scholarly journals Gastric Adenocarcinoma: Is Computed Tomography (CT) Useful in Preoperative Staging?

2009 ◽  
Vol 3 ◽  
pp. CMO.S2641 ◽  
Author(s):  
Ssther Uña Cidón ◽  
Isabel Jiménez Cuenca
Keyword(s):  
Gastric Cancer ◽  
Gastric Adenocarcinoma ◽  
Predictive Value ◽  
Gastric Wall ◽  
Preoperative Staging ◽  
Spiral Ct ◽  
Accurate Method ◽  
Lymph Node Involvement ◽  
Wall Thickening ◽  
Curative Surgery

Background and Purpose Although multiple studies testing the accuracy of CT in the preoperative staging of gastric adenocarcinoma have been carried out, their results are controversial. Whilst some authors claim that CT is an accurate method for preoperatively staging gastric cancer, others have advocated the contrary. Because of this discrepancy we have retrospectively reviewed preoperative CT findings compared with histopathological results in patients with gastric adenocarcinoma. Patients and Methods Seventy-two patients diagnosed with gastric cancer who underwent potentially curative surgery and preoperative staging CT of quality were included in the study. The size, gastric wall thickening, presence of lymphadenopathy, adjacent organ invasion and location of the gastric mass was recorded. Early tumors (T1 and T2) and more advanced tumors (T3 and T4) were grouped together. CT staging was correlated with the final histopathological stage (TNM). The global results were expressed as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results Seventy-two cases were included with fifty-five being male and a median age of 67 years (range 33–91). CT correctly identified the location of the tumor in 56 (53% antropyloric, 18% subcardial). Median time from CT scan to surgery was fourteen days (range 2–49). In T detection: T1/T2 and T3/T4 with sensitivity of 70% and 61%. Lymph node involvement: Sensitivity 49%. Overstaged in 47% Understaged in 75%. Specificity of 53%. Nine patients with colon-mesocolon (5 patients) and pancreas (4 patients) invasion. Sensitivity 44% and specificity 96%. Conclusion Spiral CT is not an accurate method in predicting preoperative stages in gastric cancer.

Gastric Wall Thickening on Spiral CT after Subtotal Gastrectomy for Gastric Cancer: Comparision between Recurrent Cancer and Benign Thickening

2000 ◽  
Vol 43 (6) ◽  
pp. 735
Author(s):  
Chang Sook Park ◽  
Jong Cheol Choi ◽  
Sung Kuk Yoon ◽  
Jae Ik Kim ◽  
Jong Young Oh ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Gastric Wall ◽  
Subtotal Gastrectomy ◽  
Spiral Ct ◽  
Wall Thickening ◽  
Recurrent Cancer

Helical CT Findings of Gastric Wall Thickening by Peptic Ulcer: Compared with Gastric Adenocarcinoma with Ulcer

2000 ◽  
Vol 42 (2) ◽  
pp. 281
Author(s):  
Won Jung Jung ◽  
Jong Chul Choi ◽  
Keum Soo Seo ◽  
Bon Sik Koo ◽  
Byeong Ho Park ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Gastric Adenocarcinoma ◽  
Gastric Wall ◽  
Helical Ct ◽  
Wall Thickening ◽  
Ct Findings

scholarly journals The Application Value of ceMDCT in the Diagnosis of Gastric Cancer Extramural Vascular Invasion and Its Influencing Factors

2022 ◽  
Vol 2022 ◽  
pp. 1-5
Author(s):  
Shifeng Yang ◽  
Xiaoming Zou ◽  
Jiacheng Li ◽  
Ange Zhang ◽  
Lei Zhu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Influencing Factors ◽  
Growth Pattern ◽  
Predictive Value ◽  
Vascular Invasion ◽  
Spiral Ct ◽  
Multislice Spiral Ct ◽  
Tumour Diameter ◽  
Kappa Value ◽  
Sensitivity Specificity

