Multidetector computed tomography in the preoperative staging of gastric adenocarcinoma

Barros, Ricardo Hoelz de Oliveira; Penachim, Thiago José; Martins, Daniel Lahan; Andreollo, Nelson Adami; Caserta, Nelson Marcio Gomes

doi:10.1590/0100-3984.2014.0021

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Sumário

ORIGINAL ARTICLES • Radiol Bras 48 (2) • Mar-Apr 2015 • https://doi.org/10.1590/0100-3984.2014.0021 copy

Multidetector computed tomography in the preoperative staging of gastric adenocarcinoma^* * Study developed at Department of Radiology – Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

To evaluate the role of multidetector computed tomography in the preoperative investigation of tumor invasion depth and lymph node and metastatic involvement according to the TNM classification, in patients with gastric adenocarcinoma.

Materials and Methods:

Fifty-four patients with biopsy-confirmed gastric cancer underwent preoperative staging with 64-channel multidetector computed tomography. Two independent radiologists analyzed the images and classified the findings. Sensitivity, specificity, accuracy and overall accuracy were calculated for each observer. The interobserver agreement was also evaluated.

Results:

The accuracy in the classification of categories T ranged from 74% to 96% for observer 1 and from 80% to 92% for observer 2. The overall accuracy was 70% for both observers. The weighted kappa index was 0.75, consistent with a significant interobserver agreement. The accuracy in the classification of lymph node involvement (category N) ranged from 55% to 79% for observer 1 and from 73% to 82% for observer 2. The evaluation of metastatic involvement showed an overall accuracy of 89.6% for both observers.

Conclusion:

64-channel multidetector computed tomography demonstrated clinically relevant accuracy in the preoperative staging of gastric adenocarcinoma as regards invasion depth (T category) and metastatic involvement (M category).

Gastric cancer; Computed tomography; Staging

Category T (6th ed.)	Category T (7th ed.)	Histological criteria	Tomographic criteria
T1	T1	Invasion of the lamina propria (T1a) or submucosa (T1b)	Lesion non detectable at CT Focal thickening or abnormal enhancement of the gastric mucosa, with a preserved hypodense strip deep to the lesion, corresponding to the submucosal layer (Figure 1)
T2	T2 or T3	Muscularis propria (T2) or subserosal layer (T3) invasion	Thickening and abnormal enhancement involving the whole thickness of the gastric wall, with smooth external contour of the stomach (Figure 2)
T3	T4A	Extraserosal extension (invasion of the visceral peritoneum)	Thickening and abnormal enhancement involving the whole thickness of the gastric wall, associated with linear or reticular striations extending towards the perigastric fat (Figure 3)
T4	T4B	Invasion of adjacent organs/structures	The above described alterations extend to adjacent organs/structures (Figure 4)

Category T (6th ed.)	Category T (7th ed.)	Observer 1	Observer 2	Number of cases	Percentage
T1	T1	Sensitivity: 60%	Sensitivity: 70%	10	20%
		Specificity: 95%	Specificity: 98%
		Accuracy: 88%	Accuracy: 92%
T2	T2 ou T3	Sensitivity: 62%	Sensitivity: 54%	13	26%
		Specificity: 78%	Specificity: 92%
		Accuracy: 74%	Accuracy: 82%
T3	T4A	Sensitivity: 71%	Sensitivity: 64%	14	28%
		Specificity: 86%	Specificity: 86%
		Accuracy: 82%	Accuracy: 80%
T4	T4B	Sensitivity: 85%	Sensitivity: 92%	13	26%
		Specificity: 100%	Specificity: 84%
		Accuracy: 96%	Accuracy: 86%
Global accuracy		70 %	70 %

Category N (7th ed.)	Observer 1	Observer 2
N0	Sensitivity: 90%	Sensitivity: 90%
	Specificity: 74%	Specificity: 74%
	Accuracy: 79%	Accuracy: 79%
N1	Sensitivity: 13%	Sensitivity: 13%
	Specificity: 68%	Specificity: 92%
	Accuracy: 55%	Accuracy: 73%
N2	Sensitivity: 20%	Sensitivity: 40%
	Specificity: 86%	Specificity: 89%
	Accuracy: 76%	Accuracy: 82%
N3	Sensitivity: 36%	Sensitivity: 64%
	Specificity: 100%	Specificity: 86%
	Accuracy: 79%	Accuracy: 79%
Global accuracy	45.5 %	60.6 %

Category M (7th ed.)	Observer 1	Observer 2
M0	Sensitivity: 100%	Sensitivity: 93%
	Specificity: 72%	Specificity: 83%
	Accuracy: 90%	Accuracy: 90%
Ml	Sensitivity: 72%	Sensitivity: 83%
	Specificity: 100%	Specificity: 93%
	Accuracy: 90%	Accuracy: 90%
Global accuracy	89.6 %	89.6 %

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[1] Mailing Address: Dr. Ricardo Hoelz de Oliveira Barros. Universidade Estadual de Campinas – Departamento de Radiologia. Rua Tessália Vieira de Camargo, 126, Cidade de Universitária Zeferino Vaz. Campinas, SP, Brazil, 13083-970. E-mail: rhobarros@ hotmail.com.

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Multidetector computed tomography in the preoperative staging of gastric adenocarcinoma* * Study developed at Department of Radiology – Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.

Objective:

Materials and Methods:

Results:

Conclusion:

Multidetector computed tomography in the preoperative staging of gastric adenocarcinoma^* * Study developed at Department of Radiology – Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.