Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2020; 12(4): 435-446
Published online Apr 15, 2020. doi: 10.4251/wjgo.v12.i4.435
Diagnostic ability of multi-detector spiral computed tomography for pathological lymph node metastasis of advanced gastric cancer
Zhi-Yong Jiang, Shinichi Kinami, Naohiko Nakamura, Takashi Miyata, Hideto Fujita, Hiroyuki Takamura, Nobuhiko Ueda, Takeo Kosaka
Zhi-Yong Jiang, Shinichi Kinami, Naohiko Nakamura, Takashi Miyata, Hideto Fujita, Hiroyuki Takamura, Nobuhiko Ueda, Takeo Kosaka, Department of Surgical Oncology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa 920-0293, Japan
Author contributions: Jiang ZY was responsible for the scientific context and writing of the manuscript. Kinami S was responsible for instructing on the scientific research and writing of the manuscript. Nakamura N, Miyata T, Fujita H, Ueda N, Takamura H and Kosaka T contributed to the literature review; data analysis; drafting, editing, and critical revision of the manuscript; and approval of the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Kanazawa Medical University Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. Regarding data use in the retrospective study, the patients were given the opportunity to optout of the study at any time.
Conflict-of-interest statement: The authors declare no conflicts of interest related to the publication of the study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shinichi Kinami, MD, PhD, Professor, Department of Surgical Oncology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa 920-0293, Japan. kinami@kanazawa-med.ac.jp
Received: November 21, 2019
Peer-review started: November 21, 2019
First decision: December 12, 2019
Revised: February 12, 2020
Accepted: February 23, 2020
Article in press: February 23, 2020
Published online: April 15, 2020
Abstract
BACKGROUND

The reliability of preoperative nodal diagnosis of advanced gastric cancer by multi-detector spiral computed tomography (MDCT) is still unclear.

AIM

To examine the diagnostic ability of MDCT more precisely by using data on intranodal pathological metastatic patterns.

METHODS

A total of 108 patients with advanced gastric cancer who underwent MDCT and curative gastrectomy at Kanazawa Medical University Hospital were enrolled in this study. The nodal sizes measured on computed tomography (CT) images were compared with the pathology results. A receiver-operating characteristic curve was constructed, from which the critical value (CV) was calculated by using the data of the first 69 patients retrospectively. By using the CV, sensitivity and specificity were calculated with prospectively collected data from 39 consecutive patients. This enabled a more precise one-to-one correspondence of lymph nodes between CT and pathological examination by using the size data of lymph node mapping. The intranodal pathological metastatic patterns were classified into the following four types: Small nodular, peripheral, large nodular, and diffuse.

RESULTS

Although all the cases were clinically suspected as having metastasis, 81 had lymph node metastasis and 27 had no metastasis. The number of dissected, detected on CT, and metastatic nodes were, 4241, 897, and 801, respectively. The CV obtained from the receiver-operating characteristic was 7.6 mm for the long axis. The sensitivity was 91.4% and the specificity was 47.3% in the prospective phase. The large nodular and diffuse metastases were easy to diagnose because metastatic nodes with a large axis often exhibit these forms.

CONCLUSION

The ability of MDCT to contribute to a nodal diagnosis of advanced gastric cancer was examined prospectively with precise size data from node mapping, using a CV of 7.6 mm for the long axis that was calculated from the retrospectively collected data. The sensitivity was as high as 91%, and would be improved when referring to the enhanced patterns. However, its specificity was as low as 47%, because most of metastatic nodes in gastric cancer being small in size. The small nodular or peripheral type metastatic nodes were often small and considered difficult to diagnose.

Keywords: Advanced gastric cancer, Lymph node metastasis, Multi-detector spiral computed tomography, Pathological diagnosis

Core tip: The preoperative nodal diagnostic ability of multi-detector spiral computed tomography for advanced gastric cancer was examined more precisely using data from patients for whom precise one-to-one correspondence of lymph nodes could be performed between computed tomography and intranodal pathological metastatic patterns by using lymph node mapping. The number of dissected, metastatic, and detected nodes on computed tomography were 4241, 801, and 897, respectively. The sensitivity of multi-detector spiral computed tomography for nodal diagnosis was as good as 91% with the critical value of 7.6 mm for the long axis. The large nodular or diffuse metastases were easy to diagnose. However, the specificity was as low as 47%, because most of the metastatic nodes in gastric cancer were small nodes.