Hydro-dynamic CT preoperative staging of gastric cancer: correlation with pathological findings. A prospective study of 107 cases
Hydro-dynamic CT preoperative staging of gastric cancer: correlation with pathological findings. A prospective study of 107 cases
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DOI：
10.1007/s003300000537
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发表时间：
2000-01-01
影响因子：
5.9
通讯作者：
Grani, M
中科院分区：
文献类型：
--
作者：
D'Elia, F;Zingarelli, A;Grani, M
本研究的目的是评价动态CT在胃癌术前分期中的准确性。107名通过内窥镜活检诊断为癌症的患者在肿瘤切除前通过动态CT进行了前瞻性分期。在口服400-600 ml自来水和静脉输注低渗剂后，使用双相技术通过动力注射器给予200 ml非离子型造影剂。前瞻性分析CT表现，并与手术病理结果相关联。动态CT对早期和进展期胃癌肿瘤检测的准确性分别为80%和99%，总体检出率为96%（103/107）。3例早期（pT 1）和1例晚期（pT 2）癌症未检出。107例患者中，83例动态CT确定的肿瘤分期与病理结果一致，总体准确率为78%。早期和晚期癌症中，CT检测肿瘤浸润深度增加程度与病理TNM分期相比的准确性分别为20%（3/15）和87%（80/92）。CT在术前分期（pT 3-pT 4 vs pT 1-pT 2）中的敏感性、特异性和准确性分别为93%、90%和91.6%。CT诊断区域淋巴结转移的敏感性、特异性和准确性分别为97.2%、65.7%和87%。计算机断层扫描对107例患者中的105例进行了正确的肝转移分期，总体敏感性为87.5%，特异性为99%。当无腹水或腹膜结节时，腹膜受累的敏感性为30%.我们的研究结果表明，动态CT可以发挥作用，术前定义胃癌分期。结果可用于在手术前优化每位患者的治疗策略，从而避免不必要的干预，并允许对符合条件的患者仔细规划延长手术。
The aim of this study was to evaluate the accuracy of dynamic CT in the preoperative staging of gastric cancer. One hundred seven patients affected cancer diagnosed by endoscopic biopsy were prospectively staged by dynamic CT prior to tumor resection. After an oral intake of 400-600 ml of tap water and an intravenous infusion of a hypotonic agent, 200 ml of non-ionic contrast agent were administered by power injector using a biphasic technique. The CT findings were prospectively analyzed and correlated with the pathological findings at surgery. The accuracy of dynamic CT for tumor detection was 80 and 99 % in early and advanced gastric cancer, respectively, with overall detection rate of 96 % (103 of 107). Three early (pT1) and one advanced (pT2) cancers were undetected. Tumor stage as determined by dynamic CT agreed with pathological findings in 83 of 107 patients with an overall accuracy of 78 %. The accuracy of CT in detecting increasing degrees of depth of tumor invasion when compared with pathological TNM staging was 20 % (3 of 15) and 87 % (80 of 92) in early and advanced cancer, respectively. The sensitivity, specificity, and accuracy of CT in the preoperative staging (pT3-pT4 vs pT1-pT2) was 93, 90, and 91.6 %, respectively. The sensitivity, specificity, and accuracy of CT in assessing metastasis to regional lymph nodes was 97.2, 65.7, and 87 %, respectively. Computed tomography correctly staged liver metastases of 105 of 107 patients with an overall sensitivity of 87.5 % and specificity of 99 %. The sensitivity of peritoneal involvement was 30 % when ascites or peritoneal nodules were absent. Our findings show that dynamic CT can play a role in the preoperative definition of gastric cancer stage. The results can be used to optimize the therapeutic strategy for each individual patient prior to surgery, thus avoiding unnecessary intervention and allowing careful planning of extended surgery in eligible patients.