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Kim TH, Kim IH, Kang SJ, Choi M, Kim BH, Eom BW, Kim BJ, Min BH, Choi CI, Shin CM, Tae CH, Gong CS, Kim DJ, Cho AEH, Gong EJ, Song GJ, Im HS, Ahn HS, Lim H, Kim HD, Kim JJ, Yu JI, Lee JW, Park JY, Kim JH, Song KD, Jung M, Jung MR, Son SY, Park SH, Kim SJ, Lee SH, Kim TY, Bae WK, Koom WS, Jee Y, Kim YM, Kwak Y, Park YS, Han HS, Nam SY, Kong SH. Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach. J Gastric Cancer 2023; 23:3-106. [PMID: 36750993 PMCID: PMC9911619 DOI: 10.5230/jgc.2023.23.e11] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.
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Affiliation(s)
- Tae-Han Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - In-Ho Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Joo Kang
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center Seoul, Seoul, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Baek-Hui Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Bum Jun Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Seoul, Korea
| | - Chang In Choi
- Department of Surgery, Pusan National University Hospital, Pusan, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seungnam, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, Ewha Woman’s University College of Medicine, Seoul, Korea
| | - Chung sik Gong
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Jin Kim
- Department of Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Eun Jeong Gong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Geum Jong Song
- Department of Surgery, Soonchunhyang University, Cheonan, Korea
| | - Hyeon-Su Im
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hye Seong Ahn
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyun Lim
- Department of Gastroenterology, Hallym University Sacred Heart Hospital, University of Hallym College of Medicine, Anyang, Korea
| | - Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joon Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, Catholic Kwandong University, College of Medicine, Incheon, Korea
| | - Ji Yeon Park
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jwa Hoon Kim
- Division of Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Minkyu Jung
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Shin-Hoo Park
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Soo Jin Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Woo Kyun Bae
- Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yeseob Jee
- Department of Surgery, Dankook University Hospital, Cheonan, Korea
| | - Yoo Min Kim
- Department of Surgery, Severance Hospital, Seoul, Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
| | - Su Youn Nam
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital and Seoul National University College of Medicine Cancer Research Institute, Seoul, Korea.
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Lee YH, Chan WH, Lai YC, Chen AH, Chen CM. Gastric hydrodistension CT versus CT without gastric distension in preoperative TN staging of gastric carcinoma: analysis of single-center cancer registry. Sci Rep 2022; 12:11321. [PMID: 35790760 PMCID: PMC9256680 DOI: 10.1038/s41598-022-15619-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/27/2022] [Indexed: 11/09/2022] Open
Abstract
Accurate staging of gastric cancer is essential for the selection and optimization of therapy. Hydrodistension of the stomach is recommended to improve the accuracy of preoperative staging with contrast-enhanced multidetector computed tomography (MDCT). This study compares the performance of contrast-enhanced gastric water distension versus a nondistension MDCT protocol for T and N staging and serosal invasion in comparison to surgical histopathology. After propensity score matching, 86 patients in each group were included for analysis. The overall accuracy of distension versus nondistension group in T staging was 45% (95% CI 35-56) and 55% (95% CI 44-65), respectively (p = 0.29). There was no difference in the sensitivity and specificity in individual T staging and assessment of serosal invasion (all p > 0.41). Individual stage concordance with pathology was not significantly different (all p > 0.41). The overall accuracy of N staging was the same for distension and nondistension groups (51% [95% CI 40-62]). The majority of N0 staging (78-81%) were correctly staged, whereas N3 staging cases (63-68%) were predominantly understaged. In summary, there was no significant difference in the diagnostic performance of individual TN staging and assessment of serosal invasion using MDCT with or without gastric water distension.
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Affiliation(s)
- Yu-Hsien Lee
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, 5 Fuxing Street, Guishan District, Taoyuan, Taiwan
| | - Wen-Hui Chan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, 5 Fuxing Street, Guishan District, Taoyuan, Taiwan
| | - Ying-Chieh Lai
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, 5 Fuxing Street, Guishan District, Taoyuan, Taiwan
| | - An-Hsin Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, 5 Fuxing Street, Guishan District, Taoyuan, Taiwan
| | - Chien-Ming Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, 5 Fuxing Street, Guishan District, Taoyuan, Taiwan.
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Qian L, Zhang J, Lu S, He X, Feng J, Shi J, Liu Y. Potential key roles of tumour budding: a representative malignant pathological feature of non-small cell lung cancer and a sensitive indicator of prognosis. BMJ Open 2022; 12:e054009. [PMID: 35361643 PMCID: PMC8971788 DOI: 10.1136/bmjopen-2021-054009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate the relationship between tumour budding, clinicopathological characteristics of patients and prognosis in non-small cell lung cancer. STUDY DESIGN A retrospective study was used. PARTICIPANTS We selected 532 patients with non-small cell lung cancer from China, including 380 patients with adenocarcinoma and 152 with squamous cell carcinoma. PRIMARY AND SECONDARY OUTCOME MEASURES Tumour budding was visible using H&E staining as well as pancytokeratin staining. The count data and measurement data were compared using the χ2 test and the t-test, respectively. The overall survival rate was the follow-up result. The survival curves were drawn using the Kaplan-Meier method, and the differences between groups were analysed using the log-rank method. The independent prognostic factor of patients with lung cancer was determined using a multivariate Cox proportional hazard model. RESULTS In patients with lung adenocarcinoma, there was a correlation between tumour budding and spread through air spaces (OR 36.698; 95% CI 13.925 to 96.715; p<0.001), and in patients with squamous cell carcinoma, tumour budding state was closely related to the peritumoural space (OR 11.667; 95% CI 4.041 to 33.683; p<0.001). On Cox regression analysis, multivariate analysis showed that tumour budding, pleural and vascular invasion, spread through air spaces, tumour size, lymph node metastasis, and tumour node metastasis stage were independent risk factors of prognosis for patients with non-small cell lung cancer. CONCLUSIONS As an effective and simple pathological diagnostic index, it is necessary to establish an effective grading system in the clinical diagnosis of lung cancer to verify the value of tumour budding as a prognostic indicator. We hope that this analysis of Chinese patients with non-small cell lung cancer can provide useful reference material for the continued study of tumour budding.
