Is Accurate N – Staging for Gastric Cancer Possible?

Aim. This study is aimed at comparing gastric cancer T and N staging between virtual monochromatic energy images and fusion images generated by dual-source computed tomography (DSCT) dual-energy mode data acquisition prospectively while measuring the iodine concentration of gastric cancer and lymph nodes at different T and N stages from iodine map retrospectively. Methods. A total of 71 patients (50 males and 21 females; mean age: 59 ± 11 years) confirmed with gastric cancer by endoscopic biopsy with no neoadjuvant chemotherapy were enrolled for the CT examination before surgeries. The preoperative T and N staging results were compared between groups with pathological results as the gold standard. The iodine concentrations of the gastric lesions and LNs were measured on the iodine-based material decomposition images. All iodine concentration values were normalized against those in the abdominal aorta and defined as normalized iodine concentration (nIC) values. The short axis length of LNs and nIC values were statistically analyzed. Results. Group A was better than group B for T3 and T4 staging. No statistically significant difference in the overall accuracies for N staging was found between groups. For the late arterial and delayed phases, T3 and T4 nIC values of the extraserosal adipose tissue showed statistically significant differences. The nIC values between N0 and Nm (N1–N3) showed statistically significant differences in the portal phase only. Conclusions. T3 and T4 nIC values of the extraserosal adipose tissue showed statistically significant differences. Hence, dual-source CT may be helpful in the differential diagnosis between T3 and T4.

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The actual accuracy of endoscopic ultrasound for detailed tumor depth determination in nonserosal exposed gastric cancer: What should we do to increase the accuracy of endoscopic ultrasound?

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.20 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 20-20

Author(s):

H. Lee ◽

J. H. Lee

Keyword(s):

Gastric Cancer ◽

Endoscopic Ultrasound ◽

Preoperative Staging ◽

Exposed Group ◽

Tumor Depth ◽

Factors Affecting ◽

T Stage ◽

Staging Of Gastric Cancer ◽

Gastric Cancer Patients ◽

N Staging

20 Background: The accuracy of endoscopic ultrasound (EUS) for preoperative staging of gastric cancer varies. The aim of this study was to investigate the accuracy of EUS T and N staging in all and non-serosal exposed cases and identify the histopathological factors influencing accuracy. Methods: A total of 309 gastric cancer patients with confirmed pathological staging underwent EUS examination for preoperative staging at Seoul St. Mary's Hospital, Korea, between January and December 2009. Of these, 262 patients were diagnosed with non-serosal exposed gastric cancer. Results: Overall accuracies of EUS for T stage, the detailed T stages of all cases, and the detailed T stage in the non-serosal exposed group were 70.2%, 43.0%, and 41.2%, respectively. In the non-serosal exposed group, tumors greater than 5 cm in diameter were significantly associated with T overstaging (odds ratio [OR], 2.583). The overall accuracies of EUS for N staging in all cases and in the non-serosal exposed group were 71.2% and 76.7%, respectively. Tumor size (2 cm ≤ size < 5 cm; OR, 4.467; and 5 cm ≤ size; OR, 8.668) and tumor depth (submucosa; OR, 3.267; muscular propria; OR, 6.675 and subserosa; OR, 4.831) were significant factors affecting incorrect nodal detection in non-serosal exposed gastric cancer cases. Conclusions: Careful attention is required during EUS examination of large-sized gastric cancers to increase accuracy, especially for T staging. No significant financial relationships to disclose.

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The clinicopathological characteristics of understaging and overstaging of the preoperative assessment for gastric cancer by endoscopic ultrasonography and computed tomography.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.34 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 34-34

Author(s):

Ae-Ra Lee ◽

Dong Ho Lee ◽

Jae Jin Hwang ◽

Cheol Min Shin ◽

Hyuk Yoon ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Preoperative Staging ◽

Preoperative Assessment ◽

Clinicopathological Characteristics ◽

T Stage ◽

Cancer Group ◽

Lower Accuracy ◽

Ulcerative Lesions ◽

N Staging

34 Background: Despite the development of EUS and CT technology, there are no clinically relevant imaging tools to detect accurate preoperative staging such as lymph node (LN) metastases. The aim of this study was to elucidate of the clinicopathological characteristics of understaging and overstaging of the preoperative assessment for the gastric cancer by EUS and CT. Methods: In total, 180 patients who underwent EUS and CT, followed by gastrectomy at Bundang Hospital, Seoul National University, from July 2012 to June 2014, were analyzed. The results from the preoperative EUS and CT were compared to the postoperative pathological findings. Results: For T staging, a total of 180 patients who underwent CT and EUS have been recruited and 99 patients with visualized primary lesions on CT were analyzed. For N staging, 180 patients who underwent EUS and CT were analyzed. The overall accuracy of EUS and CT for T staging was 63.7% and 69%, respectively. The overall accuracy for N staging was 74.3% and 69.6%, respectively. Compared with variables of under and over staging group with accurate staging group, Accuracy of T staging for lesions at the cardia (36.4% vs. 63.6%, P = 0.021), advanced gastric cancer group (55% vs. 90.9%, P = 0.005) and advanced T stage group (24.4% vs. 5.2 %, P = 0.001) was higher than that non-cardia lesions and EGC group. Ulcerative lesion (38.5% vs. 61.5%, P < 0.001) and histologically undifferentiated type (3.8% vs. 93.8%, P = 0.002) had significantly lower accuracy in N staging than non-ulcerative lesions and the differentiated cancer. Conclusions: Caution is required in interpreting the T staging of the advanced T stage (T3 and T4) lesions, lesions at the cardia and advanced gastric cancer lesions. The ulcerative and undifferentiated lesions needed careful interpretation for N staging. However, there seemed to be no significant differences of clinicopathological characteristics between EUS and CT. The accuracy of CT was close to that of EUS and both modalities were useful and complementary for the locoregional staging of gastric cancer.

