High Accuracy of Multislices Computed Tomography (MSCT) for Para-Aortic Lymph Node Metastases from Gastric Cancer: A Prospective Single-Center Study
- 224 Downloads
The purpose of this study is to analyze the diagnostic accuracy of MSCT in the identification of para-aortic lymph node metastases from gastric cancer.
A total of 92 consecutive patients with primary gastric cancer were prospectively submitted to preoperative MSCT staging according to a standard protocol in the period 2003–2010. All diagnostic procedures were performed by dedicated radiologists who were unaware of the final pathological nodal status. Subsequently all patients underwent potentially curative (R0) resection with extended lymphadenectomy plus para-aortic nodal dissection. Lymph node mapping in different stations and retrieval of single lymph nodes were performed by the surgeon on the fresh specimen and then submitted for pathological examination. Clinical, radiological, and pathological data were prospectively stored on database.
A median number of 47 (range: 18–114) total lymph nodes and 7 (range: 3–29) para-aortic lymph nodes were removed. In 13 of 92 included patients (14%), histological examination demonstrated para-aortic nodal metastases; MSCT was correctly positive in 11 of these cases (sensitivity: 85%). In 79 patients para-aortic nodes were not involved, and MSCT resulted correctly negative in 75 of these patients (specificity: 95%). Positive (PPV) and negative (NPV) predictive values were 73 and 97%, with a global accuracy of 93%.
MSCT performed according to a standard protocol by dedicated radiologists demonstrated high accuracy in preoperative identification of para-aortic nodal metastases from gastric cancer. These results may be useful in planning surgical approach or during clinical staging before neoadjuvant chemotherapy.
KeywordsGastric Cancer Linitis Plastica Late Arterial Phase Dedicated Radiologist Maximum Lymph Node Size
- 3.Siewert JR, Böttcher K, Roder JD, Busch R, Hermanek P, Meyer HJ; German Gastric Carcinoma Study Group. Prognostic relevance of systematic lymph node dissection in gastric carcinoma. Br J Surg. 1993;80:1015–8.Google Scholar
- 4.Roviello F, Marrelli D, Morgagni P, de Manzoni G, Di Leo A, Vindigni C, et al.; Italian Research Group for Gastric Cancer. Survival benefit of extended D2 lymphadenectomy in gastric cancer with involvement of second level lymph nodes: a longitudinal multicenter study. Ann Surg Oncol. 2002;9:894–900.Google Scholar
- 7.Degiuli M, Sasako M, Ponti A; Italian Gastric Cancer Study Group. Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg. 2010;97:643–9.Google Scholar
- 9.Kodera Y, Sasako M, Yamamoto S, Sano T, Nashimoto A, Kurita A; Gastric Cancer Surgery Study Group of Japan Clinical Oncology Group. Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer. Br J Surg. 2005;92:1103–9.Google Scholar
- 12.Kulig J, Popiela T, Kolodziejczyk P, Sierzega M, Szczepanik A, Polish Gastric Cancer Study Group. Standard D2 versus extended D2 (D2+) lymphadenectomy for gastric cancer: an interim safety analysis of a multicenter, randomized, clinical trial. Am J Surg. 2007;193:10–5.Google Scholar
- 13.Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, et al.; Japan Clinical Oncology Group. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359:453–62.Google Scholar
- 24.Sobin LH, Wittekind CH. TNM Classification of Malignant Tumors. 6th ed. New York: Wiley-Liss, 2002.Google Scholar
- 25.Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy—Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004;22:2767–73.PubMedCrossRefGoogle Scholar
- 33.Kim EY, Lee WJ, Choi D, Lee SJ, Choi JY, Kim BT, et al. The value of PET/CT for preoperative staging of advanced gastric cancer: Comparison with contrast-enhanced CT. Eur J Radiol. 2010 [Epub ahead of print].Google Scholar
- 34.Nomura E, Sasako M, Yamamoto S, Sano T, Tsujinaka T, Kinoshita T, et al.; Gastric Cancer Surgical Study Group of the Japan Clinical Oncology Group. Risk factors for para-aortic lymph node metastasis of gastric cancer from a randomized controlled trial of JCOG9501. Jpn J Clin Oncol. 2007;37:429–33.Google Scholar