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Utility of the gastric window in computed tomography for differentiation of early gastric cancer (T1 stage) from muscularis involvement (T2 stage)

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Abstract

Objective

To analyze the diagnostic value of using the gastric window in computed tomography for differentiation of early gastric cancer (T1 stage) from muscularis involvement (T2 stage).

Materials and methods

All patients with pathologically confirmed T1 stage and T2 stage gastric cancer and who underwent endoscopic resection or gastrectomy at our institution from January 2011 to November 2018 were examined. Each patient received an enhanced CT scan of the abdomen before the operation. T staging of tumors based on the CT scans was performed independently by two radiologists using the gastric window (width 150–200 HU, level 80–100 HU) and the abdominal window (width 350–400 HU, level 50 HU).

Results

Use of the gastric window to diagnose stage T1 EGC led to an accuracy of 88.9% for observer1 and 91.5% for observer2; use of the abdominal window led to an accuracy of 53.6% for observer1 and 51.6% (38/106) for observer2. Use of the gastric window to diagnose stage T2 led to an accuracy of 85.6% for observer1 and 82.4% for observer2; use of the abdominal window led to an accuracy of 52.3% for both observer1 and observer2. For observer1, use of the gastric window had a diagnostic accuracy of 69.2% for stage T1a and 62.5% for stage T1b; for observer2, the diagnostic accuracy was 65.1% for stage T1a and 67.0% for stage T1b. A Kappa test indicated moderate and substantial inter-observer agreement for T staging with gastric window (κ = 0.598, P < 0.001) and abdominal window (κ = 0.745, P < 0.001).

Conclusion

Use of the gastric window in computed tomography provided more accurate staging for T1 and T2 stages of gastric cancer than the conventional abdominal window.

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Abbreviations

CT:

Computed tomography

EGC:

Early gastric cancer

References

  1. Nitti D, Marchet A, Mammano E, Ambrosi A, Belluco C, Mencarelli R, et al. Extended lymphadenectomy (D2) in patients with early gastric cancer. Eur J Surg Oncol, 2005. 31(8): p. 875-81.

    Article  CAS  Google Scholar 

  2. Pertl A, Jagoditsch M, Jatzko GR, Denk H, Stettner HM. Long-term results of early gastric cancer accomplished in a European institution by Japanese-type radical resection. Gastric Cancer, 1999. 2(2): p. 115-121.

    Article  Google Scholar 

  3. Saragoni L, Scarpi E, Ravaioli A, Morgagni P, Roviello F, Vindigni C, et al. Early Gastric Cancer: Clinical Behavior and Treatment Options. Results of an Italian Multicenter Study on Behalf of the Italian Gastric Cancer Research Group (GIRCG). Oncologist, 2018. 23(7): p. 852–858.

  4. Hyung WJ, Cheong JH, Kim J, Chen J, Choi SH, Noh SH, et al. Application of minimally invasive treatment for early gastric cancer. J Surg Oncol, 2004. 85(4): p. 181–5; discussion 186.

  5. Custureri F, D'Orazi V, Peparini N, Gabatel R, Urciuoli P, Patrizi G, et al. Choice of the surgical treatment in early gastric cancer. Hepatogastroenterology, 2004. 51(58): p. 1210-4.

    PubMed  Google Scholar 

  6. Everett SM, Axon AT. Early gastric cancer in Europe. Gut, 1997. 41(2): p. 142-50.

    Article  CAS  Google Scholar 

  7. Tanaka N, Katai H, Taniguchi H, Saka M, Morita S, Fukagawa T, et al. Trends in characteristics of surgically treated early gastric cancer patients after the introduction of gastric cancer treatment guidelines in Japan. Gastric Cancer. 2010 Jun;13(2):74-7.

    Article  Google Scholar 

  8. Cardoso R, Coburn N, Seevaratnam R, Sutradhar R, Lourenco LG, Mahar A, et al. A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer. Gastric Cancer, 2012. 15 Suppl 1: p. S19-26.

    Article  Google Scholar 

  9. Tsurumaru D, Miyasaka M, Nishimuta Y, Asayama Y, Nishie A, Kawanami S, et al. Diffe rentiation of early gastric cancer with ulceration and resectable advanced gastric cancer using multiphasic dynamic multidetector CT. Eur Radiol, 2016. 26(5): p. 1330-7.

    Article  Google Scholar 

  10. Ahn HS, Lee HJ, Yoo MW, Kim SG, Im JP, Kim SH, et al. Diagnostic accuracy of T and N stages with endoscopy, stomach protocol CT, and endoscopic ultrasonography in early gastric cancer. J Surg Oncol, 2009. 99(1): p. 20-7.