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Affiliation(s)
- Li Qian
- Pathology, Affiliated Hospital of Nantong University, Nantong, China
| | - Jianguo Zhang
- Pathology, Affiliated Hospital of Nantong University, Nantong, China
| | - Shumin Lu
- Oncology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xin He
- Pathology, Affiliated Hospital of Nantong University, Nantong, China
| | - Jia Feng
- Pathology, Affiliated Hospital of Nantong University, Nantong, China
| | - Jiahai Shi
- Nantong Key Laboratory of Translational Medicine in Cardiothoracic Diseases, Affiliated Hospital of Nantong University, Nantong, China
| | - Yifei Liu
- Pathology, Affiliated Hospital of Nantong University, Nantong, China
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Xu Q, Sun Z, Li X, Ye C, Zhou C, Zhang L, Lu G. Advanced gastric cancer: CT radiomics prediction and early detection of downstaging with neoadjuvant chemotherapy. Eur Radiol 2021; 31:8765-8774. [PMID: 33909133 PMCID: PMC8523390 DOI: 10.1007/s00330-021-07962-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/08/2021] [Accepted: 03/29/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To develop and evaluate machine learning models using baseline and restaging computed tomography (CT) for predicting and early detecting pathological downstaging (pDS) with neoadjuvant chemotherapy in advanced gastric cancer (AGC). METHODS We collected 292 AGC patients who received neoadjuvant chemotherapy. They were classified into (a) primary cohort (206 patients with 3-4 cycles chemotherapy) for model development and internal validation, (b) testing cohort I (46 patients with 3-4 cycles chemotherapy) for evaluating models' predictive ability before and after the complete course, and (c) testing cohort II (n = 40) for model evaluation on its performance at early treatment. We extracted 1,231 radiomics features from venous phase CT at baseline and restaging. We selected radiomics models based on 28 cross-combination models and measured the areas under the curve (AUC). Our prediction radiomics (PR) model is designed to predict pDS outcomes using baseline CT. Detection radiomics (DR) model is applied to restaging CT for early pDS detection. RESULTS PR model achieved promising outcomes in two testing cohorts (AUC 0.750, p = .009 and AUC 0.889, p = .000). DR model also showed a good predictive ability (AUC 0.922, p = .000 and AUC 0.850, p = .000), outperforming the commonly used RECIST method (NRI 39.5% and NRI 35.4%). Furthermore, the improved DR model with averaging outcome scores of PR and DR models showed boosted results in two testing cohorts (AUC 0.961, p = .000 and AUC 0.921, p = .000). CONCLUSIONS CT-based radiomics models perform well on prediction and early detection tasks of pDS and can potentially assist surgical decision-making in AGC patients. KEY POINTS • Baseline contrast-enhanced computed tomography (CECT)-based radiomics features were predictive of pathological downstaging, allowing accurate identification of non-responders before therapy. • Restaging CECT-based radiomics features were predictive to achieve pDS after and even at an early stage of neoadjuvant chemotherapy. • Combination of baseline and restaging CECT-based radiomics features was promising for early detection and preoperative evaluation of pathological downstaging of AGC.
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Affiliation(s)
- Qinmei Xu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Zeyu Sun
- Deepwise AI Lab, Deepwise Inc., No. 8 Haidian avenue, Sinosteel International Plaza, Beijing, 100080, China
| | - Xiuli Li
- Deepwise AI Lab, Deepwise Inc., No. 8 Haidian avenue, Sinosteel International Plaza, Beijing, 100080, China
| | - Chen Ye
- Research Institute of General Surgery, Jinling Hospital, Nanjing, 210002, Jiangsu, China
| | - Changsheng Zhou
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Longjiang Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China.
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Zytoon AA, El-Atfey SIB, Hassanein SAH. Diagnosis of gastric cancer by MDCT gastrography: diagnostic characteristics and management potential. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-0148-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Gastric cancer is regarded as the fifth most frequent tumor globally but the third most common fatal illness. As early as possible, we diagnose cancer stomach especially at early stages, the higher the rate of life. Nevertheless, most cases are diagnosed at late cases where surgery is not of the same benefit at early stages because of clinically indefinite symptoms. The prospective study goal is to estimate the role of MDCT in diagnosis and staging of cancer stomach.
Results
In our study, it was found that there was a high relationship between pathological and CT staging by using MPR. CT with MPR was specific and accurate in diagnosis of all stages of gastric cancer with specificity ranged between 93 and 97% and accuracy ranged between 90 and 92.5%. However, it showed lowest sensitivity in diagnosis of stage 1 of gastric cancer. On the other hand, it showed highest sensitivity (90%) in diagnosis of stage IV as well as we found that MPR and VR of MDCT are much more accurate (92.5%) than multi-detector computed tomography axial images (80%) in the diagnosis of all stages of gastric cancer with the difference between the two sequences was significant (P = 0.009).
Conclusion
Our results demonstrate that preoperative MDCT with contrast filling technique for abdomen and pelvis evaluates the local disease process of gastric cancer as well as the potential areas of spread. This information is vital in choosing between palliative or radical surgery. MPR and VR help in the assessment of tumor extension and considered as a highly representative prognostic value. Making it the imaging modality of choice in diagnosis and staging of gastric cancers.
