Diagnostic value of clinical T staging assessed by endoscopy and stomach protocol computed tomography in gastric cancer: the experience of a low-volume institute

Abstract

Purpose: Clinical staging of gastric cancer appears to be important more and more for tailored therapy. This study aimed to verify the accuracy of clinical T staging in a low-volume institute.

Materials and methods: We retrospectively reviewed prospectively collected data of gastric cancer patients who underwent resection. A total of 268 patients of gastric cancer were enrolled from March 2004 to June 2012. These demographics, tumor characteristics, and clinical stages were analyzed for identification of diagnostic value of clinical T staging.

Results: The predictive values for pT1 of endoscopy and computed tomography were 90.0% and 89.4%, respectively. In detail, the predictive values of endoscopy for pT1a, pT1b, and pT2 or more were 87%, 58.5%, and 90.6%, respectively. The predictive values of computed tomography for pT1a, pT1b, and pT2 or more were 68.8%, 73.9%, and 84.4%, respectively. The factors leading to underestimation of pT2 or more lesions by gastroscopy were the middle third location, the size greater than 2 cm, and younger age. Those for overestimation of pT1 lesion by computed tomography were male, age more than 70 years, elevated type, and size greater than 3 cm.

Conclusions: Diagnostic accuracy of early gastric cancer was 90%, which is comparable to those of high volume center. In patients with early gastric cancer, limited gastrectomy or minimal invasive surgery can be safely introduced at a low volume center also. However, the surgeon of low-volume institute should consider the accuracy of clinical staging before extending the indication of limited treatment.

Keywords: Gastroscopy; Neoplasm staging; Stomach neoplasms; Technology, radiologic.

Fig. 1

Clinical T staging using gastroscopy. (A) A superficial spreading lesion with shallow and even depression corresponding to 'mucosa lesion'. (B) A deep ulceration with marked marginal elevation and abnormal converging folds corresponding to 'submucosa lesion'. (C) A ulcerative lesion surrounded by dam formation corresponding to 'advanced gastric cancer'.

Fig. 2

Clinical T staging using stomach protocol computed tomography. (A) Enhancing mucosal thickening into middle layer with intact outer layers and a low-density-stripe layer corresponding to 'submucosal lesion'. (B) A enhancing lesion that reaches into outer layer with smooth outline corresponding to 'proper muscular lesion'. (C) Lesions without the discrimination between the enhancing gastric lesion and the outer layer with a few small linear stranding in the perigastric fat plane corresponding to 'subserosal lesion'. (D) Lesions with gastric wall thickening with spiculation and the preservation of fat plane between the gastric lesion and adjacent organ corresponding to 'serosal lesion'.