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. 2015 Mar-Apr;48(2):74-80.
doi: 10.1590/0100-3984.2014.0021.

Multidetector computed tomography in the preoperative staging of gastric adenocarcinoma

Ricardo Hoelz de Oliveira Barros  1 , Thiago José Penachim  1 , Daniel Lahan Martins  1 , Nelson Adami Andreollo  2 , Nelson Marcio Gomes Caserta  3
Affiliations

Multidetector computed tomography in the preoperative staging of gastric adenocarcinoma

Ricardo Hoelz de Oliveira Barros et al. Radiol Bras. 2015 Mar-Apr.

Abstract
in English, Portuguese

Objective: To evaluate the role of multidetector computed tomography in the preoperative investigation of tumor invasion depth and lymph node and metastatic involvement according to the TNM classification, in patients with gastric adenocarcinoma.

Materials and methods: Fifty-four patients with biopsy-confirmed gastric cancer underwent preoperative staging with 64-channel multidetector computed tomography. Two independent radiologists analyzed the images and classified the findings. Sensitivity, specificity, accuracy and overall accuracy were calculated for each observer. The interobserver agreement was also evaluated.

Results: The accuracy in the classification of categories T ranged from 74% to 96% for observer 1 and from 80% to 92% for observer 2. The overall accuracy was 70% for both observers. The weighted kappa index was 0.75, consistent with a significant interobserver agreement. The accuracy in the classification of lymph node involvement (category N) ranged from 55% to 79% for observer 1 and from 73% to 82% for observer 2. The evaluation of metastatic involvement showed an overall accuracy of 89.6% for both observers.

Conclusion: 64-channel multidetector computed tomography demonstrated clinically relevant accuracy in the preoperative staging of gastric adenocarcinoma as regards invasion depth (T category) and metastatic involvement (M category).

Objetivo: Avaliar a tomografia computadorizada com múltiplas fileiras de detectores na análise pré-operatória da profundidade de invasão tumoral, acometimento linfonodal e metastático, de acordo com a classificação TNM, em pacientes com adenocarcinoma gástrico.

Materiais e métodos: Cinquenta e quatro pacientes com câncer gástrico foram submetido a estadiamento pré-operatório com tomografia computadorizada de 64 canais de detectores. Dois radiologistas analisaram, independentemente, as imagens e classificaram os achados. A sensibilidade, especificidade, acurácia e acurácia global para cada avaliador foram calculadas. A concordância interobservador também foi avaliada.

Resultados: A acurácia na classificação das categorias T variou entre 74% e 96% para o observador 1 e entre 80% e 92% para o observador 2. A acurácia global foi 70% para ambos os observadores. O kappa ponderado foi 0,75, consistente com uma concordância interobservador substancial. A acurácia na classificação do acometimento linfonodal (categoria N) variou entre 55% e 79% para o observador 1 e entre 73% e 82% para o observador 2. A avaliação do acometimento metastático mostrou acurácia global de 89,6% para ambos os observadores.

Conclusão: A tomografia computadorizada com 64 canais de detectores demonstrou acurácia clinicamente relevante no estadiamento pré-operatório do adenocarcinoma gástrico em relação à profundidade de invasão e acometimento metastático.

Keywords: Computed tomography; Gastric cancer; Staging.

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Figures

Figure 1
Figure 1
Focal thickening or abnormal enhancement of the gastric mucosa, with a preserved hypodense strip deep to the lesion, corresponding to the submucosal layer – category T1 at the histopathological analysis.
Figure 2
Figure 2
Thickening and abnormal enhancement involving the whole thickness of the gastric wall, with smooth external contour of the stomach – category T2 after histopathological analysis.
Figure 3
Figure 3
Thickening and abnormal enhancement involving the whole thickness of the gastric wall, associated with linear or reticular striations extending towards the perigastric fat – category T4A after histopathological analysis.
Figure 4
Figure 4
Signs of invasion of the pancreatic head and body – category T4B.
See this image and copyright information in PMC

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