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Radiologic serosal invasion sign as a new criterion of T4a gastric cancer on computed tomography: diagnostic performance and prognostic significance in patients with advanced gastric cancer. Abdom Radiol (NY) 2020; 45:2950-2959. [PMID: 31359095 DOI: 10.1007/s00261-019-02156-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the diagnostic performance and prognostic significance of a new criterion for radiologic T4a staging on computed tomography (CT) in patients with advanced gastric cancer (AGC). METHODS Between January 2010 and April 2019, 101 patients with pathologically confirmed gastric cancer were collected. Among them, 53 patients with pathologic T3 and T4a cancers were included in this study. Three reviewers assessed preoperative CT scans for radiologic T staging in two sessions, independently and in consensus at a 2-week interval, while blinded about the pathologic T stage. The radiologic serosal invasion sign was defined as a nodular extension from the outer gastric wall reaching beyond the perigastric vascular plane and adopted as a new CT criterion for T4a cancer. We evaluated the diagnostic performance, interobserver agreement, and prognostic significance of this sign for the postoperative recurrence. RESULTS There were 46 pathologic T3 cancers (86.7%) and seven pathologic T4a cancers (13.2%). The diagnostic performance of the radiologic serosal invasion sign in the differentiation between T3 and T4a cancers was as follows: sensitivity, 91.3%; specificity, 71.43%; and accuracy, 88.68% for R1 and sensitivity, 78.26%; specificity, 85.71%; and accuracy, 79.25% for R2. The k-value was 0.64. Among the clinical and pathologic variables, radiologic T4a sign [hazard ratio (HR): 7.96; 95% confidence interval (CI) 2.36-26.86, p = 0.001], pathologic T4a (HR 9.82, 95% CI 2.35-40.95, p = 0.002), tumor size (HR 1.18, 95% CI 1.02-1.35, p = 0.026), and lymphovascular invasion (HR 6.39, 95% CI 1.42-28.75, p = 0.015) were the significant factors for postoperative recurrence. CONCLUSIONS Radiologic serosal invasion sign is reliable as a new CT criterion for T4a cancer staging in patients with advanced gastric cancer, demonstrating 80% to 88% accuracy. Radiologic serosal invasion sign can also serve as a prognostic factor for postoperative recurrence as well as pathologic T4a stage.
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Performance of a machine learning-based decision model to help clinicians decide the extent of lymphadenectomy (D1 vs. D2) in gastric cancer before surgical resection. Abdom Radiol (NY) 2019; 44:3019-3029. [PMID: 31201432 DOI: 10.1007/s00261-019-02098-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Controversy still exists on the optimal surgical resection for potentially curable gastric cancer (GC). Use of radiologic evaluation and machine learning algorithms might predict extent of lymphadenectomy to limit unnecessary surgical treatment. We purposed to design a machine learning-based clinical decision-support model for predicting extent of lymphadenectomy (D1 vs. D2) in local advanced GC. METHODS Clinicoradiologic features available from routine clinical assignments in 557 patients with GCs were retrospectively interpreted by an expert panel blinded to all histopathologic information. All patients underwent surgery using standard D2 resection. Decision models were developed with a logistic regression (LR), support vector machine (SVM) and auto-encoder (AE) algorithm in 371 training and tested in 186 test data, respectively. The primary end point was to measure diagnostic performance of decision model and a Japanese gastric cancer treatment guideline version 4th (JPN 4th) criteria for discriminate D1 (pT1 + pN0) versus D2 (≥ pT1 + ≥ pN1) lymphadenectomy. RESULTS The decision model with AE analysis produced highest area under ROC curve (train: 0.965, 95% confidence interval (CI) 0.948-0.978; test: 0.946, 95% CI 0.925-0.978), followed by SVM (train: 0.925, 95% CI 0.902-0.944; test: 0.942, 95% CI 0.922-0.973) and LR (train: 0.886, 95% CI 0.858-0.910; test: 0.891, 95% CI 0.891-0.952). By this improvement, overtreatment was reduced from 21.7% (121/557) by treat-all pattern, to 15.1% (84/557) by JPN 4th criteria, and to 0.7-0.9% (4-5/557) by the new approach. CONCLUSIONS The decision model with machine learning analysis demonstrates high accuracy for identifying patients who are candidates for D1 versus D2 resection. Its approximate 14-20% improvements in overtreatment compared to treat-all pattern and JPN 4th criteria potentially increase the number of patients with local advanced GCs who can safely avoid unnecessary lymphadenectomy.
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Shi H, Sun Y, Yan R, Liu S, Zhu L, Liu S, Feng Y, Wang P, He J, Zhou Z, Ye D. Magnetic Semiconductor Gd-Doping CuS Nanoparticles as Activatable Nanoprobes for Bimodal Imaging and Targeted Photothermal Therapy of Gastric Tumors. NANO LETTERS 2019; 19:937-947. [PMID: 30688465 DOI: 10.1021/acs.nanolett.8b04179] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Targeted delivery of enzyme-activatable probes into cancer cells to facilitate accurate imaging and on-demand photothermal therapy (PTT) of cancers with high spatiotemporal precision promises to advance cancer diagnosis and therapy. Here, we report a tumor-targeted and matrix metalloprotease-2 (MMP-2)-activatable nanoprobe (T-MAN) formed by covalent modification of Gd-doping CuS micellar nanoparticles with cRGD and an MMP-2-cleavable fluorescent substrate. T-MAN displays a high r1 relaxivity (∼60.0 mM-1 s-1 per Gd3+ at 1 T) and a large near-infrared (NIR) fluorescence turn-on ratio (∼185-fold) in response to MMP-2, allowing high-spatial-resolution magnetic resonance imaging (MRI) and low-background fluorescence imaging of gastric tumors as well as lymph node (LN) metastasis in living mice. Moreover, T-MAN has a high photothermal conversion efficiency (PCE, ∼70.1%) under 808 nm laser irradiation, endowing it with the ability to efficiently generate heat to kill tumor cells. We demonstrate that T-MAN can accumulate preferentially in gastric tumors (∼23.4% ID%/g at 12 h) after intravenous injection into mice, creating opportunities for fluorescence/MR bimodal imaging-guided PTT of subcutaneous and metastatic gastric tumors. For the first time, accurate detection and laser irradiation-initiated photothermal ablation of orthotopic gastric tumors in intraoperative mice was also achieved. This study highlights the versatility of using a combination of dual biomarker recognition (i.e., αvβ3 and MMP-2) and dual modality imaging (i.e., MRI and NIR fluorescence) to design tumor-targeting and activatable nanoprobes with improved selectivity for cancer theranostics in vivo.
