Staging Of Gastric Adenocarcinoma Research Articles

Gastrectomies for the treatment of gastric cancer in a reference cancer center present better pathological results and survival compared to non-specialized hospitals.

Some studies have shown that gastrectomy performed by experienced surgeons in high-volume specialized hospitals with the possibility of complete treatment has better results. This study aimed to compare the results of patients who underwent surgery at a reference center with non-specialized centers. Patients with gastric adenocarcinoma stage as pTNM II and III who underwent curative gastrectomy and were referred for adjuvant chemotherapy between 2009 and 2018 were included. Patients were divided into two groups: patients operated on in a reference center with complete oncological treatment (Reference Group); and those operated on in an external Hospital and referred for adjuvant treatment at the reference center (External Group). A total of 643 patients were evaluated, 307 in the external group and 336 in the reference group. Patients in the external group were younger (58.9 vs. 62.6 years; p < 0.001) and with fewer comorbidities according to the Charlson-Deyo index (p < 0.001). The pathological result showed more dissected lymph nodes (41.4 vs. 23.5; p < 0.001) and a higher R0 resection rate (98.5% vs. 95.1%; p = 0.013) in the reference group. Patients of the external group underwent more adjuvant radiotherapy (49.5% vs. 33.9%; p < 0.001) with no difference concerning adjuvant chemotherapy (p = 0.066). Peritoneal recurrence was more common in the external group (63.2% vs 38.7%, p < 0.001). The disease-free survival rate was higher in the reference group (p < 0.001) as well as overall survival (p = 0.01). Patients who received full oncological treatment at a reference center had better survival outcomes compared to those operated in external services.

Histopathological Study of Gastric Adenocarcinoma with Special Reference to Expression of HER2/neu and Ki-67 Assessed by Immunohistochemistry

Abstract Introduction Gastric cancer has become the third leading cause of cancer deaths globally. It accounts for 5.7% of cancer around the world, with a rate of mortality around 8.2%. Evaluation of human epidermal growth factor receptor 2 (HER2)/neu overexpression for targeted therapies is presently the mainstay of treatment in gastric cancer. High Ki-67 index expression in gastric cancer is an indicator of poor prognosis. Objectives To study the prevalence of HER2/neu expression and Ki-67 index in various types, sites, grade, and stage of gastric adenocarcinoma and to determine the correlation between HER2/neu expression and Ki-67 index. Materials and Methods This is a prospective study in a tertiary care hospital, Kolkata from January 2019 to June 2020. Gastrectomy and endoscopic biopsy of gastric adenocarcinoma were studied for histopathology and immunohistochemistry (HER2/neu and Ki-67 index). Statistical analysis used: SPSS (version 21.0, IBM, Chicago, Illinois, United States) for windows software. Results Among 54 cases, most of them were intestinal type, antral, moderately differentiated, stage III cases. HER2 expression and high Ki-67 index were observed in 28.0 and 40.75% cases, respectively. Statistically significant correlation was found in both HER2 expression and high Ki-67 index with location of the tumor and pathological nodal (pN) stage. A positive correlation was found between HER2/neu score and Ki-67 index (p = 0.007) (correlation coefficient = 0.4). Conclusion A positive correlation was found between HER2/neu positivity and high Ki-67 index, both were associated with higher pathological tumor stage and pN stage. So, advanced cases may be considered for targeted therapy using trastuzumab.

Gastric Cancer Surgery in the US: a Contemporary Trend Analysis of Lymphadenectomy and the Impact of Minimally Invasive Approaches

