Sensitivity, specificity, and predictive value of laparoscopy for the staging of gastric cancer and for the detection of liver metastases

Objective: To investigate the correlations between dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) perfusion histogram parameters and vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) expressions in advanced gastric cancer (AGC).Methods: This retrospective study included 80 pathologically confirmed patients with AGC who underwent DCE-MRI before surgery from February 2017 to May 2021. The DCE-MRI perfusion histogram parameters were calculated by Omni Kinetics software in four quantitative parameter maps. Immunohistochemical methods were used to detect VEGF and EGFR expressions and calculate the immunohistochemical score.Results: VEGF expression was relatively lower in patients with intestinal-type AGC than those with diffuse-type AGC (p < 0.05). For VEGF, Receiver operating characteristics (ROC) curve analysis revealed that Quantile 90 of Ktrans, Meanvalue of Kep and Quantile 50 of Ve provided the perfect combination of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for distinguishing high and low VEGF expression, For EGFR, Skewness of Ktrans, Energy of Kep and Entropy of Vp provided the perfect combination of sensitivity, specificity, PPV and NPV for distinguishing high and low EGFR expression. Ktrans (Quantile 90, Entropy) showed the strongest correlation with VEGF and EGFR in patients with intestinal-type AGC (r = 0.854 and r = 0.627, respectively); Ktrans (Mean value, Entropy) had the strongest correlation with VEGF and EGFR in patients with diffuse-type AGC (r = 0.635 and 0.656, respectively).Conclusion: DCE-MRI perfusion histogram parameters can serve as imaging biomarkers to reflect VEGF and EGFR expressions and estimate their difference in different Lauren classifications of AGC.

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Use of Diffusion-Weighted Magnetic Resonance Imaging and Apparent Diffusion Coefficient in Gastric Cancer Staging

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616666200218124926 ◽

2020 ◽

Vol 16 ◽

Cited By ~ 1

Author(s):

Levent Soydan ◽

Ali Aslan Demir ◽

Mehmet Torun ◽

Makbule Arar Cikrikcioglu

Keyword(s):

Magnetic Resonance Imaging ◽

Gastric Cancer ◽

Diffusion Coefficient ◽

Resonance Imaging ◽

Quantitative Parameter ◽

Apparent Diffusion ◽

Adc Values ◽

Weighted Magnetic Resonance Imaging ◽

Staging Of Gastric Cancer ◽

Sensitivity Specificity

Background: The apparent diffusion coefficient (ADC), the quantitative parameter of diffusion-weighted magnetic resonance imaging (DW-MRI), is a measure for this restricted diffusion, and its role in gastric cancer (GC) including distinguishing malignant segments from healthy gastric wall, metastatic perigastric lymph nodes from benign nodes and evaluating response of GC to neoadjuvant chemotherapy has been investigated in previous studies. Evidence suggests that ADC may also be of help in assessment of aggressiveness and preoperative staging of gastric cancer, which needs to be explored in further studies. Objective: To investigate the role of DW-MRI and its quantitative parameter, ADC in staging of gastric cancer. Methods: Forty-six patients (28 male, 18 female, mean age 62 years) with non-metastatic biopsy-proven GC who underwent abdominal DW-MRI before surgery were included in this retrospective study. Tumor invasion depth (T-stage) and nodal involvement (N-stage) were evaluated using signal increase on DW-MRI, and tumor ADC was measured. Diagnostic performance of these results was assessed by comparing them with postsurgical histopathology based on 8th TNM classification. Results: Sensitivity, specificity, and accuracy of DW-MRI in T-staging were 92.1%, 75%, 89.1% for ≤T2 vs. ≥T3; and 75%, 88.5%, 82.6% for ≤T3 vs. T4. However, sensitivity, specificity, and accuracy of DW-MRI in N-staging were 89.3%, 88.9%, 89.1% for ≤N1 vs. ≥N2; and 73.7%, 96.3%, 86.9% for ≤N2 vs. N3, respectively. Relative preoperative ADC values correlated with pT staging (r=-0.397, p=0.006). There was also a statistically significant difference of relative ADC values between ≤T3 and T4 stages, and a cut-off of 0.64 s/mm2 could differentiate these stages with an odds ratio of 7.714 (95% confidence interval, 1.479-40.243). The area under the receiver operating characteristic curve for differentiating ≤T3 and T4 stages was 0.725. Conclusion: DW-MRI may contribute to the clinical staging of non-metastatic GC. In particular, relative ADC of DW-MRI can distinguish T4 gastric cancer from less advanced T-stages.

