The Role of Triphasic Multi Detector CT Scan of the Abdomen in Staging of Gastric Carcinoma
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- Category: Vol. 85, September 2017
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The Role of Triphasic Multi Detector CT Scan of the Abdomen in Staging of Gastric Carcinoma, MARYSE Y. AWADALLAH, YOUSTINA G. SHOKRY, HANEY A. SHAWALI and SAMIRA A. MAHMOUD
Abstract
Background: Multi-Detector CT (MDCT) is a powerful non invasive tool for evaluation of gastric cancer. It provide accurate staging of the primary mass, regional, distant lym-phadenopathy, and distant metastasis. Multiplanar Reconstruc-tion (MPR) images increased the accuracy of gastric cancer staging, which provides a useful diagnostic method for pre-operative evaluation of gastric cancer patients.
Aim of Work: To evaluate the role of multidetector CT with MPR images in pre-therapeutic staging of gastric carci-noma based on the updated TNM staging system, and to clarify its effect on the management plan of gastric cancer.
Patients and Methods: 20 patients (9 males and 11 females; mean age 55 years), underwent upper GI endoscopy and biopsy with a histopathological evidence of primary gastric carcinoma, followed by triphasic MDCT examination of the abdomen and pelvis for accurate staging, with negative oral contrast, 2mm slice thickness followed by MPR. We evaluated the depth of tumor invasion into the gastric wall, nodal and distant metastatic spread according to Lee et al., 2012. The results were correlated with surgical findings and post-operative pathological staging when applicable. Diagnostic accuracy was analyzed accordingly.
Results: 20 patients with Advanced Gastric Cancer (AGC), 11 patients underwent surgery and post-operative histopathol-ogy, 8 cases were inoperable and have received neoadjuvant chemotherapy without any palliative surgery, and one case was operable but refused the surgical operation, the detection rate was 20/20 (100%) for MDCT. The overall accuracy in determination of serosal involvement with or without organ invasion as compared to the pathological staging was 90% with (80% sensitivity and 100% specificity, 100% PPV, and 85, 7 NPP) while that of nodal staging was 86.4% with (100% sensitivity, 50% specificity, 84.2% PPV and 100% NPP).
Conclusion: Triphasic MDCT scan with water/gas disten-tion of the stomach follower by MPR should be regarded as the modality of choice of preoperative work up of cancer stomach as it has high diagnostic accuracy in staging of gastric cancer which enables the selection of more efficient and safer treatment strategies.