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Preoperative Staging of Gastric Cancer Using Computed Tomography and Its Correlation with Histopathology with Emphasis on Multi-planar Reformations and Virtual Gastroscopy

Journal of Gastrointestinal Cancer volume 52, pages 606–615 (2021)Cite this article

Abstract

Background

Gastric cancer is the fifth most common cancer in the world. Preoperative staging of gastric cancer has assumed pivotal role in deciding appropriate management of gastric cancer with multi-detector computed tomography (MDCT) using hydro- and gaseous distension of stomach superseding endoscopic ultrasound in tumor (T) and nodal (N) staging. We undertook this study to evaluate the diagnostic accuracy of MDCT in the T and N staging of gastric cancer with an attempt to differentiate between early and advanced gastric carcinomas.

Methods

A total of 160 patients with endoscopically diagnosed and biopsy-proven gastric cancer were subjected to MDCT after adequate gaseous and hydro-distention of stomach. Multi-planar reformatted (MPR) as well as virtual gastroscopy images were also obtained. Gastric lesions were categorized into T1 to T4 stages with N staging from N0 to N3. Preoperative CT findings were correlated with histopathological findings.

Results

Overall diagnostic accuracy of T staging in our study was 82.5% (132/160) with an accuracy of 75% (120/160) for N staging. The diagnostic accuracy of CT for early gastric carcinoma in our study was 93.75% with high specificity of 96% but low sensitivity of 66.7%.

Conclusion

MDCT using gaseous and hydro-distension of stomach is an excellent modality for near accurate preoperative T staging of gastric cancer. However, CT has a limited role in the N staging of gastric cancer. This study also suggested that the combined use of virtual gastroscopy and MPR images helps in better detection of early gastric cancers.

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Data Availability

All the data and material were obtained from patients registered in our hospital.

Abbreviations

AJCC:

American Joint Committee on Cancer

AAR:

age-adjusted rate

EGC:

early gastric cancer

EGD:

esophagogastroduodenoscopy

EUS:

endoscopic ultrasound

GI:

gastrointestinal

IEC:

Institutional Ethical Committee

MDCT:

multi-detector computed tomography

MPR:

multi-planar reformation

MS:

Microsoft

NPV:

negative predictive value

N:

nodal

PPV:

positive predictive value

SSPS:

Statistical Package for the Social Sciences

T:

tumor

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Affiliations

  1. Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Soura Srinagar, Jammu & Kashmir, 190011, India

    Abdul Haseeb Wani, Arshed Hussain Parry & Naseer Ahmad Choh

  2. Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Soura Srinagar, Jammu & Kashmir, 190011, India

    Imza Feroz

Authors
  1. Abdul Haseeb Wani
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  2. Arshed Hussain Parry
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  3. Imza Feroz
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  4. Naseer Ahmad Choh
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Contributions

WA analyzed and interpreted the computed tomography (CT) images. PA and NC also helped in interpretation and analysis of CT images. FI performed the histopathological examination of surgical specimen. FI was also involved in obtaining surgical specimen. All authors were involved in statistical analysis and data interpretation. All authors were also involved in manuscript preparation and literature research. All the authors have read and approved the manuscript.

Corresponding author

Correspondence to Abdul Haseeb Wani.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethics Approval

This observational study was duly approved by the Institutional Ethical Committee (IEC) of Sher-i-Kashmir Institute of Medical Sciences (SKIMS) under the no. SIMS 131/IEC-SKIMS/2015-83. No animal participants were used in this study.

Consent to Participate

Informed verbal consent was obtained from all the patients included in the study.

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Cite this article

Wani, A.H., Parry, A.H., Feroz, I. et al. Preoperative Staging of Gastric Cancer Using Computed Tomography and Its Correlation with Histopathology with Emphasis on Multi-planar Reformations and Virtual Gastroscopy. J Gastrointest Canc 52, 606–615 (2021). https://doi.org/10.1007/s12029-020-00436-6

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  • DOI: https://doi.org/10.1007/s12029-020-00436-6

Keywords

  • Multi-detector computed tomography
  • Early gastric cancer
  • Virtual gastroscopy
  • Advanced gastric cancer and hydro-distension