Objective. To investigate the value of enhanced multislice spiral CT (ceMDCT) in the diagnosis of extramural vascular invasion of gastric cancer and the influencing factors of extramural vascular invasion. There are different methods used in this paper. Method. 131 patients with primary gastric cancer treated in our hospital from January 2017 to May 2019 were selected. All patients underwent surgical resection and ceMDCT examination before operation. Result. There were 40 cases with extramural vascular invasion of gastric cancer by surgical pathological diagnosis. The kappa value of ceMDCT in diagnosing extramural vascular invasion of gastric cancer was 0.947, and the consistency was excellent. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value were 100.00%, 96.70%, 93.02%, and 100.00%, respectively. The proportions of T3-T4, tumour diameter ≥5.0 cm, and growth pattern of proximal nodular + diffuse type in patients with gastric cancer extramural vascular invasion were 92.50%, 85.00%, and 65.00%, respectively, which were significantly higher than those in patients without extramural vascular invasion ( P < 0.05 ). The logistic regression analysis results showed that T3-T4, tumour diameter ≥5.0 cm, proximal nodular + diffuse growth pattern were the risk factors for extrahepatic vascular invasion in gastric cancer (OR = 3.751, 2.901, and 3.367, P < 0.05 ). Conclusion. ceMDCT has good application value in diagnosing gastric cancer extramural vascular invasion. The occurrence of gastric cancer extramural vascular invasion is affected by T staging, tumour diameter, and tumour growth pattern.

scholarly journals Computed tomography with a stomach protocol and virtual gastroscopy in the staging of gastric cancer: an initial experience

2018 ◽  
Vol 51 (4) ◽  
pp. 211-217 ◽  
Author(s):  
Maria Fernanda Arruda Almeida ◽  
Leonardo Verza ◽  
Almir Galvão Vieira Bitencourt ◽  
Camila Silva Boaventura ◽  
Paula Nicole Vieira Pinto Barbosa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Computed Tomography ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Multidetector Computed Tomography ◽  
Gastric Adenocarcinoma ◽  
Preoperative Staging ◽  
Lymph Node Staging ◽  
Virtual Gastroscopy ◽  
Staging Of Gastric Cancer

Abstract Objective: To evaluate the accuracy of multidetector computed tomography with a stomach protocol in staging of gastric cancer. Materials and Methods: We evaluated 14 patients who underwent computed tomography in a 16-channel scanner for preoperative staging of gastric adenocarcinoma between September 2015 and December 2016. All images were analyzed by the same radiologist, who had extensive experience in abdominal cancer imaging. The sensitivity, specificity, and accuracy of the method were calculated by comparing it with the pathology result. All patients underwent partial or total gastrectomy. Results: The mean age was 61.5 years, and 53.8% of the patients were male. The gastric lesions were classified as T1/T2 in 35.7% of the cases, as T3 in 28.5%, and as T4 in 35.7%. Eleven patients (68.7%) had suspicious (N positive) lymph nodes. The accuracy of the T1/T2, T3, T4, and lymph node staging tests was 85%, 78%, 90%, and 78%, respectively. The respective sensitivity and specificity values were 71% and 100% for T1/T2, 66% and 81% for T3, 100% and 90% for T4, and 88% and 60% for lymph nodes. Conclusion: Multidetector computed tomography with a stomach protocol, used in conjunction with virtual gastroscopy, shows good accuracy in the tumor and lymph node staging of gastric adenocarcinoma.

scholarly journals Direct Liver Invasion from a Gastric Adenocarcinoma as an Initial Presentation of Extranodal Tumor Spread

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Mitanshu Shah ◽  
Apsara Prasad ◽  
Dhyan Rajan ◽  
Christopher B. Tan ◽  
Mansi Shah ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Gastric Adenocarcinoma ◽  
Gastric Wall ◽  
Initial Presentation ◽  
Treatment Modalities ◽  
Curative Intent ◽  
Initial Manifestation ◽  
Tumor Spread ◽  
Direct Invasion ◽  
Wall Perforation

Gastric cancer often carries a poor prognosis, with an estimated 740,000 deaths from the malignancy occurring yearly worldwide (Dicken et al., 2005). The mortality of disease is largely dependent on the extent of tumor spread, as gastric cancer has a predilection to metastasize to other visceral secondaries via hematogenous and lymphatic dissemination. Direct invasion of a gastric adenocarcinoma to adjacent organs secondary to gastric wall perforation does occur; however, it is often present in the setting of advanced disease. Rarely does direct tumor invasion to adjacent organs from a gastric adenocarcinoma present as the initial manifestation of extranodal tumor spread. We present a case of a 40-year-old male with direct tumor extension to the liver as an initial presentation of extranodal tumor spread from a gastric adenocarcinoma. Clinicians should be aware of such an occurrence, as treatment modalities in direct liver extension from a gastric adenocarcinoma vary and may be directed towards palliation rather than curative intent.