BackgroundThe National Comprehensive Cancer Network guidelines recommend harvesting 16 or more lymph nodes for the adequate staging of gastric adenocarcinoma. This study examines the rate of adequate lymphadenectomy over recent years, its predictors, and its impact on overall survival(OS). Study designThe National Cancer Database was utilized to identify patients who underwent surgical treatment for gastric adenocarcinoma between 2006–2019. Trend analysis was performed for lymphadenectomy rates during the study period. Logistic regression, Kaplan-Meier survival plots, and Cox proportional hazard regression were utilized. ResultsA total of 57,039 patients who underwent surgical treatment for gastric adenocarcinoma were identified. Only 50.5% of the patients underwent a lymphadenectomy of ≥ 16 nodes. Trend analysis showed that this rate significantly improved over the years, from 35.1% in 2006 to 63.3% in 2019 (p < .0001). The main independent predictors of adequate lymphadenectomy included high-volume facility with ≥ 31 gastrectomies/year (OR: 2.71; 95%CI:2.46–2.99), surgery between 2015–2019 (OR: 1.68; 95%CI: 1.60–1.75), and preoperative chemotherapy (OR:1.49; 95%CI:1.41–1.58). Patients with adequate lymphadenectomy had better OS than patients who did not: median survival: 59 versus 43 months (Log-Rank: p < .0001). Adequate lymphadenectomy was independently associated with improved OS (HR:0.79; 95%CI:0.77–0.81). Laparoscopic and robotic gastrectomies were independently associated with adequate lymphadenectomy compared to open, OR: 1.11, 95%CI:1.05–1.18 and OR: 1.24, 95%CI:1.13–1.35, respectively. ConclusionAlthough the rate of adequate lymphadenectomy improved over the study period, a large number of patients still lacked adequate lymph node dissection, negatively impacting their OS despite multimodality therapy. Laparoscopic and robotic surgeries were associated with a significantly higher rate of lymphadenectomy ≥ 16 nodes.

Staging I in a Gastric Adenocarcinoma Cohort Description of Clinical, Imaging and Pathological Findings

Background: Gastric cancer was the fourth cause of cancer-related deaths in 2020 in the world. The aim of this study was to describe the characteristics of patients with gastric adenocarcinoma Stage I describing clinical, pathological, and neoadjuvant staging in a prospective cohort at A.C. Camargo Cancer Center (ACCCC). Methods: Sixty-three patients with Stage I gastric adenocarcinoma treated at ACCCC were evaluated for clinical, pathological, and clinical Stages. For the comparison between the clinical staging and the post-treatment one (surgical and neoadjuvant): tumor (T) and lymph nodes (N) were evaluated. Results: Of the 63 patients, 29/63 (46%) were clinical Stage I, and 34/63 (54%) were initially staged as clinical Stage II and III that migrated to Stage I after surgical and neoadjuvant treatment. As for the clinical aspects, 36/63 patients (57%) were men with an average age of 58.7 years, 63% patients were Caucasian and 83% (52) had private medical insurance. In the endoscopic reports, 68.3% (n=43) of the lesions were ulcerated and the histological type, 55.6% (n=35) were diffuse. Patients treated with neoadjuvant therapy had a 100% reduction of tumors T3/T4 to T1/T2 (p&lt;0.001) and 78.5% of the regional lymph nodes, N+ to N0. (p=0.001). Conclusion: The neoadjuvant therapy on patients with gastric adenocarcinoma led to significant tumor (T) and regional lymph nodes (N) regressions, thus, increasing the migration of cases from T3/T4 to T1 /T2 and N+ to N0 in this cohort.

Back pain as an initial feature of advanced gastric cancer mimicking multiple myeloma: A case report and literature review.

Back pain is a rare initial presentation of gastric cancer. Isolated back pain with red flags in middle-aged patients might indicate multiple myeloma. However, it is rarely present in advanced gastric adenocarcinoma; hence, data are limited to case reports only. For a timely diagnosis of the underlying malignancy, endoscopy should be considered if the initial workup for this backache is unrevealing. We present a 34-year-old previously healthy gentleman with severe unremitting backache. He was ultimately diagnosed with gastric adenocarcinoma stage IV and received palliative treatment. The manuscript also reviewed relevant literature. In rare cases, gastric malignancy can initially present as back pain with lytic bone lesions, mimicking multiple myeloma. Endoscopy early in the course of investigations may help reduce associated morbidities. Further, more extensive studies are required to understand better the clinical characteristics, demographics, and management of such patients.

Diagnostic laparoscopy is underutilized in the staging of gastric adenocarcinoma regardless of hospital type: An US safety net collaborative analysis.

