Diagnostic validity of CT gastrography versus gastroscopy for primary lesions in gastric cancer: evaluating the response to chemotherapy, a retrospective analysis
Diagnostic validity of CT gastrography versus gastroscopy for primary lesions in gastric cancer: evaluating the response to chemotherapy, a retrospective analysis
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DOI：
10.1007/s10120-012-0217-7
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发表时间：
2013-10-01
期刊：
影响因子：
7.4
通讯作者：
Kato, Junji
中科院分区：
文献类型：
--
作者：
Takahashi, Sho;Hirayama, Michiaki;Kato, Junji
本回顾性研究旨在比较CT胃造影和传统光学胃镜检查对胃癌原发灶化疗的疗效。对于原发性病变，根据日本胃癌分类（JCGC）标准第13版和实体瘤疗效评价标准（RECIST），在化疗后进行CT胃造影和内窥镜评估。对包括淋巴结在内的转移性实性病灶，根据RECIST标准进行CT评估，对23例患者的资料进行分析。中位随访时间为9.4个月（范围2-23个月），通过GS和CT胃造影评估了58次检查。以光学内镜结果为金标准，根据JCGC第13版标准，CT胃造影对原发性胃病变的准确性为77.6%（45/58）（加权kappa = 0.72; P < 0.01），根据RECIST标准，准确性为90.0%（52/58）（加权kappa = 0.75; P < 0.01）。当所有结果分为两组[非进展性疾病（非PD）组和PD组]时，准确性为93.1%（52/58）（kappa = 0.81; P < 0.01），灵敏度为100%，特异性为75.0%（12/16）。此外，PD的可预测性为100%（12/12）。4例规格失败的病例如下：1例残胃癌，1例胃扩张不足，1例狭窄和瘢痕愈合，1例检查位置选择错误。PD发生的时间平均为9.9个月（5-18个月），GS与CT胃造影的一致性时间为7.2个月，两者具有良好的一致性。CT胃造影在准确性和100% PD预测性方面显示出有利的结果，这意味着在化疗后评估中使用CT胃造影作为内窥镜评估的替代品的可能性。
This retrospective study was carried out to compare computed tomographic (CT) gastrography and conventional optical gastroscopy (GS) in order to evaluate the effectiveness of chemotherapy in primary gastric lesions.Patients with unresectable advanced and unresected early gastric cancer who had primary lesions and had received chemotherapy were enrolled. For primary lesions, CT gastrography and endoscopic assessment were done after chemotherapy, based on the Japanese Classification of Gastric Carcinoma (JCGC) criteria, 13th edition, and the Response Evaluation Criteria in Solid Tumors (RECIST). For metastatic solid lesions including lymph nodes, CT assessment was done based on the RECIST criteria.Data from 23 patients were analyzed. With median follow-up of 9.4 months (range 2-23 months), 58 examinations were assessed by GS and CT gastrography. Setting optical endoscopic results as the gold standard, the accuracy of CT gastrography for primary gastric lesions was 77.6 % (45 of 58) (weighted kappa = 0.72; P < 0.01) according to the JCGC 13th edition criteria and 90.0 % (52 of 58) (weighted kappa = 0.75; P < 0.01) according to the RECIST. When all results were divided into two groups [the non-progressive disease (non-PD) group and PD group], accuracy was 93.1 % (52 of 58) (kappa = 0.81; P < 0.01), sensitivity was 100 %, and specificity was 75.0 % (12 of 16). In addition, the predictability of PD was 100 % (12 of 12). The four cases of failure in specification were the following: a case of gastric remnant cancer, a case with insufficient distension of the stomach, a healed case with stenosis and scarring, and a case in which the wrong position had been selected for the examination. The average period until PD was 9.9 months (range 5-18 months), and the concordance period between GS and CT gastrography was 7.2 months in both non-PD and PD cases.There was good concordance between the evaluations of GS and CT gastrography. CT gastrography exhibited favorable results in accuracy as well as 100 % PD predictability, which implied the possibility of using CT gastrography as a substitute for endoscopic assessments at post-chemotherapy assessments.