Fu Yi, Zhu Hui, Peng Wei-Jun
From the Department of Radiology, Fudan University Shanghai Cancer Center.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
J Comput Assist Tomogr. 2019 Nov/Dec;43(6):887-891. doi: 10.1097/RCT.0000000000000924.
This study aimed to describe the computed tomographic (CT) findings of gastric hepatoid adenocarcinoma (GHA) and determine features distinguishing it from gastric adenocarcinoma (GA).
Computed tomographic images of pathologically verified GHA (n = 11) and GA (n = 38) were retrospectively reviewed. α-Fetoprotein (AFP), carcinoembryonic antigen (CEA), and CT findings were assessed in our study. Computed tomographic findings included the location, distribution, growth pattern, ulceration, thickness of gastric wall, enhancement pattern, and the ratio of lesion attenuation to aorta CT attenuation. Short diameter of the metastatic lymph nodes, mean short diameter of metastatic lymph nodes, and the ratio of the number of enlarged lymph node on CT to the number of metastatic lymph nodes pathologically were measured and calculated. Data were compared using the χ and Student t tests; significant CT criteria were identified using receiver operating characteristic curve.
α-Fetoprotein, CEA, and CT findings, including the longest short diameter, the mean short diameter, the ratio of the number of enlarged lymph node on CT to the number of metastatic lymph nodes pathologically, the lesion in arterial phase minus portal venous phase, and the lesion/aorta ratio, were statistically significant predictors for the differentiation of GHA from GA (P < 0.05). When only the aforementioned CT findings were used as criteria, the sensitivity and specificity for diagnosing GHA were 82.86% and 90.91%, respectively. When AFP, CEA, and CT findings were used as criteria, sensitivity of 97.14% and specificity of 90.91% were achieved.
Elevated serum AFP level and CT findings could distinguish GHA and GA with a high degree of accuracy.
本研究旨在描述胃肝样腺癌（GHA）的计算机断层扫描（CT）表现，并确定其与胃腺癌（GA）的鉴别特征。
回顾性分析经病理证实的GHA（n = 11）和GA（n = 38）的CT图像。本研究评估了甲胎蛋白（AFP）、癌胚抗原（CEA）和CT表现。CT表现包括病变位置、分布、生长方式、溃疡、胃壁厚度、强化方式以及病变衰减与主动脉CT衰减的比值。测量并计算转移淋巴结的短径、转移淋巴结的平均短径以及CT上肿大淋巴结数量与病理转移淋巴结数量的比值。采用χ检验和Student t检验进行数据比较；使用受试者操作特征曲线确定显著的CT标准。
AFP、CEA和CT表现，包括最长短径、平均短径、CT上肿大淋巴结数量与病理转移淋巴结数量的比值、动脉期减门静脉期的病变以及病变/主动脉比值，是区分GHA与GA的统计学显著预测指标（P < 0.05）。仅将上述CT表现作为标准时，诊断GHA的敏感性和特异性分别为82.86%和90.91%。当将AFP、CEA和CT表现作为标准时，敏感性达到97.14%，特异性为90.91%。
血清AFP水平升高和CT表现能够高度准确地区分GHA和GA。