Diagnostic laparoscopy (DL) is a key component of staging for locally advanced gastric adenocarcinoma (GA). We hypothesized that utilization of DL varied between safety net (SNH) and affiliated tertiary referral centers (TRCs). Patients diagnosed with primary GA eligible for DL were identified from the US Safety Net Collaborative database (2012-2014). Clinicopathologic factors were analyzed for association with use of DL and findings on DL. Overall survival (OS) was analyzed by Kaplan-Meier method. Among 233 eligible patients, 69 (30%) received DL, of which 24 (35%) were positive for metastatic disease. Forty percent of eligible SNH patients underwent DL compared to 21.5% at TRCs. Lack of insurance was significantly associated with decreased use of DL (OR 0.48,p < 0.01), while African American (OR 6.87,p = 0.02) and Asian race (OR 3.12,p ≤ 0.01), signet ring cells on biopsy (OR 3.14,p < 0.01), and distal tumors (OR 1.62,p < 0.01) were associated with increased use. Median OS of patients with a negative DL was better than those without DL or a positive DL (not reached vs. 32 vs. 12 months, p < 0.005, Figure 1). Results from DL are a strong predictor of OS in GA; however, the procedure is underutilized. Patients from racial minority groups were more likely to undergo DL, which likely accounts for higher DL rates amongSNH patients.

Monocyte Chemiluminescence Traits in Gastric Cancer

Aim. A study of monocyte chemiluminescent activity at variant stages of gastric cancer.Materials and methods. The study enrolled 90 gastric cancer patients and 70 healthy donors. Spontaneous and induced chemiluminescence in monocytes was assessed for 90 min with a “BLM 3607” 36-channel chemiluminescence analyser (Russia). Opsonized zymosan-induced chemiluminescence enhancement was measured as a ratio of the areas under the induced vs. spontaneous chemiluminescence curves, the activation index. Statistical significance was estimated with the Mann—Whitney criterion (p &lt; 0.05).Results. The maximal spontaneous monocyte chemiluminescence intensity significantly decreased in stage IV gastric cancer patients compared to the control cohort (p = 0.035). Time to maximum in spontaneous chemiluminescence increased in all gastric cancer patients vs. control (p = 0.001), and in stage IV gastric cancer vs. stage I patients (p = 0.043). The areas under a curve in spontaneous and induced monocyte chemiluminescence increased in all gastric cancer patients vs. control (p = 0.001), and in stage IV gastric cancer vs. stage I patients (p = 0.037). The activation index was higher in all gastric cancer cases compared to control (p = 0.001).Conclusion. All patients with gastric adenocarcinoma, irrespective of the stage, revealed changes in the monocyte chemiluminescence activity, i.e. a longer time to maximum in spontaneous chemiluminescence and larger area under the curve of spontaneous and induced chemiluminescence, the activation index. Maximal monocyte spontaneous chemiluminescence intensity diminished in stage IV gastric cancer compared to the control cohort. Immune activity reflected in monocyte chemiluminescence correlates with the stage of gastric adenocarcinoma.

LINC02688 and PP7080 as novel biomarkers in early diagnosis of gastric cancer.

Despite considerable progress in gastric cancer screening, prevention, and treatment, it remains a major cause of morbidity and mortality worldwide. Due to late diagnosis of the disease, early potential diagnostic biomarkers are needed. Accumulating evidence indicates that non-coding RNAs have potential applications as diagnostic and prognostic biomarkers in gastric cancer. Herein, we investigated the expression levels of two novel non-coding RNAs, long intergenic non-protein coding RNA 2688 (LINC02688) and LOC25845 (PP7080) by real-time PCR for the first time in 47 gastric cancer patients. We found significant downregulation of LINC02688 and LOC25845 (PP7080) with 3.44 and 2.2-fold decrease, respectively in tumoral tissues in comparison with their adjacent non-tumoral counterparts (P < 0.0001). Our data also indicates that more than 96% and 88% of patients showed unchanged or decreased expression of LINC02688 and LOC25845 (PP7080), respectively. As most gastric cancer patients showed lower expression of these two lncRNAs, no significant association between clinicopathological features of the patients and the level of LINC02688 and LOC25845 (PP7080) expression could be detected. Furthermore, ROC curve analysis indicated that LINC02688 and PP7080 can serve as good predictive biomarkers for distinguishing tumoral tissues from their adjacent non-tumoral counterparts. Taken together, our findings suggested that these two novel tumor suppressor non-coding RNAs may act as novel diagnostic biomarkers for diagnosis of carcinogenesis event even at earlier stages of gastric adenocarcinoma.

The Significance of HOXC11 and LSH in Survival Prediction in Gastric Adenocarcinoma.