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Affiliation(s)
- Hua Shi
- Department of Radiology, Nanjing Drum Tower Hospital , the Affiliated Hospital of Nanjing University Medical School , Nanjing , 210008 , China
| | - Yidan Sun
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering , Nanjing University , Nanjing , 210093 , China
| | - Runqi Yan
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering , Nanjing University , Nanjing , 210093 , China
| | - Shunli Liu
- Department of Radiology, Nanjing Drum Tower Hospital , the Affiliated Hospital of Nanjing University Medical School , Nanjing , 210008 , China
| | - Li Zhu
- Department of Radiology, Nanjing Drum Tower Hospital , the Affiliated Hospital of Nanjing University Medical School , Nanjing , 210008 , China
| | - Song Liu
- Department of Radiology, Nanjing Drum Tower Hospital , the Affiliated Hospital of Nanjing University Medical School , Nanjing , 210008 , China
| | - Yuzhang Feng
- National Laboratory of Solid State Microstructures, College of Engineering and Applied Sciences and Collaborative Innovation Center of Advanced Microstructures , Nanjing University , Nanjing , 210093 , China
| | - Peng Wang
- National Laboratory of Solid State Microstructures, College of Engineering and Applied Sciences and Collaborative Innovation Center of Advanced Microstructures , Nanjing University , Nanjing , 210093 , China
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital , the Affiliated Hospital of Nanjing University Medical School , Nanjing , 210008 , China
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital , the Affiliated Hospital of Nanjing University Medical School , Nanjing , 210008 , China
| | - Deju Ye
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering , Nanjing University , Nanjing , 210093 , China
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Yang L, Li Y, Zhou T, Shi G, Pan J, Liu J, Wang G. Effect of the degree of gastric filling on the measured thickness of advanced gastric cancer by computed tomography. Oncol Lett 2018; 16:2335-2343. [PMID: 30008937 PMCID: PMC6036544 DOI: 10.3892/ol.2018.8907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 01/25/2018] [Indexed: 11/24/2022] Open
Abstract
Imaging of gastric cancer thickness is closely associated with the depth of tumor invasion, which provides guidance for clinical staging and assists the evaluation of the effects of adjuvant therapy. However, it is unclear whether the measurement of thickness is affected by the degree of gastric filling, and its accuracy and reliability are under-reported. The present study aimed to investigate the influence of the degree of gastric filling on the measurement of gastric cancer thickness. A total of 38 patients with advanced gastric cancer who underwent enhanced abdominal computed tomography (CT) scanning at the Department of CT and MR in The Fourth Hospital of Hebei Medical University (Shijiazhuang, China) between July and September 2016 were recruited, consisting of 21 newly diagnosed cases and 17 follow-up cases following non-surgical treatments. Plain scanning (prior to filling) and enhanced scanning in venous phase (following filling) were performed. Axial CT images prior to and following filling of the normal part of gastric wall and the lesions were compared. The same procedure was repeated on these participants 1 month later by the same radiologist, and the results were compared with those obtained previously. Normal gastric wall thickness prior to and following gastric filling was significantly different (all P<0.001) with the most substantial changes observed at the greater curvature. Lesion thickness prior to and following filling was similar in newly diagnosed patients, but significantly different in patients for re-examination (P<0.05). The two thickness measurements in the same patients were consistent. The measured thickness of gastric cancer in newly diagnosed patients was relatively stable, and could be used as an indicator in baseline CT examination. Maintaining a similar degree of gastric filling during re-examination could aid the accurate evaluation of treatment efficacy.
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Affiliation(s)
- Li Yang
- Department of Computed Tomography and Magnetic Resonance, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Yong Li
- Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Tao Zhou
- Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Gaofeng Shi
- Department of Computed Tomography and Magnetic Resonance, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Jiangyang Pan
- Department of Computed Tomography and Magnetic Resonance, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Jing Liu
- Department of Computed Tomography and Magnetic Resonance, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Guangda Wang
- Department of Computed Tomography and Magnetic Resonance, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
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Preoperative tumor restaging and resectability assessment of gastric cancers after chemotherapy: diagnostic accuracy of MDCT using new staging criteria. Abdom Radiol (NY) 2017. [PMID: 28643135 DOI: 10.1007/s00261-017-1224-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of preoperative MDCT for tumor restaging and determination of resectability in gastric cancers after chemotherapy using new staging criteria. METHODS This retrospective study was approved by our institutional review board and the requirement for informed consent was waived. Thirty-seven patients with initially unresectable gastric cancers who had received chemotherapy followed by surgery were included. Two independent radiologists reviewed preoperative MDCT images to determine the TNM staging and rate the overall likelihood of resectability using a 5-point scale (5: definitely unresectable, 1: definitely resectable). New post-chemotherapy MDCT criteria do not use non-enhancing perigastric infiltrations, non-enhancing lymph nodes (LNs), and subtle remaining infiltrations after marked decrease in the size of distant metastases for T, N, and M upstaging, respectively. Discrepancies in TNM staging were resolved by a third reviewer. The diagnostic performances of MDCT were assessed using pathologic results or operation records as reference standards. RESULTS For predicting resectability, the areas under the ROC curve were 0.885 and 0.882 (95% CIs 0.737-0.966 and 0.733-0.964) in reviewers 1 and 2, respectively, with substantial inter-reader agreement (weighted κ = 0.689). Sensitivities and specificities of MDCT for tumor restaging on a consensus review were 80.0% (4/5) and 100% (29/29) for T4b, 35.3% (6/17) and 81.3% (13/16) for N-positive, and 63.6% (7/11) and 100% (26/26) for M1, respectively. CONCLUSIONS For gastric cancers after chemotherapy, new MDCT criteria demonstrated high specificities for T4b and M-staging and good performances to predict resectability before conversion surgery.
