Accuracy of Multidetector-Row Computed Tomography in the Preoperative Diagnosis of Lymph Node Metastasis in Patients with Gastric Cancer

Abstract

Background/aims: Preoperative lymph node staging in gastric cancer patients is important. The aim of this study was to assess the diagnostic accuracy of computed tomography (CT) in assessing lymph nodes in patients with gastric cancer.

Methods: A total of 56 patients had undergone standardized gastric resection with lymphadenectomy between October 2013 and June 2015 were reviewed retrospectively. The short axis diameter of the largest lymph node per station was recorded when reviewing the preoperative CT images. Diagnostic accuracy was calculated by comparing CT with histopathological findings.

Results: In 518 stations dissected at surgery, 56 included lymph nodes with metastasis. Among them, lymph nodes were visualized on preoperative CT in 26 stations. No lymph node was detected in 382 stations among 462 infiltration-negative stations. The cutoff of 12 mm had the highest accuracy rate of 0.896.

Conclusion: The accuracy of CT in the preoperative diagnosis of lymph node metastasis in patients with gastric cancer remains poor. Therefore, surgeons should pay attention to the visibility of lymph nodes on CT. Detection of lymph nodes on CT can be utilized for a more accurate diagnosis such as fine-needle aspiration biopsy.

Keywords: Computed tomography; Gastric cancer; Lymph node metastasis.

Fig. 1

Some representative CT scan images of lymph nodes of gastric cancer patients. a Enlarged lymph nodes of a patient with histopathologically infiltration-positive lymph nodes (arrows). The short axis diameter of the largest lymph node was 19 mm. b In another patient with histopathologically infiltration-positive lymph nodes, only tiny lymph nodes (maximum 5 mm) were visualized on preoperative CT scan (arrows). c In a patient with no histopathologically infiltration-positive lymph nodes, some large lymph nodes (11 mm) were visualized on CT scan (arrows).