Korean J Gastroenterol.  2017 Jul;70(1):21-26. 10.4166/kjg.2017.70.1.21.

The Value of Computed Tomography in Preoperative N Staging of Early Gastric Cancer Meeting the Endoscopic Resection Criteria

• Kim SJ
• Kim TU
• Choi CW
• Kang DH
• Kim HW
• Park SB
• Nam HS
• Ryu DG

• KMID: 2390780
• DOI: http://doi.org/10.4166/kjg.2017.70.1.21

Abstract

BACKGROUND/AIMS
This study evaluated the value of abdominal computed tomography (CT) in preoperative N staging of early gastric cancers (EGCs) within standard and expanded indications of endoscopic resection (ER) and investigated the factors affecting accuracy.
METHODS
Between March 2009 and March 2016, a total of 268 patients with EGC within the standard and expanded indications of ER underwent preoperative abdominal CT and surgical gastrectomy with lymph node (LN) dissection. Preoperative N staging of CT was compared with the pathologic result.
RESULTS
The accuracy of N staging for EGCs within the standard and expanded indications was 86.1% (235/268). There was no LN metastasis in patients with cN1 in CT staging. LN metastasis was found in 7 patients with EGCs that met the expanded ER indication and cN0 in CT staging. According to the univariate analysis, ulcers, including scars, were associated with the false positive of lymph node metastasis in abdominal CT (odds ratio 3.56; 95% confidence interval 1.56-8.15).
CONCLUSIONS
The present study suggests that the value of abdominal CT is limited for nodal staging of EGCs that meet the ER indication.

Keyword

Gastric cancer; Multidetector computed tomography; Lymphatic metastasis

MeSH Terms

Cicatrix
Gastrectomy
Humans
Lymph Nodes
Lymphatic Metastasis
Multidetector Computed Tomography
Neoplasm Metastasis
Stomach Neoplasms*
Tomography, X-Ray Computed
Ulcer

Figure

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  Fig. 1. Early gastric cancer (well differentiated adenocarcinoma, depth of invasion limited to the lamina propria, size 0.4×0.2 cm) with no lymph node involvement (32 regional lymph nodes). (A) Conventional endoscopy shows a flat and elevated lesion with erosion on the surface. (B) Computed tomography shows a lymph node enlargement (4.0×2.3 cm) on the left gastric area.

• 

  Fig. 2. Early gastric cancer (mixed histology consisted of 70% moderately differentiated and 30% poorly differentiated adenocarcinoma, depth of invasion limited to the mucosa, size 2.5×1.7 cm) with lymph node involvement (metastasis to 1 out of 22 regional lymph nodes). (A) Conventional endoscopy shows a depressed scar lesion with irregular surface. (B) Computed tomography shows no perigastric lymph node enlargement.

Reference

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