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Arslan H, Fatih Özbay M, Çallı İ, Doğan E, Çelik S, Batur A, Bora A, Yavuz A, Bulut MD, Özgökçe M, Çetin Kotan M. Contribution of diffusion weighted MRI to diagnosis and staging in gastric tumors and comparison with multi-detector computed tomography. Radiol Oncol 2017; 51:23-29. [PMID: 28265229 PMCID: PMC5330170 DOI: 10.1515/raon-2017-0002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 08/24/2016] [Indexed: 12/19/2022] Open
Abstract
Background Diagnostic performance of Diffusion-Weighted magnetic resonance Imaging (DWI) and Multi-Detector Computed Tomography (MDCT) for TNM (Tumor, Lymph node, Metastasis) staging of gastric cancer was compared. Patients and methods We used axial T2-weighted images and DWI (b-0,400 and b-800 s/mm2) protocol on 51 pre-operative patients who had been diagnosed with gastric cancer. We also conducted MDCT examinations on them. We looked for a signal increase in the series of DWI images. The depth of tumor invasion in the stomach wall (tumor (T) staging), the involvement of lymph nodes (nodal (N) staging), and the presence or absence of metastases (metastatic staging) in DWI and CT images according to the TNM staging system were evaluated. In each diagnosis of the tumors, sensitivity, specificity, positive and negative accuracy rates of DWI and MDCT examinations were found through a comparison with the results of the surgical pathology, which is the gold standard method. In addition to the compatibilities of each examination with surgical pathology, kappa statistics were used. Results Sensitivity and specificity of DWI and MDCT in lymph node staging were as follows: N1: DWI: 75.0%, 84.6%; MDCT: 66.7%, 82%;N2: DWI: 79.3%, 77.3%; MDCT: 69.0%, 68.2%; N3: DWI: 60.0%, 97.6%; MDCT: 50.0%, 90.2%. The diagnostic tool DWI seemed more compatible with the gold standard method (surgical pathology), especially in the staging of lymph node, when compared to MDCT. On the other hand, in T staging, the results of DWI and MDCT were better than the gold standard when the T stage increased. However, DWI did not demonstrate superiority to MDCT. The sensitivity and specificity of both imaging techniques for detecting distant metastasis were 100%. Conclusions The diagnostic accuracy of DWI for TNM staging in gastric cancer before surgery is at a comparable level with MDCT and adding DWI to routine protocol of evaluating lymph nodes metastasis might increase diagnostic accuracy.
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Affiliation(s)
- Harun Arslan
- YuzuncuYil University DursunOdabas Medical Center, Department of Radiology, Van, Turkey
| | - Mehmet Fatih Özbay
- Van Training and Research Hospital, Department of İnternal Medicine, Van, Turkey
| | - İskan Çallı
- Van Training and Research Hospital, Department of General Surgery, Van, Turkey
| | - Erkan Doğan
- YuzuncuYil University DursunOdabas Medical Center, Department of Medical Oncology, Van, Turkey
| | - Sebahattin Çelik
- YuzuncuYil University DursunOdabas Medical Center, Department of General Surgery, Van, Turkey
| | - Abdussamet Batur
- YuzuncuYil University DursunOdabas Medical Center, Department of Radiology, Van, Turkey
| | - Aydın Bora
- YuzuncuYil University DursunOdabas Medical Center, Department of Radiology, Van, Turkey
| | - Alpaslan Yavuz
- YuzuncuYil University DursunOdabas Medical Center, Department of Radiology, Van, Turkey
| | - Mehmet Deniz Bulut
- YuzuncuYil University DursunOdabas Medical Center, Department of Radiology, Van, Turkey
| | - Mesut Özgökçe
- YuzuncuYil University DursunOdabas Medical Center, Department of Radiology, Van, Turkey
| | - Mehmet Çetin Kotan
- YuzuncuYil University DursunOdabas Medical Center, Department of Radiology, Van, Turkey
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Lee SL, Ku YM, Jeon HM, Lee HH. Impact of the Cross-Sectional Location of Multidetector Computed Tomography Scans on Prediction of Serosal Exposure in Patients with Advanced Gastric Cancer. Ann Surg Oncol 2016; 24:1003-1009. [PMID: 27830389 DOI: 10.1245/s10434-016-5670-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The extent of serosal exposure varies depending on the cross-section of the stomach that is viewed, affected by the visceral peritoneum of the omentum. Although multidetector computed tomography (MDCT) is the most useful method to predict serosal exposure, the MDCT criteria for such exposure by cross-sectional location remain to be established. METHODS The MDCT of gastric cancer patients who underwent surgery, and for whom pathological reports were available, were reviewed by radiologists. The MDCT criteria for invasion depth were divided into five grades: (1) smooth margin; (2) undulating margin; (3) streaky margin within vessels; (4) nodular margin within perigastric vessels; and (5) streaky or nodular margin over the perigastric vessels. The five grades were compared in terms of pathological tumor depth by curvature and wall group. RESULTS A total of 125 patients of stage ≥ T2 were enrolled. The five MDCT grades correlated with tumor depth (P < 0.001). Exposed serosal lesions of grade 3 (P = 0.031) and 5 (P = 0.030) constituted significantly the largest proportion of wall and curvature cancers, respectively. The accuracy of MDCT in terms of T staging using the five grades was calculated by cross-sectional location. The highest accuracies were associated with curvature- and wall-located tumors (55.1 and 64.3%, respectively) when serosal exposure was graded 5 and 3, respectively. The highest overall accuracy for T staging was 59.2% when the various MDCT criteria were applied by reference to the cross-sectional location. CONCLUSIONS The MDCT criteria for serosal exposure vary by the cross-sectional location of the gastric cancer.
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Affiliation(s)
- Su Lim Lee
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Mi Ku
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae Myung Jeon
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Han Hong Lee
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. .,Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Gyenggi-Do, Korea.
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Indiran V. Re: Chokkappan K, Chinchure D, Chawla A, Subramanian M, Krishnan V, Narayana Shenoy J, Srinivasan S. An approach to various gastric pathologies using an "image appearance-based classification" on computed tomography. Curr Probl Diagn Radiol. 2016;45(1):23-38. Curr Probl Diagn Radiol 2016; 45:235. [DOI: 10.1067/j.cpradiol.2016.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 01/31/2016] [Indexed: 11/22/2022]
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Individualized nomogram improves diagnostic accuracy of stage I-II gallbladder cancer in chronic cholecystitis patients with gallbladder wall thickening. Hepatobiliary Pancreat Dis Int 2016; 15:180-8. [PMID: 27020635 DOI: 10.1016/s1499-3872(16)60073-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Early diagnosis of gallbladder cancer (GBC) can remarkably improve the prognosis of patients. This study aimed to develop a nomogram for individualized diagnosis of stage I-II GBC in chronic cholecystitis patients with gallbladder wall thickening. METHODS The nomogram was developed using logistic regression analyses based on a retrospective cohort consisting of 89 consecutive patients with stage I-II GBC and 1240 patients with gallbladder wall thickening treated at one biliary surgery center in Shanghai between January 2009 and December 2011. The accuracy of the nomogram was validated by discrimination, calibration and a prospective cohort treated at another center between January 2012 and December 2014 (n=928). RESULTS Factors included in the nomogram were advanced age, hazardous alcohol consumption, long-standing diagnosed gallstones, atrophic gallbladder, gallbladder wall calcification, intraluminal polypoid lesion, higher wall thickness ratio and mucosal line disruption. The nomogram had concordance indices of 0.889 and 0.856 for the two cohorts, respectively. Internal and external calibration curves fitted well. The area under the receiver-operating characteristic curves of the nomogram was higher than that of multidetector row computed tomography in diagnosis of stage I-II GBC (P<0.001). CONCLUSION The proposed nomogram improves individualized diagnosis of stage I-II GBC in chronic cholecystitis patients with gallbladder wall thickening, especially for those the imaging features alone do not allow to confirm the diagnosis.
