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Liang Y, Guo W, Li C, Shen G, Tan H, Sun P, Chen Z, Huang H, Li Z, Li Z, Ren Y, Li G, Hu Y. Tumor-Targeted Polydopamine-Based Nanoparticles for Multimodal Mapping Following Photothermal Therapy of Metastatic Lymph Nodes. Int J Nanomedicine 2022; 17:4659-4675. [PMID: 36199474 PMCID: PMC9528963 DOI: 10.2147/ijn.s367975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Lymphadenectomy with lymph node (LN) mapping is essential for surgical removal of solid tumors. Existing agents do not provide accurate multimodal mapping and antitumor therapy for metastatic LNs; therefore, we fabricated a polydopamine (PDA) nanoparticle (NP)-based tumor-targeted LN mapping agent capable of multimodal mapping and guided photothermal therapy (PTT) for metastatic LNs. Materials and Methods PDA NPs modified with polyethylene glycol (PEG) were obtained by polymerization under alkaline conditions. The PEG-PDA NPs were loaded with the circular tripeptide Arg-Gly-Asp (cRGD) to achieve tumor-targeting capacity and with the fluorescent dye IR820 and magnetic resonance imaging (MRI) contrast Gd(NH2)2 for in situ detection. The resulting cRGD-PEG-PDA@IR820/Gd(NH2)2 (cRGD-PPIG) NPs were tested for their biosafety and metastatic LN mapping ability. They were drained specifically into LNs and selectively taken up by gastric MKN45 cells via αvβ3 integrin-mediated endocytosis. Results This phenomenon enabled MR/optical/near-infrared fluorescence multimodal metastatic LN mapping, guiding the creation of accurate and highly efficient PTT for gastric cancer metastatic LNs in mice. Conclusion In summary, we fabricated tumor-targeted cRGD-PPIG NPs with MR/optical/near-infrared fluorescence multimodal metastatic LN mapping capacity for surgery and efficient PTT guidance post-surgery.
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Affiliation(s)
- Yanrui Liang
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Weihong Guo
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Chuangji Li
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Guodong Shen
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Haoxian Tan
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China
| | - Peiwen Sun
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China
| | - Zhian Chen
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Huilin Huang
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Zhenhao Li
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Zhenyuan Li
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Yingxin Ren
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Guoxin Li
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
- Correspondence: Guoxin Li; Yanfeng Hu, Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Ave, Baiyun District, Guangzhou, 510515, People’s Republic of China, Tel +86-20-6164-1681; +86-20-6164-1682, Fax +86-20-6164-1681, Email ;
| | - Yanfeng Hu
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
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Magnetic Fields and Cancer: Epidemiology, Cellular Biology, and Theranostics. Int J Mol Sci 2022; 23:ijms23031339. [PMID: 35163262 PMCID: PMC8835851 DOI: 10.3390/ijms23031339] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/22/2022] [Accepted: 01/22/2022] [Indexed: 02/08/2023] Open
Abstract
Humans are exposed to a complex mix of man-made electric and magnetic fields (MFs) at many different frequencies, at home and at work. Epidemiological studies indicate that there is a positive relationship between residential/domestic and occupational exposure to extremely low frequency electromagnetic fields and some types of cancer, although some other studies indicate no relationship. In this review, after an introduction on the MF definition and a description of natural/anthropogenic sources, the epidemiology of residential/domestic and occupational exposure to MFs and cancer is reviewed, with reference to leukemia, brain, and breast cancer. The in vivo and in vitro effects of MFs on cancer are reviewed considering both human and animal cells, with particular reference to the involvement of reactive oxygen species (ROS). MF application on cancer diagnostic and therapy (theranostic) are also reviewed by describing the use of different magnetic resonance imaging (MRI) applications for the detection of several cancers. Finally, the use of magnetic nanoparticles is described in terms of treatment of cancer by nanomedical applications for the precise delivery of anticancer drugs, nanosurgery by magnetomechanic methods, and selective killing of cancer cells by magnetic hyperthermia. The supplementary tables provide quantitative data and methodologies in epidemiological and cell biology studies. Although scientists do not generally agree that there is a cause-effect relationship between exposure to MF and cancer, MFs might not be the direct cause of cancer but may contribute to produce ROS and generate oxidative stress, which could trigger or enhance the expression of oncogenes.
