[Diagnostic accuracy of computerized tomography. Preoperative staging of gastric cancer]

Abstract

"Imaging techniques" have assumed greater clinical value in the further assessment of an endoscopically or radiologically verified neoplastic lesion of the stomach through the ability to evaluate its extent of invasion, metastatic involvement of lymphnodes and/or distant organs. US, CT, and more recently NMR are non-invasive modalities that provide an accurate preoperative assessment of potential surgery decision making. Common current practice of preoperative CT in gastric cancer and relevant results documented in letterature, have inclined many clinicians in its use in staging this disease. The aim of the study is to evaluate and assign the efficacy of CT imaging in the preoperative staging of gastric cancer by comparing the results obtained with this imaging technique with the postoperative histopatologic findings of 25 patients with adenocarcinoma of the stomach. CT demonstrates the primitive lesion as a gastric wall differentiate T1 (parietal invasion extending to the lamina propria and submucosa) and T2 (invasion of the muscolaris propria and the submucosa). The performance values of CT in detecting tumor extension to the sierosa were as follows: sensitivity of 78%, specificity of 63%; and overall accuracy of 72%. The sensitivity and specificity of CT in demonstrating adjacent organ involvement were approximately 75% and 85% respectively, and overall accuracy of 84%. In the detection of metastatic involvement of lymphnodes CT demonstrated to be 70% sensitive, 62% specific with an efficacy of 68%. In terms of M-stage, CT imaging identified liver metastases in 3 patients (2 located in the VII segment and 1 in the IV) and 1 metastasis to the adrenal gland. All were confirmed by specimen histopathologic findings.