Gastric Adenocarcinoma: Is Computed Tomography (CT) Useful in Preoperative Staging?

Abstract

Background and purpose: Although multiple studies testing the accuracy of CT in the preoperative staging of gastric adenocarcinoma have been carried out, their results are controversial. Whilst some authors claim that CT is an accurate method for preoperatively staging gastric cancer, others have advocated the contrary. Because of this discrepancy we have retrospectively reviewed preoperative CT findings compared with histopathological results in patients with gastric adenocarcinoma.

Patients and methods: Seventy-two patients diagnosed with gastric cancer who underwent potentially curative surgery and preoperative staging CT of quality were included in the study. The size, gastric wall thickening, presence of lymphadenopathy, adjacent organ invasion and location of the gastric mass was recorded. Early tumors (T1 and T2) and more advanced tumors (T3 and T4) were grouped together. CT staging was correlated with the final histopathological stage (TNM). The global results were expressed as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).

Results: Seventy-two cases were included with fifty-five being male and a median age of 67 years (range 33-91). CT correctly identified the location of the tumor in 56 (53% antropyloric, 18% subcardial). Median time from CT scan to surgery was fourteen days (range 2-49). In T detection: T1/T2 and T3/T4 with sensitivity of 70% and 61%. Lymph node involvement: Sensitivity 49%. Overstaged in 47% Understaged in 75%. Specificity of 53%. Nine patients with colon-mesocolon (5 patients) and pancreas (4 patients) invasion. Sensitivity 44% and specificity 96%.

Conclusion: Spiral CT is not an accurate method in predicting preoperative stages in gastric cancer.

Keywords: computed tomography, (CT); gastric adenocarcinoma; preoperative staging.

Figure 1.

A 71-year-old man with antrum gastric cancer. A) Transverse axial contrast-enhanced CT image shows a wall thickening of the gastric antrum. B) Coronal reconstruction CT image shows irregularly wall thickening of the gastric antrum.

Figure 2.

A 57-year-old man with advanced gastric cancer. C) A transverse axial contrast-enhanced CT image shows several enlarged lymph nodes along the gastrohepatic ligament. This image shows gastrohepatic ligament lymphadenopathies. Their clinical significance was uncertain. These lymph nodes were pathologically proved to be metastatic lymph nodes. D) This coronal reconstruction shows several enlarged lymphadenopathies suggesting metastatic disease which was confirmed by pathological study.