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Awiwi MO, Ramanan RV, Elshikh M, Vikram R. Imaging of Gastric Carcinoma. Part One: Diagnosis and Staging. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1735217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractGastric cancer is one of the leading causes of death from malignancy. Despite the enormous advancement in medical oncology over the past decade, surgical resection of early tumors remains the most effective treatment. Accurate interpretation of radiologic imaging studies is crucial for staging local disease spread, predicting possible lymphatic involvement, and identifying metastatic disease, thereby guiding management plans. This article reviews imaging patterns of the normal stomach along with appearances of gastric cancer, its local spread patterns and distant metastasis, and also describes key features pertaining to preoperative staging.
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Affiliation(s)
- Muhammad O. Awiwi
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Texas, United States
| | | | - Mohamed Elshikh
- Department of Radiology, The University of Texas Medical Branch, Texas, United States
| | - Raghunandan Vikram
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Texas, United States
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Ao S, Wang Y, Song Q, Ye Y, Lyu G. Current status and future perspectives on neoadjuvant therapy in gastric cancer. Chin J Cancer Res 2021; 33:181-192. [PMID: 34158738 PMCID: PMC8181872 DOI: 10.21147/j.issn.1000-9604.2021.02.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/07/2021] [Indexed: 12/12/2022] Open
Abstract
Gastric cancer, with high morbidity and mortality rates, is one of the most heterogeneous tumors. Radical gastrectomy and postoperative chemotherapy are the standard treatments. However, the safety and efficacy of neoadjuvant therapy (NAT) need to be confirmed by many trials before implementation, creating a bottleneck in development. Although clinical benefits of NAT have been observed, a series of problems remain to be solved. Before therapy, more contributing factors should be offered for choice in the intended population and ideal regimens. Enhanced computed tomography (CT) scanning is usually applied to evaluate effectiveness according to Response Evaluation Criteria in Solid Tumors (RECIST), yet CT scanning results sometimes differ from pathological responses. After NAT, the appropriate time for surgery is still empirically defined. Our review aims to discuss the abovementioned issues regarding NAT for GC, including indications, selection of regimens, lesion assessment and NAT-surgery interval time.
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Affiliation(s)
- Sheng Ao
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518000, China
- Department of Gastrointestinal Surgery, Peking University People’s Hospital, Beijing 100044, China
| | - Yuchen Wang
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518000, China
| | - Qingzhi Song
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518000, China
| | - Yingjiang Ye
- Department of Gastrointestinal Surgery, Peking University People’s Hospital, Beijing 100044, China
| | - Guoqing Lyu
- Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518000, China
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Machlowska J, Baj J, Sitarz M, Maciejewski R, Sitarz R. Gastric Cancer: Epidemiology, Risk Factors, Classification, Genomic Characteristics and Treatment Strategies. Int J Mol Sci 2020; 21:E4012. [PMID: 32512697 PMCID: PMC7312039 DOI: 10.3390/ijms21114012] [Citation(s) in RCA: 605] [Impact Index Per Article: 151.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer (GC) is one of the most common malignancies worldwide and it is the fourth leading cause of cancer-related death. GC is a multifactorial disease, where both environmental and genetic factors can have an impact on its occurrence and development. The incidence rate of GC rises progressively with age; the median age at diagnosis is 70 years. However, approximately 10% of gastric carcinomas are detected at the age of 45 or younger. Early-onset gastric cancer is a good model to study genetic alterations related to the carcinogenesis process, as young patients are less exposed to environmental carcinogens. Carcinogenesis is a multistage disease process specified by the progressive development of mutations and epigenetic alterations in the expression of various genes, which are responsible for the occurrence of the disease.