Madelung's Disease as the First Presentation of an Occult Gastric Adenocarcinoma

2015 ◽  
Vol 100 (9-10) ◽  
pp. 1323-1325
Author(s):  
Livia S. Smidt ◽  
Cleber D. P. Kruel ◽  
Marcio F. Chedid
Keyword(s):  
Gastric Cancer ◽  
Gastric Adenocarcinoma ◽  
Frozen Section ◽  
Gastric Wall ◽  
Subtotal Gastrectomy ◽  
Signet Ring Cell ◽  
Pathology Report ◽  
Madelung's Disease ◽  
Madelung’S Disease ◽  
Signet Ring

Madelung's disease is a rare disorder defined as cervical benign symmetric lipomatosis. Its association to alcoholism, pulmonary pathology, and neck cancer has been reported. We first describe the occurrence of this syndrome during the course of a gastric cancer. A 65-year-old white Latino male patient was referred to our service for investigation of dyspeptic symptoms, weight loss, and small bilateral symmetric and painless cervical masses. Upper endoscopy revealed a pyloric ulcer, treated with a 3-month regimen of antibiotics and omeprazole. A new endoscopy revealed persistence of the gastric ulcer, and biopsy pathology report showed chronic inflammatory changes but no malignant cells. Two months after the biopsy, the patient was admitted to the Emergency unit for gastric obstruction. Gastric wall enlargement and distention were found at the operation. Intraoperative frozen section gastric biopsy was inconclusive. Resection was not performed and a gastroenteric anastomosis was constructed. Definitive pathology report revealed gastric adenocarcinoma with signet-ring cells. Thus, the patient underwent subtotal gastrectomy. Definitive pathology report confirmed diffuse signet-ring cell gastric cancer with duodenal invasion; 1 lymph node was positive for cancer. Postoperative course was uneventful, and adjuvant chemotherapy was performed. Gastric cancer recurred and the patient died 2 years after the operation. Madelung's disease did not show any progress during the disease-free period. Madelung's disease has been associated with head and neck cancers and now with gastric adenocarcinoma. We suggest that patients presenting with cervical lipomatosis also should be screened for occult gastric cancer and abdominal malignancy.

Safety in numbers? Gastric cancer survival varies with total retrieved lymph nodes.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 4058-4058
Author(s):  
Omidreza Tabatabaie ◽  
Gyulnara G. Kasumova ◽  
Stijn van Roessel ◽  
Promise Ukandu ◽  
Sing Chau Ng ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Gastric Adenocarcinoma ◽  
Cox Proportional Hazards ◽  
Curative Surgery ◽  
Lymph Node Count ◽  
Risk Of Death ◽  
Lymph Node Retrieval

4058 Background: Recently published AJCC 8thTNM-staging guidelines recommend a minimum of 16 lymph nodes be assessed in gastric cancer surgery with more lymph nodes ( 30) being desirable. However, the independent effects of greater numbers of lymph nodes excised on the overall survival of patients with gastric adenocarcinoma are understudied. Methods: National Cancer Database (NCDB) was reviewed from 2010 to 2014 for patients who underwent potentially curative surgery for gastric adenocarcinoma. Patients with zero or unknown number of harvested lymph nodes were excluded, as were those with metastatic or in-situ disease, or who received neoadjuvant chemo- or radiotherapy. Cox proportional hazards modeling was used for multivariate survival analysis. Results: Of the 12,507 patients who met selection criteria, 4,880 (39.0%) were female. The median age was 69 years [IQR: 59-77]. Median number of lymph nodes examined for each clinical T and N-stage is provided in the table. Overall, 51.0% of patients had < 16 lymph nodes examined. After adjusting for clinical T and N-stages, sex, age, tumor size, grade, facility type, receipt of adjuvant chemotherapy, resection type and race, and compared to patients with < 16 nodes examined, the hazard ratios for death in patients with 16-29, 30-44 and ≥45 examined lymph nodes were 0.87 (95% CI = 0.82-0.93), 0.79 (95% CI = 0.71-0.88) and 0.68 (95% CI = 0.56-0.83), respectively. Conclusions: Total lymph node count is an important independent predictor of overall survival in resectable gastric cancer, with an increased number of excised lymph nodes being associated with progressively decreased risk of death. These findings support the latest AJCC guidelines that higher number of lymph node retrieval is desirable. The recommended oncologic standard for at least 16 nodes to be assessed pathologically is not attained in more than half of upfront gastric resections performed for cancer. [Table: see text]

