Role of Multidetector CT in Staging of Gastric Carcinoma

Abstract

Background: Radiology plays an essential role in the diagnosis, staging and surveillance of oncology patients. CT is the most sensitive imaging modality in the workup of these patients. Aim of the Study: The aim of this work is to detect the role of MDCT (multidetector computed tomography) in the preoperative investigation of gastric adenocarcinoma patients according to TNM staging. Patients and Methods: This is a prospective study enrolling 20 patients who had histologically proven adenocarcinoma based upon an upper gastrointestinal endoscopic biopsy for MDCT staging of gastric carcinoma during the period from June 2016 to June 2017. The MSCT data were correlated and compared with the histopathological results. The study was conducted in the Radiology Department of Assiut University Hospital using 64-MDCT (Toshiba Aquilion). Results: According to our study results, the sensitivity of determining T1 stage on CT scan can’t be detected as there was only 1 case pathologically proved T1 and overstaged as T2 by MSCT; however, accuracy and specificity are quite high, which was 95% and 100% respectively. For T2 stage tumors (25.0% of cases), accuracy is 95%, sensitivity—100%, and specificity—93.7%. According to our results the accuracy and sensitivity of T3 staging are 75% and 100%, while those of T4 stage were 75% and 44.4% respectively. Tumor was correctly staged in 14 of 20 patients (the valid T staging rate was 70.0%). Tumor was under-staged in 5 of 20 patients (25.0%) (staged as T3, but pathologically proven to be T4a). As regards N staging accuracy found results for N0 (62.5%), N2 (87.5%) and N3 (75%), while N1 accuracy recorded 37.5%. As regards the nodal staging sensitivity which had a range from (0% for N4) to (66% for N2) this wide range of sensitivity demonstrates the problem of CT in nodal staging. As regards sensitivity of M0, accuracy was 100% and 85% respectively. While that of M1 was (62.5%) and (85%) respectively. Conclusion: MSCT can be the first choice for the preoperative evaluation of patients with gastric carcinoma. It presents excellent accuracy in the staging of tumor invasion depth (T) and in the staging of metastatic neoplastic disease (M). Despite the good accuracy in the staging of patients without lymph node disease (N0), the method presents limitations in the staging of lymph node involvement.