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Is D2 surgery necessary for clinical T1 gastric cancer with nodal swelling?

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.288 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 288-288

Author(s):

Takeyuki Wada ◽

Takaki Yoshikawa ◽

Ayako Kamiya ◽

Keichi Date ◽

Tsutomu Hayashi ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Positive Predictive Value ◽

Predictive Value ◽

False Positive ◽

False Positive Rate ◽

False Positivity ◽

Positive Rate ◽

D2 Surgery ◽

Sensitivity Specificity

288 Background: D2 surgery is required for clinical T1 gastric cancer with nodal swelling, however, D2 has a higher risk for morbidity than D1/D1+. Moreover, previous study demonstrated that the false positive rate for nodal diagnosis in clinical T1 was very high. To select optimal surgery with high probability, we explored risk factors for false positivity in clinical T1 disease. Methods: Patients who underwent radical gastrectomy for clinical T1 gastric cancer between April 2015 and June 2019 were enrolled. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive values for nodal diagnosis were retrospectively investigated. The risk factors for false positivity were also analyzed by the following factors; age, sex, histological type, tumor size, tumor depth, location, tumor type, presence of ulcer, and timing of CT that is (1) the patients who underwent primary endoscopic mucosal dissection (ESD) but resulted in non-curative resection, then received CT to proceed to surgery (delayed CT group) or (2) the other patients who had received CT before primary surgery or before non-curative ESD (primary CT group). Results: A total of 679 patients were examined in the present study. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 83.5% (567/679), 14.3% (13/91), 94.2% (554/588), 27.7% (13/47), and 87.7% (554/632), respectively. The false positive rate was 72.3% (34/47). In univariate analysis, differentiated tumor ( p= 0.012) and delayed CT (p < 0.001) were associated with the false positivity. Multivariate analysis revealed that delayed CT (OR, 4.534; p < 0.001) was a sole significant risk factor for false positivity. False positive rate was 100% (13/13) in the delayed CT group and 61.8% (21/34) in the primary CT group ( p= 0.009). Conclusions: False positive rate was high in clinical T1 disease, especially when the patients received delayed CT after non-curative ESD. D2 surgery would be unnecessary even though nodal swelling was detected in CT after non-curative ESD.

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Pre-operative laparoscopic staging of gastric cancer in patients who are candidates for neo-adjuvant chemotherapy: A Cross Sectional Study

BioMolecular Concepts ◽

10.1515/bmc-2019-0008 ◽

2019 ◽

Vol 10 (1) ◽

pp. 68-72

Author(s):

