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Evaluation of 64-Channel Contrast-Enhanced Multi-detector Row Computed Tomography for Preoperative N Staging in cT2-4 Gastric Carcinoma

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Abstract

Background

Preoperative N staging is essential for the best treatment planning in patients with gastric carcinoma. The aim of this study was to evaluate the accuracy of preoperative N staging using contrast-enhanced multi-detector row computed tomography (CE-MDCT) in patients with resectable cT2-4 gastric carcinoma.

Methods

A total of 218 patients who underwent a gastrectomy with D2 lymphadenectomy for previously untreated cT2-4 primary gastric carcinoma were studied. Preoperative N staging was performed according to the 7th (UICC) TNM Staging System using pre-specified criteria on a 64-channel CE-MDCT and was compared with postoperative pathologic N staging.

Results

In all 218 patients, a distal or total gastrectomy was performed. The overall accuracy of the preoperative N staging was 46.3 % (101/218), with the proportion of over- and under-staging being 26.6 % (58/218) and 27.1 % (59/218), respectively. The sensitivity, specificity, and accuracy for lymph node metastasis (≥pN1) were 79.1 % (106/134), 50.0 % (42/84), and 67.9 % (148/218), respectively. The sensitivity, specificity, and accuracy for multiple lymph node metastases (≥pN2) were 80.2 % (73/91), 68.5 % (87/127), and 73.4 % (160/218), respectively. Multivariate analyses showed that macroscopic type 2 and ≥6 cm-sized tumors were associated with preoperative over-N staging, while macroscopic type 1/3 tumors were associated with under-N staging.

Conclusion

Preoperative N staging with pinpoint accuracy is difficult. However, CE-MDCT offers a reasonably high sensitivity and specificity for ≥pN2 and may be useful for selecting candidates for neoadjuvant therapies. The macroscopic type and size of the primary tumor may affect the accuracy of preoperative N staging.

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Authors and Affiliations

  1. Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Masaki Ohashi, Shinji Morita, Takeo Fukagawa, Takeyuki Wada & Hitoshi Katai

  2. Pathology Division, National Cancer Center Hospital, Tokyo, Japan

    Ryoji Kushima

  3. Diagnostic Radiology Division, National Cancer Center Hospital, Tokyo, Japan

    Hiroaki Onaya

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  1. Masaki Ohashi
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  2. Shinji Morita
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  3. Takeo Fukagawa
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  4. Takeyuki Wada
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  5. Ryoji Kushima
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  6. Hiroaki Onaya
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  7. Hitoshi Katai
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Correspondence to Hitoshi Katai.

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Ohashi, M., Morita, S., Fukagawa, T. et al. Evaluation of 64-Channel Contrast-Enhanced Multi-detector Row Computed Tomography for Preoperative N Staging in cT2-4 Gastric Carcinoma. World J Surg 40, 165–171 (2016). https://doi.org/10.1007/s00268-015-3318-8

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  • DOI: https://doi.org/10.1007/s00268-015-3318-8

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