PurposeGastric adenocarcinoma is one of the most important causes of cancer death and lacks effective treatment. Eighty-four gastric adenocarcinoma tissue samples along with the clinical information were collected. After analyzing the expression of HOXC11 and LSH in the gastric adenocarcinoma tissues, we explored the prognosis of patients and its correlation with clinical characteristics. Both HOXC11 and LSH were over-expressed in MKN-45 cell lines to verify the effect of high expression of HOXC11 and LSH on GAC.MethodsThe expression of HOXC11 and LSH in 84 cases with gastric adenocarcinoma (GAC) was detected via immunohistochemistry, including 17 cases in stage I, 7 cases in stage II, 27 cases in stage III and 33 cases in stage IV. The expression levels of HOXC11 and LSH, and the clinicopathological characteristics of the samples, were also studied. Cell proliferation, migration, cell cycle and apoptosis assays were utilized for demonstrating malignancy of HOXC11 and LSH over-expressed cells.ResultsAmong 84 GAC pathological samples, 12 high HOXC11 expression, and 72 showed low expression; 54.8% (46/84) high LSH expression, and 45.2% (38/84) exhibited low expression. Survival analysis of the Kaplan-Meier plotter gastric cancer datasets showed that subjects with low expression of HOXC11 and LSH had a longer survival time, with a median survival time of 40.2 and 36.4 months, while the subjects with high HOXC11 and LSH expression were only 20.5 and 10 months, respectively. Meanwhile, HOXC11 and LSH over-expressed cells showed a stronger proliferous and migratory ability, and a sped up cell cycle.ConclusionThe high expression level of HOXC11 and LSH both manifested the poor survival prognosis of GAC patients, and more pronounced malignant phenotype in GAC cells indicated that HOXC11 and LSH can be a strong predictive factor of inferior disease-free survival. From this, we can consider that HOXC11 and LSH both have significant status in GAC stage and survival prediction.

1225 Gastric Adenocarcinoma Incidence and Incidence-Based Mortality: A Population-Based Study of 62,863 Cases From the Surveillance, Epidemiology and End Results (SEER) Program Over Last Four Decades

INTRODUCTION: Gastric cancer (GC) is the third deadliest cancer worldwide therefore tracking its morbidity and mortality trends is necessary to identify the most susceptible population groups, and develop targeted clinical management strategies. METHODS: We searched the SEER 9 databases to investigate the incidence and incidence-based mortality (IBM) rates of gastric adenocarcinoma (GAC) from 1973 to 2015 according to patients' gender, age, race, state of residence, and GAC stage. We analyzed the annual percent change (APC) of the incidence and IBM of GAC via Joinpoint® regression software. RESULTS: We analyzed 62,863 GAC cases. GAC incidence and IBM rates decreased by 1.66% and 1.53% (P &lt; 0.001) annually, respectively (Table 1). Incidence rates were highest among males, African Americans, and patients aged 65 years or more, whereas the IBM rates were the highest among males, American Indians, Alaska Natives, Asians and Pacific Islanders and patients aged 65 years or older. GAC incidence in stomach cardia increased by 0.66% annually, while GAC incidence in the antrum and lesser curvature decreased by 1.77% and 3.04% annually, respectively. Likewise, GAC IBM in stomach cardia increased by 0.52%, while GAC IBM in antrum and lesser curvature decreased by 1.4% and 2.2% annually, respectively. Geographically, the incidence and IBM rates of GAC decreased in all states over the study period. Notably, Hawaii (HI) had the highest incidence and IBM rates (Table 2). Also, we found that cardia GAC was the most prevalent sub-type in all states except HI, where antrum GAC was the highest. CONCLUSION: Despite an overall decrease in GAC incidence and IBM, there is an increase in cardia GAC, which may be secondary to rise in obesity and alcohol consumption along with decrease in H. pylori prevalence. The incidence rate of GAC is higher in HI, Michigan and Connecticut, which is in concordance with the published data from State Cancer Profiles between 2011-2015. We could not evaluate the underlying risk factor for each state due to study's nature; however, the higher incidence rates in HI may be attributed to genetic environmental interactions, as supported by migrant studies. In conclusion, we were able to outline trends in incidence and IBM of GAC in USA over last four decades, which suggest a need for tailoring treatment and preventive strategies to fit each state population.