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Affiliation(s)
- Julita Machlowska
- Center for Medical Genomics OMICRON, Jagiellonian University Medical College, 31-034 Kraków, Poland;
- Department of Human Anatomy, Medical University of Lublin, 20-090 Lublin, Poland; (J.B.); (R.M.)
| | - Jacek Baj
- Department of Human Anatomy, Medical University of Lublin, 20-090 Lublin, Poland; (J.B.); (R.M.)
| | - Monika Sitarz
- Department of Conservative Dentistry with Endodontics, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Ryszard Maciejewski
- Department of Human Anatomy, Medical University of Lublin, 20-090 Lublin, Poland; (J.B.); (R.M.)
| | - Robert Sitarz
- Department of Human Anatomy, Medical University of Lublin, 20-090 Lublin, Poland; (J.B.); (R.M.)
- Department of Surgery, Center of Oncology of the Lublin Region St. Jana z Dukli, 20-090 Lublin, Poland
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6
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Maman A, Sahin A, Ayan AK. The Relationship of SUV Value in PET-CT with Tumor Differentiation and Tumor Markers in Gastric Cancer. Eurasian J Med 2020; 52:67-72. [PMID: 32158318 DOI: 10.5152/eurasianjmed.2019.19016] [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: 11/22/2022] Open
Abstract
Objective We aimed to investigate the relationship between the use of fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT), maximized standardized uptake value (SUVmax) values of tumors, and tumor differentiation and tumor markers during the initial staging of patients with gastric cancer. Materials and Methods The study included 50 patients (14 women and 36 men; mean age: 63±11 years; age range: 31-80 years) who had undergone initial staging with FDG-PET/CT after the diagnosis of gastric cancer with endoscopic biopsy between January and June 2013. Serum alpha fetoprotein (AFP), carcinogenic antigen 19-9 (CA 19.9), carcinoembryonic antigen (CEA), and C-reactive protein (CRP) levels were measured in patients prior to imaging. PET/CT images were evaluated for primary tumors, locoregional spread, and distant organ metastases, and classified by tumor-node-metastasis staging. Semiquantitative data were collected by SUVmax measurements in pathological regions of involvement. Data were analyzed statistically. Results FDG-PET/CT showed primary gastric cancer with a sensitivity of 87%. Imaging findings were normal in 3 patients (1/3; mucinous adenocarcinoma, 2/3; signet-ring cell adenocarcinoma). With FDG-PET/CT, 3/50 patients were classified into Stage 1B, 3/50 patients into Stage 2, 5/50 patients into Stage 3A, 5/50 patients into Stage 3B, 5/50 patients into 3C and 29/50 patients into Stage 4. The mean SUVmax was calculated as 11.35±4.3 (poorly differentiated adenocarcinoma: 5.4±1.7; moderately differentiated adenocarcinoma: 10.3±4.8) for the primary tumor and 14.9±6.3 for tumor metastasis. A positive correlation was evident between the measured SUVmax and stage and the grade of primary tumor (p<0.05). While the relationship between SUVmax and levels of serum AFP and CRP was statistically significant (p<0.05), the relationship between SUVmax and levels of serum CA 19-9 and CEA was not statistically significant (p>0.05). Conclusion The SUVmax of primary tumors was associated with the degree of differentiation of primary tumors and the biochemical tumor markers CRP and AFP. The fact that SUVmax of primary tumors is high supplies clues about the presence of the factors affecting prognosis of the disease.
