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Can lymphovascular invasion be predicted by preoperative multiphasic dynamic CT in patients with advanced gastric cancer?

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To determine whether multiphasic dynamic CT can preoperatively predict lymphovascular invasion (LVI) in advanced gastric cancer (AGC).

Methods

278 patients with AGC who underwent preoperative multiphasic dynamic CT were retrospectively recruited. Tumour CT attenuation difference between non-contrast and arterial (ΔAP), portal (ΔPP) and delayed phase (ΔDP), tumour-spleen attenuation difference in the portal phase (ΔT-S), tumour contrast enhancement ratios (CERs), tumour-to-spleen ratio (TSR) and tumour volumes were obtained. All CT-derived parameters and clinicopathological variables associated with LVI were analysed by univariate analysis, followed by multivariate and receiver operator characteristics (ROC) analysis. Associations between CT predictors for LVI and histopathological characteristics were evaluated by the chi-square test.

Results

ΔPP (OR, 1.056; 95% CI: 1.032–1.080) and ΔT-S (OR, 1.043; 95% CI: 1.020–1.066) are independent predictors for LVI in AGC. ΔPP, ΔT-S and their combination correctly predicted LVI in 74.8% (AUC, 0.775; sensitivity, 88.6%; specificity, 54.1%), 68.7% (AUC, 0.747; sensitivity, 68.3%; specificity, 69.4%) and 71.7% (AUC, 0.800; sensitivity, 67.6%; specificity, 77.8%), respectively. There were significant associations between CT predictors for LVI with tumour histological differentiation and Lauren classification.

Conclusion

Multiphasic dynamic CT provides a non-invasive method to predict LVI in AGC through quantitative enhancement measurement.

Key points

• Lymphovascular invasion rarely can be evaluated preoperatively in advanced gastric cancer (AGC).

• Δ PP and Δ T-S were independent predictors for LVI in patients with AGC.

• Δ PP and Δ T-S showed acceptable predictive performance for LVI.

• Combination of Δ PP and Δ T-S improved predictive performance for LVI.

• Multiphasic dynamic CT may be a useful adjunct for detecting LVI preoperatively.

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Abbreviations

AGC:

Advanced gastric cancer

AUC:

Area under the curve

CEA:

Carcinoembryonic antigen

CER:

Contrast enhancement ratio

GTV:

Gross tumour volume

HU:

Hounsfield unit

ICC:

Intraclass correlation coefficient

NPV:

Negative predictive value

PPV:

Positive predictive value

ROC:

Receiver operator characteristics

ROI:

Region of interest

TSR:

Tumour-to-spleen ratio

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Acknowledgements

The scientific guarantor of this publication is Zaiyi Liu. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

This study received funding from the National Natural Scientific Foundation of China (No. 81271569, No. 81601469 and NO.U1301258).

No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Study subjects or cohorts have not been previously reported. Methodology: retrospective diagnostic study, performed at one institution.

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    Authors and Affiliations

    1. Southern Medical University, Guangzhou, Guangdong, 510515, China

      Zelan Ma, Cuishan Liang, Xiaomei Huang, Yabing Xiong & Zaiyi Liu

    2. Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhong Shan Er Lu, Guangzhou, Guangdong Province, 510080, China

      Zelan Ma, Changhong Liang, Yanqi Huang, Lan He, Cuishan Liang, Xiaomei Huang & Zaiyi Liu

    3. School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510006, China

      Lan He

    4. Department of Radiology, The Affiliated Guangzhou First People’ Hospital, Guangzhou Medical University, Guangzhou, Guangdong, 510180, China

      Xin Chen

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    1. Zelan Ma
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    Zelan Ma and Changhong Liang contributed equally to this work.

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    Ma, Z., Liang, C., Huang, Y. et al. Can lymphovascular invasion be predicted by preoperative multiphasic dynamic CT in patients with advanced gastric cancer?. Eur Radiol 27, 3383–3391 (2017). https://doi.org/10.1007/s00330-016-4695-6

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    • DOI: https://doi.org/10.1007/s00330-016-4695-6

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