Intracholecystic papillary-tubular neoplasm in a patient with choledochal cyst and anomalous pancreaticobiliary junction: case report

A 75-year-old female incidentally presented with an enhancing intraluminal gallbladder mass, main bile duct dilatation and anomalous pancreaticobiliary junction (APBJ) during the staging of gastric adenocarcinoma. Histopathological analysis confirmed the diagnosis of intracholecystic papillary-tubular neoplasm. Intracholecystic papillary-tubular neoplasms (ICPN) of the gallbladder are rare gallbladder neoplasms, defined as intramucosal, preinvasive, exophytic, mass forming lesions. An association between choledochal cysts and anomalous pancreaticobiliary junction with gallbladder neoplasms is well known, and this case potentially illustrates gallbladder carcinogenesis related to these biliary anomalies.

Using recursive partitioning approach to select tumor-associated antigens in immunodiagnosis of gastric adenocarcinoma.

The present study aimed to select anti‐tumor‐associated antigen (TAA) autoantibodies as biomarkers in the immunodiagnosis of gastric adenocarcinoma (GAC) by the recursive partitioning approach (RPA) and further construct and evaluate a predictive model. A case‐control study was designed including 407 GAC patients as the case group and 407 normal controls. In addition, 67 serial serum samples from 25 GAC patients were collected at different time points before and after gastrectomy treatment. Autoantibodies against 14 TAA were measured in sera from all subjects by enzyme immunoassay. Finally, RPA resulted in the selection of nine‐panel TAA (c‐Myc, p16, HSPD1, PTEN, p53, NPM1, ENO1, p62, HCC1.4) from all detected TAA in the case‐control study; the classification tree based on this nine‐TAA panel had area under curve (AUC) of 0.857, sensitivity of 71.5% and specificity of 71.3%; The optimal panel also can identify GAC patients at an early stage from normal individuals, with AUC of 0.737, sensitivity of 64.9% and specificity of 70.5%. However, frequencies of the nine autoantibodies showed no correlation with GAC stage, tumor size, lymphatic metastasis or differentiation. GAC patients positive for more than two autoantibodies in the nine‐TAA panel had a worse prognosis than that of the GAC patients positive for no or one antibody. Titers of 10 autoantibodies in serial serum samples were significantly higher in GAC patients after surgical resection than before. In conclusion, this study showed that the panel of nine multiple TAAs could enhance the detection of anti‐TAA antibodies in GAC, and may be potential prognostic biomarkers in GAC.

MicroRNA-21 induces loss of 15-hydroxyprostaglandin dehydrogenase in early gastric tubular adenocarcinoma

15-hydroxyprostaglandin dehydrogenase (15-PGDH), the rate-limiting enzyme in prostaglandin E2 degradation, is decreased in gastric cancers and microRNA (miR)-21 is one of the regulators. We investigated the expression and regulation of 15-PGDH in eary gastric carcinogenesis utilizing endoscopic submucosal dissection (ESD) and gastric cancer cell lines. Expression of 15-PGDH and cyclooxygenase-2 as well as the promoter methylation of 15-PGDH were evaluted. CRISPR, miR-21 transfection, proliferation and apoptosis assays were also done. We observed significant decreases in 15-PGDH expression but no promoter methylation was detected in any ESDs. 15-PGDH suppression by CRISPR induced enhanced growth kinetics. miR-21, which was detected in high level in gastric tumors from the TGCA data, caused increased proliferation, decreased apoptosis. miR-21 overexpression was confirmed with CISH and RT-PCR in the ESDs. Loss of 15-PGDH occurs at the very early stage of gastric adenocarcinoma by miR-21. H. pylori infection may affect miR-21 up regulation. Maintaining 15-PGDH enzyme activity could be a new strategic measure in preventing gastric cancer especially tubular adenocarcinoma.

Computed tomography scan efficacy in staging gastric linitis plastica lesion: a retrospective multicentric French study.