Multi-detector Row Computed Tomography (MDCT) versus Endorectal Coil Magnetic Resonance Imaging (ECMRI) in Staging of Carcinoma Rectum

JMS SKIMS ◽  
2012 ◽  
Vol 15 (1) ◽  
pp. 32-38
Author(s):  
Nisar A Chowdri ◽  
Rayees Ahmad Dar ◽  
Fazl Qadir Parray ◽  
Feroze Shaheen ◽  
Sabiya Hamid Wani ◽  
...  
Keyword(s):  
Lymph Node ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Malignant Tumors ◽  
Preoperative Staging ◽  
Lymph Node Involvement ◽  
Resected Specimen ◽  
Diagnostic Modality ◽  
Endorectal Coil ◽  
Node Involvement

BACKGROUND: Rectal cancer is one of the most common tumors in industrialized countries and one of the most common malignant tumors of the gastrointestinal tract. OBJECTIVE: To compare the diagnostic accuracy of MDCT and ECMRI in preoperative staging of rectal cancers and correlation with intraoperative and histo-pathologic staging of resected specimen with respect to depth of tumor invasion (T-staging), lymph node metastasis (N- staging), and extra rectal spread (M-staging). METHODS: The study was a prospective one and consisted of 68 patients with biopsy proved rectal carcinoma. Patients were randomly selected for either of these two staging modalities (i.e., MDCT or ECMRI) using a random number table. MDCT and ECMRI findings were compared with intraoperative and histopathologic (reference standard) findings. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of each diagnostic modality were assessed. RESULTS: The diagnostic accuracies of MDCT and ECMRI for T1/T2 lesions were 75% and 87.5%, respectively, the difference being significant. For T3 lesions, the diagnostic accuracies of MDCT and ECMRI were 85.2% and 100%, respectively. The diagnostic accuracy of both for T4 lesions was found to be 100%. Both ECMRI and MDCT were found to be almost equally accurate and specific in detecting perirectal lymph node involvement. CONCLUSION: Endorectal coil MRI is superior to MDCT in local (T) staging of tumor and has overall more diagnostic accuracy, sensitivity and specificity than MDCT. ECMRI has a less tendency to under-stage the disease. However, both ECMRI and MDCT are almost equally accurate and specific in detecting perirectal lymph node involvement. JMS 2012;15(1):32-38.

Immunoglobulin G4 (IgG4)-related disease of the stomach – a challenging differential diagnosis in suspected gastric cancer

2019 ◽  
Vol 57 (11) ◽  
pp. 1298-1303 ◽  
Author(s):  
Andreas Probst ◽  
Tina Schaller ◽  
Florian Sommer ◽  
Bernd Geissler ◽  
Abbas Agaimy ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Surgical Resection ◽  
Gastric Wall ◽  
Elevated Serum ◽  
Gastric Ulcers ◽  
Wall Thickening ◽  
Immunoglobulin G4 ◽  
Female Patients ◽  
Related Disease ◽  
Serum Igg4