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Is tumor size a predictor of preoperative N staging in T2–T4a stage advanced gastric cancer?

Surgical Oncology ◽

10.1016/j.suronc.2014.01.003 ◽

2014 ◽

Vol 23 (1) ◽

pp. 5-10 ◽

Cited By ~ 9

Author(s):

Chang-Ming Huang ◽

Mu Xu ◽

Jia-Bin Wang ◽

Chao-Hui Zheng ◽

Ping Li ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Tumor Size ◽

N Staging

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Su1977 Accuracy of Multidetector-Row Computed Tomography (MDCT) for Clinical N Staging in Early Gastric Cancer

Gastroenterology ◽

10.1016/s0016-5085(14)61857-6 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-513

Author(s):

Eun Hyo Jin ◽

Dong Ho Lee ◽

Ji Yeon Seo ◽

Jaihwan Kim ◽

Young Su Park ◽

...

Keyword(s):

Gastric Cancer ◽

Computed Tomography ◽

Early Gastric Cancer ◽

Multidetector Row Computed Tomography ◽

Multidetector Row ◽

N Staging

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Comparison of MRI and endoscope ultrasound detection in preoperative T/N staging of gastric cancer

Molecular and Clinical Oncology ◽

10.3892/mco.2013.103 ◽

2013 ◽

Vol 1 (4) ◽

pp. 699-702 ◽

Cited By ~ 15

Author(s):

CUI LEI ◽

LIMING HUANG ◽

YANLIN WANG ◽

YILING HUANG ◽

YURONG HUANG

Keyword(s):

Gastric Cancer ◽

Staging Of Gastric Cancer ◽

N Staging

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Clinicopathological factors influence diagnostic accuracy of clinical N staging for early gastric cancer

Annals of Oncology ◽

10.1093/annonc/mdx261.380 ◽

2017 ◽

Vol 28 ◽

pp. iii135-iii136

Author(s):

A. Grothey ◽

M. Shah ◽

T. Yoshino ◽

E. Van Cutsem ◽

J. Taieb ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Diagnostic Accuracy ◽

Clinicopathological Factors ◽

N Staging

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[68Ga]Ga-DOTA-FAPI-04 PET/CT in The Staging of Gastric Cancer: Improved Diagnostic Efficacy Confirmed By Postoperative Histopathology

10.21203/rs.3.rs-1142541/v1 ◽

2021 ◽

Author(s):

Rong Lin ◽

Zefang Lin ◽

Zhenying Chen ◽

Shan Zheng ◽

Jiaying Zhang ◽

...

Keyword(s):

Gastric Cancer ◽

Fdg Pet ◽

Standardized Uptake Value ◽

Response To Treatment ◽

Diagnostic Efficacy ◽

Primary Tumors ◽

Metastatic Lesions ◽

Pet Ct ◽

Fdg Pet Ct ◽

N Staging

Abstract Purpose This study aimed to compare the diagnostic performance of [68Ga]Ga-DOTA-FAPI-04 and [18F]-FDG PET/CT in the primary and metastatic lesions of gastric cancer. Methods Fifty-six patients with histologically proven gastric carcinomas were enrolled in this study. Each patient underwent both [18F]-FDG and [68Ga]Ga-FAPI-04 PET/CT within one week. Activity of tracer accumulation in lesions were assessed by maximum standardized uptake value (SUVmax) and TBR (lesions SUVmax/ ascending aorta SUVmean). Histological work-up including immunohistochemical staining for FAP served as a standard of reference. Results [68Ga]Ga-FAPI PET/CT is superior in detecting primary tumors both in patient-based (100% [45/45] vs. 97.8% [44/45]) and lesion-based analyses (97.8% [45/46] vs. 95.7% [44/46]), showing higher SUVmax (10.25 vs. 8.13, P = 0.004) and TBR (11.63 vs. 5.83, P < 0.001), compared with [18F]-FDG PET/CT. The specificity and positive predictive value of [68Ga]Ga-FAPI were significantly higher than that of [18F]-FDG (100.0% vs. 97.7%, P < 0.001; 100.0% vs. 57.1%, P = 0.001) in determining the lymph node (LN) metastases. [68Ga]Ga-FAPI PET/CT was superior to [18F]-FDG PET/CT in N-staging (47.1% [8/17] vs. 23.5% [4/17]), and in evaluation for LN, peritoneum and bone metastases. [68Ga]Ga-FAPI PET/CT detected positive recurrent lesions in all patients and showed more positive lesions and clearer tumor delineation. Two patients underwent follow-up [68Ga]Ga-FAPI PET/CT scans after chemotherapy, which both showed remission. Conclusions [68Ga]Ga-FAPI PET/CT can better detect primary gastric cancer and metastatic lesions in peritoneum, abdominal LNs and bone, showing high usefulness in guiding N staging. Furthermore, [68Ga]Ga-FAPI PET/CT provides more information for patients with recurrence detection and also has great potential in monitoring response to treatment.

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