BackgroundComputed tomography (CT) scan is a key imaging technique in the staging of gastric adenocarcinoma and therapeutic management of patients. The aim of this study was to evaluate the performance of CT scan in the staging of parietal and metastatic invasion in gastric linitis plastica group.MethodsA retrospective multicentric French study was conducted from January 2006 to December 2015 on patients with no metastatic gastric linitis plastica and operated by gastrec-tomy. A 2/1 matching based on pTNM stage and center was performed.ResultsFifty patients were included in the linitis plastica group and 100 in the control group. Patients from the linitis group were significantly different from those from the control group with a lower age at diagnosis, a more advanced histological lesion, a more frequent undiagnosed peritoneal carcinomatosis, and a higher risk of R1 resection. Sensitivity and specificity of CT scan for the diagnosis of lymph node involvement were 44% and 75%, respectively, in the linitis plastica group and 55% and 60%, respectively, in the control group. The sensitivity and specificity of CT scan for the T3–T4 parietal invasion were 26% and 100%, respectively, in the linitis group and 40% and 72%, respectively, in the control group.ConclusionCT scan has an equal sensitivity and specificity for the evaluation of lymph node and parietal involvement in gastric adenocarcinoma, including linitis plastica. CT scan remains the cornerstone of preoperative evaluation in gastric adenocarcinoma, including linitis plastica. However, CT presents a lack of sensitivity to diagnose low-volume peritoneal carcinomatosis.

Expression of CD44v3, erythropoietin and VEGF-C in gastric adenocarcinomas: correlations with clinicopathological features.

To investigate the expression of CD44v3 and vascular endothelial growth factor C (VEGF-C) in gastric adenocarcinoma and the correlation with erythropoietin (EPO) and clinicopathological features. The expression of CD44v3, VEGF-C and EPO was evaluated by immunohistochemical staining in 169 gastric adenocarcinomas. The correlations between these parameters and patients' clinicopathological features were analyzed statistically. CD44v3 and VEGF-C were positive in 50 (29.6%) and 82 (48.5%) patients, respectively. High CD44v3 expression was associated with poor cellular differentiation, extensive lymph node metastasis and advanced stage of gastric adenocarcinoma (P <0.05). High VEGF-C expression was significantly correlated with Lauren type, extensive lymph node metastasis and advanced stage of gastric adenocarcinoma (P <0.05). Univariate analysis of survival demonstrated that patients with a strong CD44v3 immunoreaction had a significantly worse overall survival compared with patients showing a weak CD44v3 immunoreaction (log-rank test: P = 0.0449). The mean survival time of patients with low CD44v3 expression was 30.6 months, which was much longer than the 21.6 months in patients with high expression. In addition, a strong association between immunohistochemical expression of CD44v3 and EPO was noted. Increased expression of CD44v3 and VEGF-C may play a significant role in the carcinogenesis and progression of gastric adenocarcinoma. High CD44v3 expression may be a predictor of poor prognosis in gastric adenocarcinoma patients. We infer that some mechanisms may exist in regulating the expression of CD44v3 and EPO.

Computed tomography with a stomach protocol and virtual gastroscopy in the staging of gastric cancer: an initial experience.

ObjectiveTo evaluate the accuracy of multidetector computed tomography with a stomach protocol in staging of gastric cancer.Materials and MethodsWe evaluated 14 patients who underwent computed tomography in a 16-channel scanner for preoperative staging of gastric adenocarcinoma between September 2015 and December 2016. All images were analyzed by the same radiologist, who had extensive experience in abdominal cancer imaging. The sensitivity, specificity, and accuracy of the method were calculated by comparing it with the pathology result. All patients underwent partial or total gastrectomy.ResultsThe mean age was 61.5 years, and 53.8% of the patients were male. The gastric lesions were classified as T1/T2 in 35.7% of the cases, as T3 in 28.5%, and as T4 in 35.7%. Eleven patients (68.7%) had suspicious (N positive) lymph nodes. The accuracy of the T1/T2, T3, T4, and lymph node staging tests was 85%, 78%, 90%, and 78%, respectively. The respective sensitivity and specificity values were 71% and 100% for T1/T2, 66% and 81% for T3, 100% and 90% for T4, and 88% and 60% for lymph nodes.ConclusionMultidetector computed tomography with a stomach protocol, used in conjunction with virtual gastroscopy, shows good accuracy in the tumor and lymph node staging of gastric adenocarcinoma.

CT/MRI accuracy in detecting and determining preoperative stage of gastric adenocarcinoma in Albania.