    Article  Google Scholar 

  11. Park KJ, Lee MW, Koo JH, Park Y, Kim H, Choi D, et al. Detection of early gastric cancer using hydro-stomach CT: blinded vs unblinded analysis. World J Gastroenterol, 2011. 17(8): p. 1051-7.

    Article  Google Scholar 

  12. Seevaratnam R, Cardoso R, McGregor C, Lourenco L, Mahar A, Sutradhar R, et al. How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis. Gastric Cancer, 2012. 15 Suppl 1: p. S3-18.

    Article  Google Scholar 

  13. Kim AY, Kim HJ, Ha HK. Gastric cancer by multidetector row CT: preoperative staging. Abdom Imaging, 2005. 30(4): p. 465-72.

    Article  CAS  Google Scholar 

  14. Kwee RM, Kwee TC. Imaging in assessing lymph node status in gastric cancer. Gastric Cancer, 2009. 12(1): p. 6-22.

    Article  CAS  Google Scholar 

  15. Kumano S, Murakami T, Kim T, Hori M, Iannaccone R, Nakata S. T staging of gastric cancer: role of multi-detector row CT. Radiology, 2005. 237(3): p. 961-6.

    Article  Google Scholar 

  16. Lim JS, Yun MJ, Kim MJ, Hyung WJ, Park MS, Choi JY, et al. CT and PET in Stomach Cancer: Preoperative Staging and Monitoring of Response to Therapy. Radiographics. 2006;26(1):143-56.

    Article  Google Scholar 

  17. Woo SK, Kim S, Kim TU, Lee JW, Kim GH, Choi KU, et al. Investigation of the association between CT detection of early gastric cancer and ultimate histology. Clin Radiol, 2008. 63(11): p. 1236-44.

    Article  CAS  Google Scholar 

  18. Lee IJ, Lee JM, Kim SH, Shin CI, Lee JY, Kim SH, et al. Diagnostic performance of 64-channel multidetector CT in the evaluation of gastric cancer: differentiation of mucosal cancer (T1a) from submucosal involvement (T1b and T2). Radiology, 2010. 255(3): p. 805-14.

    Article  Google Scholar 

  19. Kim JW, Shin SS, Heo SH, Choi YD, Lim HS, Park YK, et al. Diagnostic performance of 64-section CT using CT gastrography in preoperative T staging of gastric cancer according to 7th edition of AJCC cancer staging manual. Eur Radiol, 2012. 22(3): p. 654–62.

  20. Kim JH, Eun HW, Choi JH, Hong SS, Kang W, Auh YH. Diagnostic performance of virtual gastroscopy using MDCT in early gastric cancer compared with 2D axial CT: focusing on interobserver variation. AJR Am J Roentgenol, 2007. 189(2): p. 299-305.

    Article  Google Scholar 

  21. Shin KS, Kim SH, Han JK, Lee JM, Lee HJ, Yang HK, et al. Three-dimensional MDCT gastrography compared with axial CT for the detection of early gastric cancer. J Comput Assist Tomogr, 2007. 31(5): p. 741-9.

    Article  Google Scholar 

  22. Kim JH, Eun HW, Hong SS, Auh YH. Early gastric cancer: virtual gastroscopy. Abdom Imaging, 2006. 31(5): p. 507-13

    Article  CAS  Google Scholar 

  23. Kazutaka Kuroki, Shiro Oka, Shinji Tanaka, Naoki Yorita, Kosaku Hata, Takahiro Kotachi, et al. Clinical significance of endoscopic ultrasonography in diagnosing invasion depth of early gastric cancer prior to endoscopic submucosal dissection. Gastric Cancer. 2020 Jun 22.

  24. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1–19.

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Acknowledgements

This work was supported by the Beijing Organization Department’s talents Project (2017000021469G279) and the Digestive Medical Coordinated Development Center of Beijing Municipal Administration of Hospitals, (No. XXT20).

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Author notes

  1. Zhi-Long Wang and Yan-Ling Li contributed equally to this manuscript and are equal contributors.

Authors and Affiliations

  1. Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142, China

    Zhi-Long Wang, Yan-Ling Li, Lei Tang, Xiao-Ting Li & Ying-Shi Sun

  2. Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China

    Zhao-De Bu

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  1. Zhi-Long Wang
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  2. Yan-Ling Li
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Correspondence to Ying-Shi Sun.

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Wang, ZL., Li, YL., Tang, L. et al. Utility of the gastric window in computed tomography for differentiation of early gastric cancer (T1 stage) from muscularis involvement (T2 stage). Abdom Radiol 46, 1478–1486 (2021). https://doi.org/10.1007/s00261-020-02785-z

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  • DOI: https://doi.org/10.1007/s00261-020-02785-z

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