Annals of Surgical Oncology

, Volume 18, Issue 8, pp 2265–2272 | Cite as

High Accuracy of Multislices Computed Tomography (MSCT) for Para-Aortic Lymph Node Metastases from Gastric Cancer: A Prospective Single-Center Study

  • Daniele Marrelli
  • Maria Antonietta Mazzei
  • Corrado Pedrazzani
  • Marianna Di Martino
  • Carla Vindigni
  • Giovanni Corso
  • Eleonora Morelli
  • Luca Volterrani
  • Franco Roviello
Gastrointestinal Oncology



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.


Gastric Cancer Linitis Plastica Late Arterial Phase Dedicated Radiologist Maximum Lymph Node Size 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H. Surgical treatment for gastric cancer: the Japanese approach. Semin Oncol. 1996;23:360–8.PubMedGoogle Scholar
  2. 2.
    Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439–49.PubMedCrossRefGoogle Scholar
  3. 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. 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
  5. 5.
    Yoon SS, Yang HK. Lymphadenectomy for gastric adenocarcinoma: should west meet east? Oncologist. 2009;14:871–82.PubMedCrossRefGoogle Scholar
  6. 6.
    Verlato G, Roviello F, Marchet A, Giacopuzzi S, Marrelli D, Nitti D, et al. Indexes of surgical quality in gastric cancer surgery: experience of an Italian network. Ann Surg Oncol. 2009;16:594–602.PubMedCrossRefGoogle Scholar
  7. 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
  8. 8.
    de Manzoni G, Pedrazzani C, Di Leo A, Bonfiglio M, Tasselli S, Guglielmi A, et al. Metastases to the para-aortic lymph nodes in adenocarcinoma of the cardia. Eur J Surg. 2001;167:413–8.PubMedCrossRefGoogle Scholar
  9. 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
  10. 10.
    Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono H, et al. Comparison of surgical results of D2 versus D3 gastrectomy (para-aortic lymph node dissection) for advanced gastric carcinoma: a multi-institutional study. Ann Surg Oncol. 2006;13:659–67.PubMedCrossRefGoogle Scholar
  11. 11.
    Marrelli D, Pedrazzani C, Neri A, Corso G, DeStefano A, Pinto E, et al. Complications after extended (D2) and superextended (D3) lymphadenectomy for gastric cancer: analysis of potential risk factors. Ann Surg Oncol. 2007;14:25–33.PubMedCrossRefGoogle Scholar
  12. 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. 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
  14. 14.
    Takashima S, Kosaka T. Results and controversial issues regarding a para-aortic lymph node dissection for advanced gastric cancer. Surg Today. 2005;35:425–31.PubMedCrossRefGoogle Scholar
  15. 15.
    Tokunaga M, Ohyama S, Hiki N, Fukunaga T, Aikou S, Yamaguchi T. Can superextended lymph node dissection be justified for gastric cancer with pathologically positive para-aortic lymph nodes? Ann Surg Oncol. 2010;17:2031–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Roviello F, Pedrazzani C, Marrelli D, Di Leo A, Caruso S, Giacopuzzi S, et al. Super-extended (D3) lymphadenectomy in advanced gastric cancer. Eur J Surg Oncol. 2010;36:439–46.PubMedGoogle Scholar
  17. 17.
    Davies J, Chalmers AG, Sue-Ling HM, May J, Miller GV, Martin IG, et al. Spiral computed tomography and operative staging of gastric carcinoma: a comparison with histopathological staging. Gut. 1997;41:314–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Habermann CR, Weiss F, Riecken R, Honarpisheh H, Bohnacker S, Staedtler C, et al. Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US. Radiology. 2004;230:465–71.PubMedCrossRefGoogle Scholar
  19. 19.
    Kim AY, Kim HJ, Ha HK. Gastric cancer by multidetector row CT: preoperative staging. Abdom Imaging. 2005;30:465–72.PubMedCrossRefGoogle Scholar
  20. 20.