Kourosh Ghanadi ◽

Hormoz Mahmoudvand ◽

Ali Bakhtiari ◽

Mojtaba Gorji ◽

Nasroallah Moradi-kor ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

Predictive Value ◽

Cancer Staging ◽

Cross Sectional Study ◽

Sectional Study ◽

Operative Laparoscopy ◽

Cross Sectional ◽

Neo Adjuvant Chemotherapy ◽

Sensitivity Specificity

AbstractObjectiveThe aim of this study is to evaluate the laparoscopic method in gastric cancer staging before surgery in patients undergoing Neo-adjuvant chemotherapy.MethodsThis was a cross-sectional study on patients with T3-T4 and node positive non-metastatic gastric adenocarcinoma who was candidates for neo-adjuvant chemotherapy. The patients were excluded from the study when they were not in the condition to continue the study. All eligible patients underwent metastases work up by abdominal, pelvic and chest CT scans and then received neo-adjuvant chemotherapy. Pre-operative laparoscopy was performed before definitive surgery. The collected data was analyzed using SPSS software. The statistical significance, sensitivity, specificity and predictive values were calculated from this data.ResultsIn this study, out of 50 patients, 26 (52%) were male. The mean age of the patients was 62.44 ± 12.136 years. Most tumors were located in one-third distal of stomach (21 patients, 42%). The accuracy of the laparoscopic method, to determine the degree of involvement of the lymph nodes, revealed that the method had a sensitivity of 84%, a specificity of 47.62%, a positive likelihood ratio (PLR) of 1.6, a negative likelihood ratio (NLR) of 0.33%, a positive predictive value of 65.62% and a negative predictive value of 71.43%. The accuracy of the laparoscopic method, regarding determining the presence or absence of metastasis, revealed that the method had a sensitivity, specificity, positive predictive value, and a negative predictive value of 100%.ConclusionBased on the evidence of this study, and other studies in this field, it seems that the use of a step-by-step combination methods in gastric cancer staging would be logical. Alone, no singular method would be sufficient in providing the physician with sufficient information to successfully stage the tumor and thus determine the appropriate treatment. Therefore, the combination of methods should be used which, in view of the economic constraints of health systems, would be recommended for high-risk patients for metastasis (N+/ T3-T4), diagnostic pre-operative laparoscopy.

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Gastric cancer detection using the serum pepsinogen test method

Tumori Journal ◽

10.1177/03008916211014961 ◽

2021 ◽

pp. 030089162110149

Author(s):

Dragan Trivanovic ◽

Stjepko Plestina ◽

Lorena Honovic ◽

Renata Dobrila-Dintinjana ◽

Jelena Vlasic Tanaskovic ◽

...

Keyword(s):

Gastric Cancer ◽

Early Detection ◽

Predictive Value ◽

Area Under The Curve ◽

Test Method ◽

Operating Characteristics ◽

Roc Curve Analysis ◽

Laboratory Assessment ◽

Pepsinogen I ◽

Sensitivity Specificity

Background: Gastric cancer (GC) is the eighth most common cause of cancer deaths in Croatia and one of the most common causes of cancer deaths worldwide. A reliable diagnostic tool for the early detection of GC is essential. Objective: We previously suggested a pepsinogen test method to reduce the mortality from GC by allowing early detection. Here, we report an updated analysis from a prospective single-center clinical study to evaluate the sensitivity and specificity of the pepsinogen test method and to determine whether this test can be used as a part of routine laboratory assessment of high-risk patients. Methods: We present mature data of the pepsinogen test method in the Croatian population after a median follow-up of 36 months. Statistical analyses were performed using a Mann-Whitney U test, multiple logistic regression, and receiver operating characteristics (ROC) to evaluate the predictive power of the assayed biomarkers. Results: Of the 116 patients, 25 patients had GC and 91 demonstrated a nonmalignant pathology based on tissue biopsy. Cutoff values were pepsinogen I ⩽70 and pepsinogen I/II ratio ⩽3.0. Using ROC curve analysis, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were determined to be 87.22%, 78.12%, 90.10%, 71.43%, and 92.86%, respectively, for the diagnosis of GC. The area under the curve was 0.700 (95% confidence interval 0.57–0.83). Conclusion: Pepsinogen tests are valuable for screening a population in need of further diagnosis and could help to avoid unnecessary invasive endoscopic procedures.

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The “Pink Pattern” Visualized in Magnifying Endoscopy with Narrow-Band Imaging is a New Feature of Early Gastric Differentiated Cancer——A Bridge Between Endoscopic Image and Histopathological Change

10.21203/rs.3.rs-596301/v1 ◽

2021 ◽

Author(s):

Shengsen Chen ◽

Jiangping Yu ◽

Rongwei Ruan ◽

Yali Tao ◽

Zhao Cui ◽

...