Aim of the studyGastric adenocarcinoma is among most frequent among cancers in Albania. Early detection and staging is helped by imaging methods, including CT and MRI. This study provides evidence on the CT and MRI accuracy in detecting and pre-operative staging of gastric adenocarcinoma in 62 patients in a diagnostic clinic in Albania. The correct staging of the gastric adenocarcinoma helps decide on the next treatment options.Material and methodsSixty-two patients with gastric adenocarcinoma, confirmed with biopsy, underwent both CT and MRI examination at a clinic in Tirana during same week. Images were reviewed to determine the TNM classifications and staging using the current AJCC guidelines. Data on age, sex, cancer location and differentiation were also collected and analyzed. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value was estimated for both CT and MRI.Results and conclusionsCT has a higher accuracy than MRI (83% vs. 67%) for T1. Accuracy for T2 was the same (74%). Starting with T3 and upwards, MRI has a slightly more accurate ability to detect and stage the gastric adenocarcinoma (T3: 81 vs. 75; T4: 83 vs. 64). Both the CT and MRI abilities to accurately detect the N classification were the same. Regarding the M classification, the MRI has a slightly more accurate ability to detect metastases (M: 83 vs. 64). Clinicians might benefit from using CT whenever suspect gastric adenocarcinoma patients present first. Decision on surgery requires a MRI to rule out metastases.

The value of FDG-PET in the staging of gastric adenocarcinoma: A single institution retrospective review.

The value of FDG-PET in the staging of gastric adenocarcinoma (GA) has been subject to debate. We performed a retrospective review of GA patients between 2006 and 2014 and identified those who had a CT and FDG-PET before initiating treatment. CT and FDG-PET images were analyzed by a blinded body radiologist and nuclear physician, respectively. Disease stage was assessed, looking at primary tumor (PT), locoregional (LLN) and distant lymph node disease (DLN), and metastasis (M). We identified 608 patients who had biopsy-proven GA and 207 (34.0%) had a CT and FDG-PET as part of their staging work-up. Of these, imaging from 166 (27.3%) patients was available for review. CT identified PT, LLN, DLN, and M in 120 (72.3%), 84 (50.6%), 25 (15.1%), and 32 (19.3%) patients, respectively; while FDG-PET identified PT, LLN, DLN, and M in 125 (75.3%), 78 (47.0%), 41 (24.7%), and 27 (16.3%) of patients, respectively. FDG-PET up-staged 31 (18.7%) patients while it down-staged 17 (10.2%) patients. Of patients who were up-staged, 20 (64.5%) developed progressive disease. Our findings support the use of FDG-PET as a valuable adjunct to CT in the staging of GA, as it changed the stage in 48 (28.9%) patients. J. Surg. Oncol. 2016;113:640-646. © 2016 Wiley Periodicals, Inc.

Correlation between preoperative endoscopic ultrasound and surgical pathology staging of gastric adenocarcinoma: A single institution retrospective review.

Recent evidence validates the effectiveness of neoadjuvant chemotherapy in the treatment of gastric adenocarcinoma. Endoscopic ultrasonographic (EUS) staging has been proposed as a useful adjunct in this setting. We performed a retrospective review of patients treated at our institution for gastric adenocarcinoma between July 2005 and January 2014. We identified patients referred for EUS before surgery as part of a prospective treatment plan. Histopathologic staging was compared to EUS staging, with a focus on T- and N-stage. Agreement between the two modalities was examined using kappa-statistics. We identified 614 patients with biopsy-proven gastric adenocarcinoma; 145 underwent curative-intent surgery. Surgical pathology and EUS results were available from 69 patients. The accuracy of EUS for the evaluation of T- and N-stage was 44.9% and 56.5%, respectively. EUS demonstrated greater concordance with histopathology at evaluating T-stage (κ = 0.3469) than N-stage (κ = 0.1316). EUS underestimated T- and N-stage in 40.8% and 30.4% of patients, respectively. EUS seems to correlate poorly with pathology in the preoperative staging of gastric adenocarcinoma. In the majority of inaccurate cases, EUS underestimates T-stage and N-stage, limiting its utility in the neoadjuvant setting.

MDCT in the preoperative staging of gastric adenocarcinoma.

. Multiple studies have also been developed to evaluate theaccuracy of gastric adenocarcinoma staging by means of the dif-ferent imaging modalities. The role of pelvic and abdominalmultidetector-row CT in the investigation of the digestive systemhas been discussed in several studies recently published in theBrazilian literature