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Affiliation(s)
- Adem Maman
- Department of Nuclear Medicine, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ali Sahin
- Department of Nuclear Medicine, Ataturk University School of Medicine, Erzurum, Turkey
| | - Arif Kursad Ayan
- Clinic of Nuclear Medicine, Private Yücelen Hospital, Muğla, Turkey
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Borggreve AS, Goense L, Brenkman HJF, Mook S, Meijer GJ, Wessels FJ, Verheij M, Jansen EPM, van Hillegersberg R, van Rossum PSN, Ruurda JP. Imaging strategies in the management of gastric cancer: current role and future potential of MRI. Br J Radiol 2019; 92:20181044. [PMID: 30789792 DOI: 10.1259/bjr.20181044] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Accurate preoperative staging of gastric cancer and the assessment of tumor response to neoadjuvant treatment is of importance for treatment and prognosis. Current imaging techniques, mainly endoscopic ultrasonography (EUS), computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), have their limitations. Historically, the role of magnetic resonance imaging (MRI) in gastric cancer has been limited, but with the continuous technical improvements, MRI has become a more potent imaging technique for gastrointestinal malignancies. The accuracy of MRI for T- and N-staging of gastric cancer is similar to EUS and CT, making MRI a suitable alternative to other imaging strategies. There is limited evidence on the performance of MRI for M-staging of gastric cancer specifically, but MRI is widely used for diagnosing liver metastases and shows potential for diagnosing peritoneal seeding. Recent pilot studies showed that treatment response assessment as well as detection of lymph node metastases and systemic disease might benefit from functional MRI (e.g. diffusion weighted imaging and dynamic contrast enhancement). Regarding treatment guidance, additional value of MRI might be expected from its role in better defining clinical target volumes and setup verification with MR-guided radiation treatment.
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Affiliation(s)
- Alicia S Borggreve
- 1 Department of Surgery, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands.,2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Lucas Goense
- 1 Department of Surgery, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands.,2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Hylke J F Brenkman
- 1 Department of Surgery, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Stella Mook
- 2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Gert J Meijer
- 2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Frank J Wessels
- 3 Department of Radiology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Marcel Verheij
- 4 Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL) , Amsterdam , Netherlands
| | - Edwin P M Jansen
- 4 Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL) , Amsterdam , Netherlands
| | - Richard van Hillegersberg
- 1 Department of Surgery, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Peter S N van Rossum
- 2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | - Jelle P Ruurda
- 1 Department of Surgery, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
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CT/MRI accuracy in detecting and determining preoperative stage of gastric adenocarcinoma in Albania. Contemp Oncol (Pozn) 2017; 21:168-173. [PMID: 28947888 PMCID: PMC5611507 DOI: 10.5114/wo.2017.68626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/10/2017] [Indexed: 12/18/2022] Open
Abstract
AIM OF THE STUDY Gastric adenocarcinoma is among most frequent among cancers in Albania. Early detection and staging is helped by imaging methods, including CT and MRI. This study provides evidence on the CT and MRI accuracy in detecting and pre-operative staging of gastric adenocarcinoma in 62 patients in a diagnostic clinic in Albania. The correct staging of the gastric adenocarcinoma helps decide on the next treatment options. MATERIAL AND METHODS Sixty-two patients with gastric adenocarcinoma, confirmed with biopsy, underwent both CT and MRI examination at a clinic in Tirana during same week. Images were reviewed to determine the TNM classifications and staging using the current AJCC guidelines. Data on age, sex, cancer location and differentiation were also collected and analyzed. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value was estimated for both CT and MRI. RESULTS AND CONCLUSIONS CT has a higher accuracy than MRI (83% vs. 67%) for T1. Accuracy for T2 was the same (74%). Starting with T3 and upwards, MRI has a slightly more accurate ability to detect and stage the gastric adenocarcinoma (T3: 81 vs. 75; T4: 83 vs. 64). Both the CT and MRI abilities to accurately detect the N classification were the same. Regarding the M classification, the MRI has a slightly more accurate ability to detect metastases (M: 83 vs. 64). Clinicians might benefit from using CT whenever suspect gastric adenocarcinoma patients present first. Decision on surgery requires a MRI to rule out metastases.
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Berlth F, Chon SH, Chevallay M, Jung MK, Mönig SP. Preoperative staging of nodal status in gastric cancer. Transl Gastroenterol Hepatol 2017; 2:8. [PMID: 28217758 DOI: 10.21037/tgh.2017.01.08] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/04/2017] [Indexed: 12/21/2022] Open
Abstract
An accurate preoperative staging of nodal status is crucial in gastric cancer, because it has a great impact on prognosis and therapeutic decision-making. Different staging methods have been evaluated for gastric cancer in order to predict nodal involvement. So far, no technique could meet the necessary requirements, which include a high detection rate of infiltrated lymph nodes and a low frequency of false-positive results. This article summarizes different staging methods used to assess lymph node status in patients with gastric cancer, evaluates the evidence, and proposes to establish new methods.