Keyword(s):

Gastric Cancer ◽

Epithelial Cells ◽

Predictive Value ◽

Color Change ◽

Narrow Band ◽

Narrow Band Imaging ◽

Magnifying Endoscopy ◽

Cosine Similarity ◽

Diagnostic Efficiency ◽

Sensitivity Specificity

Abstract Background A pink color change found occasionally by us under the magnifying endoscopy with narrow-band imaging (ME-NBI) may be a special feature of early gastric cancer (EGC), and it was named as “pink pattern”. The purposes of this study were to reveal the relationship between the “pink pattern” and the cytopathological changes of gastric cancer cells, and explore whether the pink pattern was useful for the diagnosis of EGC. Methods The color features of ME-NBI images and pathological images on gastric cancerous mucosal surface were extracted and quantized, and then the cosine similarity was calculated to evaluate the correlation between the pink pattern and the nucleus-to-plasm ratio of cancerous epithelial cells. Two diagnostic tests were performed by 12 endoscopists using stored ME-NBI images of 185 gastric lesions to investigate the diagnostic efficiency of “pink pattern” for EGC. The diagnostic values such as area under curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) between test 1 and test 2 were compared. Results The cosine similarity in 20 lesions between the color values of ME-NBI images and pathological images was at least 0.744. The median AUC, accuracy, sensitivity, specificity, PPV and NPV of test 2 were significantly improved compared with that of test 1 in all endoscopists, junior and experienced groups. Conclusions The “pink pattern” visualized in ME-NBI images is highly correlated with the nucleus-to-plasma ratio change of gastric epithelial cells, and it can be considered as a useful marker for the diagnosis of the differentiated EGC.

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“Pink Pattern” Visualized in Magnifying Endoscopy With Narrow-Band Imaging Is a Novel Feature of Early Differentiated Gastric Cancer: A Bridge Between Endoscopic Images and Histopathological Changes

Frontiers in Medicine ◽

10.3389/fmed.2021.763675 ◽

2021 ◽

Vol 8 ◽

Author(s):

Shengsen Chen ◽

Jiangping Yu ◽

Rongwei Ruan ◽

Yandong Li ◽

Yali Tao ◽

...

Keyword(s):

Gastric Cancer ◽

Epithelial Cells ◽

Predictive Value ◽

Color Change ◽

Narrow Band ◽

Narrow Band Imaging ◽

Magnifying Endoscopy ◽

Cosine Similarity ◽

Gastric Cancer Cells ◽

Sensitivity Specificity

Background: A pink color change occasionally found by us under magnifying endoscopy with narrow-band imaging (ME-NBI) may be a special feature of early gastric cancer (EGC), and was designated the “pink pattern”. The purposes of this study were to determine the relationship between the pink pattern and the cytopathological changes in gastric cancer cells and whether the pink pattern is useful for the diagnosis of EGC.Methods: The color features of ME-NBI images and pathological images of cancerous gastric mucosal surfaces were extracted and quantified. The cosine similarity was calculated to evaluate the correlation between the pink pattern and the nucleus-to-cytoplasm ratio of cancerous epithelial cells. Two diagnostic tests were performed by 12 endoscopists using stored ME-NBI images of 185 gastric lesions to investigate the diagnostic efficacy of the pink pattern for EGC. The diagnostic values, such as the area under the curve (AUC), the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), of test 1 and test 2 were compared.Results: The cosine similarity between the color values of ME-NBI images and pathological images of 20 lesions was at least 0.744. The median AUC, accuracy, sensitivity, specificity, PPV, and NPV of test 2 were significantly better than those of test 1 for all endoscopists and for the junior and experienced groups.Conclusions: The pink pattern observed in ME-NBI images correlated strongly with the change in the nucleus-to-cytoplasm ratio of gastric epithelial cells, and could be considered a useful marker for the diagnosis of differentiated EGC.

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

Journal of Healthcare Engineering ◽

10.1155/2022/4239600 ◽

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.

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Accuracy of Whole-Body Diffusion-Weighted MRI (WB-DWI/MRI) in Diagnosis, Staging and Follow-Up of Gastric Cancer, in Comparison to CT: A Pilot Study.