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Gastric carcinoma: Evaluation with diffusion-tensor MR imaging and tractography ex vivo. Magn Reson Imaging 2016; 34:144-51. [DOI: 10.1016/j.mri.2015.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 08/20/2015] [Accepted: 10/17/2015] [Indexed: 01/20/2023]
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Motta-Ramírez GA, Almazán-Urbina FE, Aragón-Flores M, Bastida-Alquicira J, Luján-Cortés EI, Gámez Salas R. El cáncer gástrico en una institución de tercer nivel: correlación endoscópica, por tomografía computarizada e histopatológica del cáncer gástrico en el Hospital Central Militar. GACETA MEXICANA DE ONCOLOGÍA 2015. [DOI: 10.1016/j.gamo.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Yamada I, Hikishima K, Miyasaka N, Kato K, Ito E, Kojima K, Kawano T, Kobayashi D, Eishi Y, Okano H. q-space MR imaging of gastric carcinoma ex vivo: Correlation with histopathologic findings. Magn Reson Med 2015; 76:602-12. [DOI: 10.1002/mrm.25905] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 07/26/2015] [Accepted: 08/03/2015] [Indexed: 01/15/2023]
Affiliation(s)
- Ichiro Yamada
- Department of Diagnostic Radiology and Nuclear Medicine; Graduate School, Tokyo Medical and Dental University; Tokyo Japan
| | - Keigo Hikishima
- Department of Physiology; Keio University School of Medicine; Tokyo Japan
- Central Institute for Experimental Animals; Kanagawa Japan
| | - Naoyuki Miyasaka
- Department of Pediatrics, Perinatal and Maternal Medicine; Tokyo Medical and Dental University; Tokyo Japan
| | - Keiji Kato
- Department of Gastric Surgery; Tokyo Medical and Dental University; Tokyo Japan
| | - Eisaku Ito
- Department of Pathology; Tokyo Medical and Dental University; Tokyo Japan
| | - Kazuyuki Kojima
- Department of Gastric Surgery; Tokyo Medical and Dental University; Tokyo Japan
| | - Tatsuyuki Kawano
- Department of Esophageal Surgery; Tokyo Medical and Dental University; Tokyo Japan
| | - Daisuke Kobayashi
- Department of Pathology; Tokyo Medical and Dental University; Tokyo Japan
| | - Yoshinobu Eishi
- Department of Pathology; Tokyo Medical and Dental University; Tokyo Japan
| | - Hideyuki Okano
- Department of Physiology; Keio University School of Medicine; Tokyo Japan
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Barros RHDO, Penachim TJ, Martins DL, Andreollo NA, Caserta NMG. Multidetector computed tomography in the preoperative staging of gastric adenocarcinoma. Radiol Bras 2015; 48:74-80. [PMID: 25987747 PMCID: PMC4433295 DOI: 10.1590/0100-3984.2014.0021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 10/02/2014] [Indexed: 12/18/2022] Open
Abstract
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).
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Affiliation(s)
| | - Thiago José Penachim
- MDs., Radiologists at Hospital de Clínicas - Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Daniel Lahan Martins
- MDs., Radiologists at Hospital de Clínicas - Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Nelson Adami Andreollo
- PhD, Full Professor, Department of Surgery - Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
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Liu Y, Gao JB, Yue SW, Liu J, Gao XZ, Zheng Y, Zhang YL. Correlation between CT contrast enhancement ratio and CT perfusion parameters and expression of HER2 in gastric cancer. Shijie Huaren Xiaohua Zazhi 2015; 23:426-431. [DOI: 10.11569/wcjd.v23.i3.426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the correlation between the computed tomography (CT) contrast enhancement ratio (CER) in arterial phase and venous phase, CT perfusion parameters and expression of human epidermal growth factor receptor 2 (HER2) in pathologically proven gastric cancer.
METHODS: A retrospective analysis of triple-phase CER was performed on 105 patients who underwent MSCT. A retrospective analysis of CT perfusion parameters including maximal arterial flow (AF), blood volume (BV), blood flow (BF) and clearance (CL) was performed on 50 patients who underwent 320-detector-row CT perfusion. The expression of HER2 was detected by immunohistochemistry in all the patients. The differences in CER and CT perfusion parameters between the HER2-negative and HER2-positive groups were analyzed.
RESULTS: The triple-phase CER values in the HER2-negative group were 0.65±0.35, 1.18±0.53 and 2.62±1.41, respectively; the corresponding values in the HER2-positive group were 0.78±0.44, 1.47±0.61 and 2.37±1.36. CER in the venous phase was significantly higher in the HER2-positive group than in the HER2-negative group ((P = 0.010), although CER values in the arterial phase and arterial-venous phase were not significantly different ((P = 0.094, 0.597). The perfusion parameters in the HER2-negative group were as follows: AF = 117.15 mL/(100 mL·min) ± 31.56 mL/(100 mL·min), BV = 20.69 mL/100 Ml ± 13.41 mL/100 mL, BF = 6.42 mL/(100 mL·min) ± 4.25 mL/(100 mL·min), and CL = 4.46 1/s ± 2.25 1/s; the corresponding values in the HER2-positive group were 119.08 mL/(100 mL·min) ± 41.97 mL/(100 mL·min), 20.07 mL/100 mL ± 14.46 mL/100 mL, 6.39 mL/(100 mL·min) ± 3.68 mL/(100 mL·min), and 5.63 1/s ± 2.90 1/s. There was no significant difference in AF, BV, BF or CL between the two groups ((P = 0.888, 0.886, 0.979 and 0.123, respectively).