Abstract Background Immunoglobulin G4-related disease (IgG4-RD) can involve different organs and is diagnosed by a combination of clinicopathological features, including storiform fibrosclerosis infiltrated by numerous IgG4-positive plasma cells that frequently forms tumor-like lesions with or without associated obliterative phlebitis. Involvement of the stomach is rare and can occur as part of a multiorgan involvement of IgG4-RD or as isolated gastric involvement. Case report We report 2 female patients with therapy-refractory gastric ulcers associated with gastric wall thickening and lymphadenopathy that were highly suggestive of gastric cancer or lymphoma. Biopsies failed to confirm a diagnosis, and IgG4-RD was diagnosed only after surgical resection in both patients. The previous literature on gastric IgG4-RD is summarized and shows different characteristics in patients with multiorgan IgG4-RD and isolated gastric IgG4-RD. As reported for autoimmune pancreatitis type 1, patients with multiorgan IgG4-RD are mainly elderly men with frequently elevated serum IgG4 concentrations. In contrast, isolated gastric IgG4-RD predominantly affects female patients with normal serum IgG4 levels. Surgical resection is commonly performed due to the clinical suspicion of malignancy and the absence of findings indicative of IgG4-RD on biopsy. Today, diagnosis is confirmed histopathologically only after resection. Conclusion IgG4-RD should be taken into account when gastric malignancy is suspected endoscopically or radiologically and biopsies fail to confirm the presence of a malignancy (especially subepithelial tumors or refractory gastric ulcers). Serum IgG4 concentrations are insufficient to confirm localized gastric IgG4-RD. Diagnostic workups need to be improved to avoid unnecessary surgical resections with the attendant potential morbidity and mortality.

scholarly journals Diagnostic value of MRI-DWI signal intensity value combined with serum PGI, PGII and CA199 in early gastric cancer

2021 ◽  
Vol 67 (2) ◽  
pp. 95-100
Author(s):  
Minhong Li ◽  
GuangHui Zheng ◽  
Lin Yu ◽  
Li-lian Tan ◽  
Xi Li ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Signal Intensity ◽  
Statistical Significance ◽  
Gastric Wall ◽  
Diagnostic Value ◽  
Wall Thickening ◽  
Healthy Group ◽  
Cancer Group ◽  
Gastric Cancer Group

To explore the diagnostic value of MRI-DWI signal intensity value combined with serum PGI. PGII and CA199 in early gastric cancer. Sixty cases of gastric cancer patients admitted to our hospital from December 2019 to December 2020 were selected as the gastric cancer group and 80 cases of healthy volunteers who underwent physical examination in our hospital during the same period were selected as the healthy group. All the 60 patients underwent MRI-DWI examination, and the pathological diagnosis results were regarded as the gold standard. MRI-DWI images, MRI-DWI signal intensity values of patients with different degrees of gastric cancer differentiation. Serum PGI, PGII and CA199 levels of subjects in the two groups were compared. AUC was used to evaluate the diagnostic value of MRI-DWI signal intensity value combined with serum PGI, PG II and CA199 for early gastric cancer. In the healthy group, T1W1 showed relatively uniform low signal intensity. While T2WI showed no significant increase in signal intensity. In the gastric cancer group. There was diffuse gastric wall thickening, local thickening or mass formation; T1WI and WATS showed slightly lower signal intensity in the lesion area. T2WI, FLAIR and B-TFE showed slightly uneven or moderately increased signal intensity. DWI showed limited diffusion, and the signal intensity increased uniformly or more uniformly, and the range of increase was clear. The signal intensity of MRI-DWI was 89.12 ± 8.14 in patients with low differentiation, 82.17 ± 6.35 in patients with moderate differentiation, and 74.52 ± 4.53 in patients with high differentiation. There were significant differences in the signal intensity of MRI-DWI among the three groups, and the difference was statistically significant (F=12.214, P <0.05). Serum PGI levels of subjects in the gastric cancer group were significantly lower than those in the healthy group, and the levels of PGII and CA199 were significantly higher than that in the healthy group, with statistical significance (P <0.05). The AUC, sensitivity and specificity of MRI-DWI signal intensity value and serum PGI, PGII and CA199 combined indexes in the diagnosis of gastric cancer were significantly higher than those of the independent indexes, with statistical significance (P <0.05). Conclusion: MRI-DWI signal strength value, serum PGI, PGII and CA199 levels are closely related to the occurrence and development of early gastric cancer. The combined detection and diagnosis efficiency is higher, which is helpful to improve the detection rate of early gastric cancer and is worthy of extensive clinical application.

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