10.21203/rs.3.rs-99112/v1 ◽

2020 ◽

Author(s):

Sofie De Vuysere ◽

Vincent Vandecaveye ◽

Yves De Bruecker ◽

Saskia Carton ◽

Koen Vermeiren ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Predictive Value ◽

Peritoneal Metastases ◽

Whole Body ◽

Diffusion Weighted Mri ◽

Diffusion Weighted ◽

Sensitivity Specificity ◽

Malignant Lymph Nodes

Abstract Background: Accurate staging of patients with gastric cancer is necessary for selection of the most appropriate and personalized therapy. Computed Tomography (CT) is currently used as primary staging tool, being widely available with a relatively high accuracy for the detection of parenchymal metastases, but with low sensitivity for the detection of peritoneal metastases. Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) has a very high spatial and contrast resolution, suggesting a higher diagnostic performance in the detection of small peritoneal lesions. The aim of this study was to retrospectively evaluate the added value of whole-body diffusion-weighted MRI (WB-DWI/MRI) to CT for detection of peritoneal carcinomatosis (PC) and distant metastases in the preoperative staging of gastric cancer.Methods: This retrospective study included thirty-two patients with a suspicion of gastric cancer/recurrence, who underwent WB-DWI/MRI at 1.5 Tesla, in addition to CT of thorax and abdomen. Images were evaluated by two experienced abdominal radiologists in consensus. Histopathology, laparoscopy and/or 1-year follow-up were used as reference standard.Results: For overall tumor detection (n=32), CT sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was 83.3%, 100%, 100% and 82.4% respectively. For WB-DWI/MRI these values were 100%, 92.9%, 94.7% and 100%, respectively. For staging (n=18) malignant lymph nodes and metastases, CT had a sensitivity, specificity/ PPV/ NPV of 50%/ 100%/ 100%/ 71.4%, and 15.4%/ 100%/ 100%/ 31.3% respectively. For WB-DWI/MRI, all values were 100%, for both malignant lymph nodes and metastases. WB-DWI/MRI was significantly better than CT in detecting tumor infiltration of the mesenteric root, serosal involvement of the small bowel and peritoneal metastases for which WB-DWI/MRI was correct in 100% of these cases, CT 0%.Conclusions: WB-DWI/MRI is highly accurate for diagnosis, staging and follow-up of patients with suspected gastric cancer. These results need to be confirmed in larger studies.

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Differentiating T1a–T1b from T2 in gastric cancer lesions with three different measurement approaches based on contrast-enhanced T1W imaging at 3.0 T

BMC Medical Imaging ◽

10.1186/s12880-021-00672-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yuan Yuan ◽

Shengnan Ren ◽

Tiegong Wang ◽

Fu Shen ◽

Qiang Hao ◽

...

Keyword(s):

Gastric Cancer ◽

Likelihood Ratio ◽

Clinical Benefit ◽

Predictive Value ◽

Positive Likelihood Ratio ◽

Roc Curves ◽

Maximum Area ◽

T Stage ◽

Sensitivity Specificity ◽

Area And Volume

Abstract Background To explore the diagnostic value of three different measurement approaches in differentiating T1a–T1b from T2 gastric cancer (GC) lesions. Methods A total of 95 consecutive patients with T1a–T2 stage of GC who performed preoperative MRI were retrospectively enrolled between January 2017 and November 2020. The parameters MRI T stage (subjective evaluation), thickness, maximum area and volume of the lesions were evaluated by two radiologists. Specific indicators including AUC, optimal cutoff, sensitivity, specificity, accuracy, positive likelihood ratio (PLR), negative likelihood ratio (NLR), positive predictive value (PPV) and negative predictive value (NPV) of MRI T stage, thickness, maximum area and volume for differentiating T1a–T1b from T2 stage lesions were calculated. The ROC curves were compared by the Delong test. Decision curve analysis (DCA) was used to evaluate the clinical benefit. Results The ROC curves for thickness (AUC = 0.926), maximum area (AUC = 0.902) and volume (AUC = 0.897) were all significantly better than those of the MRI T stage (AUC = 0.807) in differentiating T1a–T1b from T2 lesions, with p values of 0.004, 0.034 and 0.041, respectively. The values corresponding to the thickness (including AUC, sensitivity, specificity, accuracy, PPV, NPV, PLR and NLR) were all higher than those corresponding to the MRI T stage, maximum area and volume. The DCA curves indicated that the parameter thickness could provide the highest clinical benefit if the threshold probability was above 35%. Conclusions Thickness may provide an efficient approach to rapidly distinguish T1a–T1b from T2 stage GC lesions.

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