Gundavda Kaival, Rajasimman Aishvarya Shri, Patkar Shraddha, Chhatrala Renish, Baheti Akshay D, Haria Purvi, Kolhe Manjushree, Bhandare Manish, Chaudhari Vikram, Shrikhande Shailesh V
Department of Gastrointestinal and Hepatobiliary-Pancreatic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.
Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.
J Gastrointest Cancer. 2025 May 27;56(1):123. doi: 10.1007/s12029-025-01245-5.
This study aimed to assess the diagnostic accuracy of multidetector contrast-enhanced computerised tomography (MDCT) and to establish a correlation between radiological and histopathological staging in upfront resected localised gastric cancers (GC).
All consecutive patients of resectable, localised GC who underwent upfront elective resection between 2010 and 2022 were included. The initial clinical staging determined during multidisciplinary meetings was compared with the pathological stage obtained after surgery. Subsequently, a retrospective, blinded review was conducted to assign a revised clinical staging, and accuracy was correlated.
The analysis of 138 patients revealed varying accuracy of MDCT in determining the T stage (66.9% for T1/T2, 64.6% for T3, and 87.2% for T4) and N stage (60.8% for N0, 63.7% for N1, and 83.2% for N2). The accuracy for stage group ranged from 71 to 78.65%. There was weak agreement observed between the T, N, and overall stage on clinicopathological correlation. However, a blinded radiology review by oncoradiologists resulted in improved accuracy, particularly in T1/T2 disease, and also improved pathological stage correlation.
Although MDCT is a valuable initial staging tool for gastric cancer, we found weak agreement between the clinical and the pathological stages in upfront resected gastric cancers. By implementing an expert radiology review and standardising scanning and reporting protocols, we can significantly improve the accuracy and correlation of MDCT with pathology, even for T1/T2 disease. This may help in better selecting patients for upfront surgery versus perioperative chemotherapy, especially in resource-constrained settings.
本研究旨在评估多排探测器增强计算机断层扫描（MDCT）的诊断准确性，并建立术前切除的局限性胃癌（GC）的放射学分期与组织病理学分期之间的相关性。
纳入2010年至2022年间所有接受术前择期切除的可切除局限性GC连续患者。将多学科会议期间确定的初始临床分期与手术后获得的病理分期进行比较。随后，进行回顾性、盲法审查以确定修订后的临床分期，并对准确性进行相关性分析。
对138例患者的分析显示，MDCT在确定T分期（T1/T2期为66.9%，T3期为64.6%，T4期为87.2%）和N分期（N0期为60.8%，N1期为63.7%，N2期为83.2%）方面的准确性各不相同。分期组的准确性范围为71%至78.65%。在临床病理相关性方面，T、N和总体分期之间观察到较弱的一致性。然而，肿瘤放射科医生进行的盲法放射学审查提高了准确性，特别是在T1/T2期疾病中，并且还改善了病理分期相关性。
尽管MDCT是胃癌有价值的初始分期工具，但我们发现术前切除的胃癌临床分期与病理分期之间的一致性较弱。通过实施专家放射学审查并标准化扫描和报告方案，我们可以显著提高MDCT与病理学的准确性和相关性，即使对于T1/T2期疾病也是如此。这可能有助于更好地选择适合术前手术与围手术期化疗的患者，特别是在资源有限的环境中。