CONCLUSION: The CER in venous phase is significantly higher in the HER2-positive group than in the HER2-negative group, but there is no significant difference in the CT perfusion parameters.
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Yamada I, Miyasaka N, Hikishima K, Kato K, Kojima K, Kawano T, Ito E, Kobayashi D, Eishi Y, Okano H. Gastric Carcinoma: Ex Vivo MR Imaging at 7.0 T-Correlation with Histopathologic Findings. Radiology 2015; 275:841-8. [PMID: 25584712 DOI: 10.1148/radiol.14141878] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine the imaging detail and diagnostic information that can be obtained at 7.0-T magnetic resonance (MR) imaging with a voxel volume of 9.5-14.0 nL as a means of evaluating the depth of mural invasion by gastric carcinomas ex vivo. MATERIALS AND METHODS This study was approved by the institutional review board, and written informed consent was obtained from each patient. Twenty gastric specimens containing 20 carcinomas were studied with a 7.0-T MR imaging system equipped with a four-channel surface coil. MR images were obtained with a 50-60 × 25-30 mm field of view, a 512 × 256 matrix, and a 1.0-mm section thickness, resulting in a voxel volume of 0.0095-0.0140 mm(3) (9.5-14.0 nL). The signal intensity of the gastric wall layers, tumor tissue, and fibrosis was described as low, intermediate, or high by comparing it with the signal intensity of the muscularis propria. Depth of invasion initially was assessed by two reviewers independently and then by the two reviewers in consensus. MR images were compared with histopathologic findings. RESULTS The 7.0-T T2-weighted MR images clearly depicted the normal gastric wall in all 20 specimens (100%) as consisting of seven layers, which clearly corresponded to the tissue layers of the gastric wall. These MR images enabled clear differentiation between tumor tissue and fibrosis. Reviewers disagreed on the depth of invasion at the initial reading in three (15%) of 20 specimens (between mucosa and submucosa in two specimens and between muscularis propria and subserosa and serosa in one specimen); however, in all 20 gastric carcinomas, the depth of invasion could be accurately determined on T2-weighted images after consensus interpretation. CONCLUSION Ex vivo 7.0-T MR imaging enables clear delineation of the gastric wall layers and clear differentiation of tumor tissue from fibrosis and allows one to assess the depth of mural invasion by gastric carcinomas.
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Affiliation(s)
- Ichiro Yamada
- From the Departments of Diagnostic Radiology and Oncology (I.Y.), Pediatrics, Perinatal and Maternal Medicine (N.M.), Gastric Surgery (K. Kato, K. Kojima), Esophageal Surgery (T.K.), and Pathology (E.I., D.K., Y.E.), Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; Department of Physiology, Keio University School of Medicine, Tokyo, Japan (K.H., H.O.); and Central Institute for Experimental Animals, Kawasaki, Japan (K.H.)
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Kim JW, Shin SS, Heo SH, Lim HS, Lim NY, Park YK, Jeong YY, Kang HK. The role of three-dimensional multidetector CT gastrography in the preoperative imaging of stomach cancer: emphasis on detection and localization of the tumor. Korean J Radiol 2015; 16:80-9. [PMID: 25598676 PMCID: PMC4296280 DOI: 10.3348/kjr.2015.16.1.80] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/20/2014] [Indexed: 01/17/2023] Open
Abstract
Multidetector CT (MDCT) gastrography has been regarded as a promising technique for the preoperative imaging of gastric cancer. It has the ability to produce various three-dimensional (3D) images. Because 3D reconstruction images are more effective and intuitive for recognizing abnormal changes in the gastric folds and subtle mucosal nodularity than two-dimensional images, 3D MDCT gastrography can enhance the detection rate of early gastric cancer, which, in turn, contributes to the improvement of the accuracy of preoperative tumor (T) staging. In addition, shaded surface display and tissue transition projection images provide a global view of the stomach, with the exact location of gastric cancer, which may replace the need for barium studies. In this article, we discuss technical factors in producing high-quality MDCT gastrographic images and present cases demonstrating the usefulness of MDCT gastrography for the detection and T staging of gastric cancer while emphasizing the significance of preoperative localization of gastric cancer in terms of surgical margin.
