Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama, 241-0815, Japan.
Ann Surg Oncol. 2013 Jun;20(6):2016-22. doi: 10.1245/s10434-012-2817-1. Epub 2012 Dec 25.
Multidetector-row CT (MDCT) may provide accurate preoperative staging of resectable gastric cancer. However, the standard methods and criteria to diagnose the T and N stages to select the patients who are good candidates for neoadjuvant chemotherapy have not been established yet.
The aim of this prospective study was to evaluate the accuracy of MDCT to diagnose the serosal invasion and nodal metastases of gastric cancer. Patients who had gastric adenocarcinoma underwent MDCT scanning using a standardized method. The T and N stage were diagnosed by prespecified criteria. The analyses were performed in the patients who had cN0-2 and M0 tumors and underwent curative gastrectomy as a primary treatment. The accuracy was calculated by comparing the results of MDCT with the histopathological findings.
A total of 315 patients were analyzed. The overall diagnostic accuracy (95 % confidence interval) of T staging was 71.4 % (225 of 315, 66.2-76.1). The accuracy, sensitivity, and specificity for serosal invasion were 85.7 % (81.4-89.1), 54.5 % (42.6-66.0), and 94.0 % (90.3-96.3), respectively. The false-positive rate for serosal invasion was 6.0 % (2.9-7.7). The overall diagnostic accuracy of N staging was 75.9 % (239 of 315, 70.9-80.3). The accuracy, sensitivity, and specificity for nodal metastases were 81.3 % (76.6-85.2), 46.4 % (36.8-56.3), and 96.8 % (93.5-98.4), respectively. The false-positive rate for nodal metastases was 3.2 % (1.6-6.5 %).
These results suggest that MDCT provides an accurate diagnosis with high specificity and a low false-positive rate and can be used to select the patients who are candidates for preoperative chemotherapy.
多排螺旋 CT（MDCT）可能为可切除胃癌的术前分期提供准确信息。然而，用于诊断 T 分期和 N 分期以选择适合新辅助化疗患者的标准方法和标准尚未建立。
本前瞻性研究旨在评估 MDCT 诊断胃癌浆膜侵犯和淋巴结转移的准确性。对经病理证实的胃腺癌患者行 MDCT 扫描，采用标准化方法。T 分期和 N 分期通过预设标准进行诊断。对接受根治性胃切除术作为初始治疗且 cN0-2 和 M0 肿瘤的患者进行分析。通过 MDCT 结果与组织病理学检查结果的比较计算准确性。
共分析了 315 例患者。T 分期的总体诊断准确性（95%置信区间）为 71.4%（225/315，66.2-76.1）。浆膜侵犯的准确性、敏感性和特异性分别为 85.7%（81.4-89.1）、54.5%（42.6-66.0）和 94.0%（90.3-96.3）。浆膜侵犯的假阳性率为 6.0%（2.9-7.7）。N 分期的总体诊断准确性为 75.9%（239/315，70.9-80.3）。淋巴结转移的准确性、敏感性和特异性分别为 81.3%（76.6-85.2）、46.4%（36.8-56.3）和 96.8%（93.5-98.4）。淋巴结转移的假阳性率为 3.2%（1.6-6.5）。
这些结果表明，MDCT 可以提供准确的诊断，具有高特异性和低假阳性率，可用于选择适合术前化疗的患者。
