Type-specific diagnosis and evaluation of longitudinal tumor extent of borrmann type IV gastric cancer: CT versus gastroscopy

Abstract

Objective: To compare the accuracy of computed tomography (CT) with that of gastroscopy for the extent of evaluation of longitudinal tumor and type-specific diagnosis of Borrmann type IV gastric cancer.

Materials and methods: Fifty-nine patients (35 men with mean age of 60 years and 24 women with mean age of 55 years) who underwent surgical resection of Borrmann type IV gastric cancer were included in this study. Histopathological analysis data was used as a reference standard to confirm the clinical interpretations of gastroscopy and CT for the diagnosis of Borrmann type IV and evaluation of longitudinal tumor extent. For the evaluation of longitudinal extent, gastroscopic and CT results were classified as underestimated, accurate, or overestimated. The McNemar test was used to identify statistically significant differences in the accuracy between gastroscopy and CT.

Results: For the diagnosis of Borrmann type IV gastric cancer, the accuracy of CT was significantly higher than that of gastroscopy (74.6% [44/59] vs. 44.1% [26/59], p < 0.001). CT was significantly more accurate in assessing the overall tumor extent than gastroscopy (61.4% [35/57] vs. 28.1% [16/57], p < 0.001). The proximal (75.4% [43/57] vs. 50.9% [29/57], p = 0.003) and distal tumor extent (71.9% [41/57] vs. 43.9% [25/57], p < 0.05) were more accurately predicted by CT compared with gastroscopy. The underestimation of tumor extent was a major source of error in both examinations.

Conclusion: CT was found to be more predictive than gastroscopy in type-specific diagnosis and the evaluation of longitudinal tumor extent in patients with Borrmann type IV gastric cancer.

Keywords: Borrmann type IV; CT; Cancer; Gastroscopy; Linitis plastica; Stomach.

Fig. 1

Flow chart of study profile based on recommended standards for reporting diagnostic accuracy. AGC = advanced gastric cancer, MDCT = multidetector row computed tomography

Fig. 2

Fifty four-year-old man with Borrmann type IV gastric carcinoma involving upper, middle, and lower third of stomach. Preoperative diagnosis was Borrmann type III AGC involving lower third at gastroscopic examination and Borrmann type IV AGC involving upper, middle, and lower third of stomach at CT examination. (A) Gastroscopic image reveals infiltrative mass (arrows) with depressed area which is encircling prepyloric antrum. (B) Coronal CT images show abnormal strong enhancement in upper, middle, and lower third of gastric wall, accompanied by wall thickening and hypertrophied gastric mucosal folds (arrowheads). AGC = advanced gastric cancer, CT = computed tomography

Fig. 3

Forty four-year-old man with Borrmann type IV gastric carcinoma involving lower third of stomach and duodenum. Preoperative diagnosis was pyloric stenosis due to recurrent duodenal ulcer with bulb deformity at gastroscopic examination and Borrmann type IV AGC involving lower third of stomach and duodenum at CT examination. (A) Axial image demonstrate highly enhanced, concentric wall thickening of pyloric antrum and duodenum with obstruction of gastric outlet (arrows). (B) Photomicrograph shows multifocal and discontinuous infiltrations of tumor cell clusters along gastric wall. Circles indicate regions where tumor cells invade submucosal layer, sparing superficial mucosal layer (Hematoxylin-eosin stain; original magnification, × 100). AGC = advanced gastric cancer, CT = computed tomography

Fig. 4

Fifty five-year-old man with Borrmann type IV gastric carcinoma involving lower third of stomach and proximal duodenum. Preoperative diagnosis was Borrmann type IV AGC involving lower third of stomach at gastroscopic examination and type IV AGC involving lower to mid third stomach and duodenum. (A) Gastroscopic image shows infiltrative lesion involving prepyloric anturm and pylorus ring without evidence of invasion into duodenum (B) Coronal image shows thickened gastric wall with enhancement from lower to mid third of stomach and involvement of duodenal bulb (arrows). Pathologic examination revealed type IV AGC involving lower to mid third of stomach and duodenal invasion. AGC = advanced gastric cancer, CT = computed tomography