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Affiliation(s)
- Jin Woong Kim
- Department of Radiology, Chonnam National University Medical School, Gwangju 501-757, Korea
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Medical School, Gwangju 501-757, Korea. ; Center for Aging and Geriatrics, Chonnam National University Medical School, Gwangju 501-757, Korea
| | - Suk Hee Heo
- Department of Radiology, Chonnam National University Medical School, Gwangju 501-757, Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Medical School, Gwangju 501-757, Korea
| | - Nam Yeol Lim
- Department of Radiology, Chonnam National University Hospital, Gwangju 501-757, Korea
| | - Young Kyu Park
- Department of Surgery, Chonnam National University Medical School, Gwangju 501-757, Korea
| | - Yong Yeon Jeong
- Department of Radiology, Chonnam National University Medical School, Gwangju 501-757, Korea
| | - Heoung Keun Kang
- Department of Radiology, Chonnam National University Medical School, Gwangju 501-757, Korea
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Hallinan JTPD, Venkatesh SK, Peter L, Makmur A, Yong WP, So JBY. CT volumetry for gastric carcinoma: association with TNM stage. Eur Radiol 2014; 24:3105-14. [PMID: 25038858 DOI: 10.1007/s00330-014-3316-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 06/10/2014] [Accepted: 07/04/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVES We evaluated the feasibility of performing CT volumetry of gastric carcinoma (GC) and its correlation with TNM stage. METHODS This institutional review board-approved retrospective study was performed on 153 patients who underwent a staging CT study for histologically confirmed GC. CT volumetry was performed by drawing regions of interest including abnormal thickening of the stomach wall. Reproducibility of tumour volume (Tvol) between two readers was assessed. Correlation between Tvol and TNM/peritoneal staging derived from histology/surgical findings was evaluated using ROC analysis and compared with CT evaluation of TNM/peritoneal staging. RESULTS Tvol was successfully performed in all patients. Reproducibility among readers was excellent (r = 0.97; P = 0.0001). The median Tvol of GC showed an incremental trend with T-stage (T1 = 27 ml; T2 = 32 ml; T3 = 53 ml and T4 = 121 ml, P < 0.01). Tvol predicted with good accuracy T-stage (≥T2:0.95; ≥T3:0.89 and T4:0.83, P = 0.0001), M-stage (0.87, P = 0.0001), peritoneal metastases (0.87, P = 0.0001) and final stage (≥stage 2:0.89; ≥stage 3:0.86 and stage 4:0.87, P = 0.0001), with moderate accuracy for N-stage (≥N1:0.75; ≥N2:0.74 and N3:0.75, P = 0.0001). Tvol was significantly (P < 0.05) more accurate than standard CT staging for prediction of T-stage, N3-stage, M-stage and peritoneal metastases. CONCLUSION CT volumetry may provide useful adjunct information for preoperative staging of GC. KEY POINTS CT volumetry of gastric carcinoma is feasible and reproducible. Tumour volume <19.4 ml predicts T1-stage gastric cancer with 91% sensitivity and 100% specificity (P = 0.0001). Tumour volume >95.7 ml predicts metastatic gastric cancer with 87% sensitivity and 78.5% specificity (P = 0.0001). CT volumetry may be a useful adjunct for staging gastric carcinoma.
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Affiliation(s)
- James T P D Hallinan
- Diagnostic Radiology, National University Health System (NUHS), Singapore, Singapore
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Joo I, Lee JM, Kim JH, Shin CI, Han JK, Choi BI. Prospective comparison of 3T MRI with diffusion-weighted imaging and MDCT for the preoperative TNM staging of gastric cancer. J Magn Reson Imaging 2014; 41:814-21. [PMID: 24677322 DOI: 10.1002/jmri.24586] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/08/2014] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To compare the diagnostic performance of 3T magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) and multidetector-row computed tomography (MDCT) for the preoperative TNM staging of gastric cancer. MATERIALS AND METHODS This prospective study was approved by our Institutional Review Board. Forty-nine consecutive patients with histologically confirmed gastric cancers underwent MDCT and 3T MRI followed by surgery. MRI without DWI, MRI with DWI, and MDCT were reviewed to determine preoperative TNM staging. Using the pathologic stages as the reference standard, the diagnostic performance of each imaging modality was compared. RESULTS Diagnostic accuracies of MRI with DWI, MRI without DWI, and MDCT did not show a significant difference (≤T2 vs. ≥T3: 85.1%, 78.7%, and 80.9%; ≤T3 vs. T4: 76.6%, 74.5%, and 72.3%; N-negative vs. N-positive: 76.6%, 66.0%, and 63.8%; M0 vs. M1: all 95.9%, respectively) (P > 0.05). For N staging, MRI with DWI demonstrated higher sensitivity but lower specificity (86.7% and 58.8%, respectively) than MRI without DWI (50.0% and 94.1%) or MDCT (43.3% and 100%) (P < 0.05). CONCLUSION The diagnostic accuracy of 3T MRI is comparable to that of MDCT for the preoperative TNM staging of gastric cancer, and for assessing LN metastasis, the addition of DWI to conventional MRI may increase the sensitivity.
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Affiliation(s)
- Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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Liu S, He J, Guan W, Li Q, Yu H, Zhou Z, Bao S, Zhou Z. Added value of diffusion-weighted MR imaging to T2-weighted and dynamic contrast-enhanced MR imaging in T staging of gastric cancer. Clin Imaging 2013; 38:122-8. [PMID: 24411204 DOI: 10.1016/j.clinimag.2013.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/22/2013] [Accepted: 12/04/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the utilization of diffusion-weighted (DW) magnetic resonance (MR) imaging in T staging of gastric cancer prospectively. METHODS Fifty-one patients underwent T2-weighted (T2W), contrast-enhanced (CE) and DW MR imaging. Two radiologists independently interpreted the images for T staging of the tumors. RESULTS The overall accuracy of T staging in pT1-4 gastric cancers by T2W+CE+DW (88.2%) was significantly higher than that by T2W+CE and T2W+DW (both 76.5%, P=.031). CONCLUSION DW adds useful information to T2W and CE MR imaging in T staging of gastric cancer.
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Affiliation(s)
- Song Liu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Wenxian Guan
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Qiang Li
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Haiping Yu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Zhuping Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Shanhua Bao
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008.
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Hallinan JTPD, Venkatesh SK. Gastric carcinoma: imaging diagnosis, staging and assessment of treatment response. Cancer Imaging 2013; 13:212-27. [PMID: 23722535 PMCID: PMC3667568 DOI: 10.1102/1470-7330.2013.0023] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Gastric carcinoma (GC) is one of the most common causes of cancer-related death worldwide. Surgical resection is the only cure available and is dependent on the GC stage at presentation, which incorporates depth of tumor invasion, extent of lymph node and distant metastases. Accurate preoperative staging is therefore essential for optimal surgical management with consideration of preoperative and/or postoperative chemotherapy. Multidetector computed tomography (MDCT) with its ability to assess tumor depth, nodal disease and metastases is the preferred technique for staging GC. Endoscopic ultrasonography is more accurate for assessing the depth of wall invasion in early cancer, but is limited in the assessment of advanced local or stenotic cancer and detection of distant metastases. Magnetic resonance imaging (MRI), although useful for staging, is not proven to be effective. Positron emission tomography (PET) is most useful for detecting and characterizing distant metastases. Both MDCT and PET are useful for assessment of treatment response following preoperative chemotherapy and for detection of recurrence after surgical resection. This review article discusses the usefulness of imaging modalities for detecting, staging and assessing treatment response for GC and the potential role of newer applications including CT volumetry, virtual gastroscopy and perfusion CT in the management of GC.
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