    Kim HJ, Kim AY, Oh ST, Kim JS, Kim KW, Kim PN, et al. Gastric cancer staging at multi-detector row CT gastrography: comparison of transverse and volumetric CT scanning. Radiology. 2005;236:879–85.PubMedCrossRefGoogle Scholar
  21. 21.
    Chen CY, Hsu JS, Wu DC, Kang WY, Hsieh JS, Jaw TS, et al. Gastric cancer: preoperative local staging with 3D multi-detector row CT–correlation with surgical and histopathologic results. Radiology. 2007;242:472–82.PubMedCrossRefGoogle Scholar
  22. 22.
    Kwee RM, Kwee TC. Imaging in assessing lymph node status in gastric cancer. Gastric Cancer. 2009;12:6–22.PubMedCrossRefGoogle Scholar
  23. 23.
    Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma—2nd English Edition. Gastric Cancer. 1998;1:10–24.PubMedCrossRefGoogle Scholar
  24. 24.
    Sobin LH, Wittekind CH. TNM Classification of Malignant Tumors. 6th ed. New York: Wiley-Liss, 2002.Google Scholar
  25. 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
  26. 26.
    Kodera Y. Para-aortic lymph node dissection revisited: have we been neglecting a promising treatment option for gastric carcinoma? Eur J Surg Oncol. 2010;36:447–8.PubMedGoogle Scholar
  27. 27.
    Bouvier AM, Haas O, Piard F, Roignot P, Bonithon-Kopp C, Faivre J. How many nodes must be examined to accurately stage gastric carcinomas? Results from a population based study. Cancer. 2002;94:2862–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Baxter NN, Tuttle TM. Inadequacy of lymph node staging in gastric cancer patients: a population-based study. Ann Surg Oncol. 2005;12:981–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Yang DM, Kim HC, Jin W, Ryu CW, Kang JH, Park CH, et al. 64 Multidetector-row computed tomography for preoperative evaluation of gastric cancer: histological correlation. J Comput Assist Tomogr. 2007;31:98–103.PubMedCrossRefGoogle Scholar
  30. 30.
    Yan C, Zhu ZG, Yan M, Chen KM, Chen J, Xiang M, et al. Value of multidetector-row computed tomography in the preoperative T and N staging of gastric carcinoma: a large-scale Chinese study. J Surg Oncol. 2009;100:205–14.PubMedCrossRefGoogle Scholar
  31. 31.
    Lee JH, Paik YH, Lee JS, Song HJ, Ryu KW, Kim CG, et al. Candidates for curative resection in advanced gastric cancer patients who had equivocal para-aortic lymph node metastasis on computed tomographic scan. Ann Surg Oncol. 2006;13:1163–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Tatsumi Y, Tanigawa N, Nishimura H, Nomura E, Mabuchi H, Matsuki M, Narabayashi I. Preoperative diagnosis of lymph node metastases in gastric cancer by magnetic resonance imaging with ferumoxtran-10. Gastric Cancer. 2006;9:120–8.PubMedCrossRefGoogle Scholar
  33. 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. 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
  35. 35.
    Di Leo A, Marrelli D, Roviello F, Bernini M, Minicozzi A, Giacopuzzi S, et al. Lymph node involvement in gastric cancer for different tumor sites and T stage: Italian Research Group for Gastric Cancer (IRGGC) experience. J Gastrointest Surg. 2007;11:1146–53.PubMedCrossRefGoogle Scholar
  36. 36.
    Tajima Y, Murakami M, Yamazaki K, Masuda Y, Aoki S, Kato M, et al. Risk factors for lymph node metastasis from gastric cancers with submucosal invasion. Ann Surg Oncol. 2010;17:1597–604.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Daniele Marrelli
    • 1
  • Maria Antonietta Mazzei
    • 1
  • Corrado Pedrazzani
    • 1
  • Marianna Di Martino
    • 1
  • Carla Vindigni
    • 1
  • Giovanni Corso
    • 1
  • Eleonora Morelli
    • 1
  • Luca Volterrani
    • 1
  • Franco Roviello
    • 1
  1. 1.Department of Human Pathology and Oncology, Section of Advanced Surgical OncologyUniversity of SienaSienaItaly

Personalised recommendations