anemia, weight loss, dysphagia, vomit) is already present [1].In areas like Italy, where GC’s incidence does not justify screening programs, the diagnosis of the tumor is mainly endoscopic: upper endoscopy enables tumor detection in most cases and allows biopsies for histological diagnosis [2].This diagnostic method is insufficient when it comes to the evaluation of tumor infiltration, lymph nodes involvement and distant metastases: contrast enhanced CT is still the gold standard for tumor staging, especially after the introduction of spiral technique and multiple detector technique [2].Other diagnostic methods may have higher sensitivity than CT in T staging: endoscopic ultrasound (EUS) shows high sensitivity for parietal invasion; it is more invasive and highly dependent from the operator’s experience. In areas like Italy, where GC’s incidence does not justify screening programs, the diagnosis of the tumor is mainly endoscopic: upper endoscopy enables tumor detection in most cases and allows biopsies for histological diagnosis [2]. This diagnostic method is insufficient when it comes to the evaluation of tumor infiltration, lymph nodes involvement and distant metastases: contrast enhanced CT is still the gold standard for tumor staging, especially after the introduction of spiral technique and multiple detector technique [2]. EUS role is limited to early gastric cancers, evaluated for conservative treatment [3] [4]
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