Abstract
Background
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.
Methods
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.
Results
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%.
Conclusions
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.
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References
Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H. Surgical treatment for gastric cancer: the Japanese approach. Semin Oncol. 1996;23:360–8.
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.
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.
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.
Yoon SS, Yang HK. Lymphadenectomy for gastric adenocarcinoma: should west meet east? Oncologist. 2009;14:871–82.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Kim AY, Kim HJ, Ha HK. Gastric cancer by multidetector row CT: preoperative staging. Abdom Imaging. 2005;30:465–72.
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.
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.
Kwee RM, Kwee TC. Imaging in assessing lymph node status in gastric cancer. Gastric Cancer. 2009;12:6–22.
Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma—2nd English Edition. Gastric Cancer. 1998;1:10–24.
Sobin LH, Wittekind CH. TNM Classification of Malignant Tumors. 6th ed. New York: Wiley-Liss, 2002.
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.
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.
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.
Baxter NN, Tuttle TM. Inadequacy of lymph node staging in gastric cancer patients: a population-based study. Ann Surg Oncol. 2005;12:981–7.
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.
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.
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.
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.
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].
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.
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.
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.
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Marrelli, D., Mazzei, M.A., Pedrazzani, C. et al. High Accuracy of Multislices Computed Tomography (MSCT) for Para-Aortic Lymph Node Metastases from Gastric Cancer: A Prospective Single-Center Study. Ann Surg Oncol 18, 2265–2272 (2011). https://doi.org/10.1245/s10434-010-1541-y
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DOI: https://doi.org/10.1245/s10434-010-1541-y