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Affiliation(s)
- Felix Berlth
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Seung-Hun Chon
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Mickael Chevallay
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Minoa Karin Jung
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Stefan Paul Mönig
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
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Yan C, Bao X, Shentu W, Chen J, Liu C, Ye Q, Wang L, Tan Y, Huang P. Preoperative Gross Classification of Gastric Adenocarcinoma: Comparison of Double Contrast-Enhanced Ultrasound and Multi-Detector Row CT. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1431-1440. [PMID: 27072076 DOI: 10.1016/j.ultrasmedbio.2016.01.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 12/25/2015] [Accepted: 01/23/2016] [Indexed: 06/05/2023]
Abstract
The aim of this study was to compare the accuracy of multi-detector computed tomography (MDCT) with double contrast-enhanced ultrasound (DCEUS), in which intravenous microbubbles are used alongside oral contrast-enhanced ultrasound, in determining the gross classification of patients with gastric carcinoma (GC). Altogether, 239 patients with GC proved by histology after endoscopic biopsy were included in this study. DCEUS and MDCT were performed pre-operatively. The diagnostic accuracies of DCEUS and MDCT in determining the gross classification were calculated and compared. The overall accuracy of DCEUS in determining the gross appearance of GC was higher than that of MDCT (84.9% vs. 79.9%, p < 0.001). There was no significant difference in accuracy between DCEUS and MDCT for Borrmann I and IV classifications of advanced gastric cancer (χ(2), p = 0.323 for Borrmann type I, p = 0.141 for Borrmann type IV). The accuracy of DCEUS for early GC and Borrmann II and III classifications of GC was higher than that of MDCT (χ(2), p = 0.000 for all). DCEUS may be regarded as a valuable complementary tool to MDCT in determining the gross appearance of gastric adenocarcinoma pre-operatively.
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Affiliation(s)
- Caoxin Yan
- Department of Ultrasound, The 2nd Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Xiaofeng Bao
- Department of Ultrasound, The 2nd Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Weihui Shentu
- Department of Ultrasound, The 2nd Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Jian Chen
- Department of Surgery, The 2nd Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| | - Chunmei Liu
- Department of Ultrasound, The 2nd Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Qin Ye
- Department of Pathology, The 2nd Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| | - Liuhong Wang
- Department of Radiology, The 2nd Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| | - Yangbin Tan
- Department of Radiology, The 2nd Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| | - Pintong Huang
- Department of Ultrasound, The 2nd Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China.
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Giganti F, Orsenigo E, Arcidiacono PG, Nicoletti R, Albarello L, Ambrosi A, Salerno A, Esposito A, Petrone MC, Chiari D, Staudacher C, Del Maschio A, De Cobelli F. Preoperative locoregional staging of gastric cancer: is there a place for magnetic resonance imaging? Prospective comparison with EUS and multidetector computed tomography. Gastric Cancer 2016; 19:216-25. [PMID: 25614468 DOI: 10.1007/s10120-015-0468-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/08/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to prospectively compare the diagnostic performance of magnetic resonance imaging (MRI), multidetector computed tomography (MDCT) and endoscopic ultrasonography (EUS) in the preoperative locoregional staging of gastric cancer. METHODS This study had Institutional Review Board approval, and informed consent was obtained from all patients. Fifty-two patients with biopsy-proven gastric cancer underwent preoperative 1.5-T MRI, 64-channel MDCT and EUS. All images were analysed blind, and the results were compared with histopathological findings according to the seventh edition of the TNM classification. After the population had been divided on the basis of the local invasion (T1-3 vs T4a-b) and nodal involvement (N0 vs N+), sensitivity, specificity, positive and negative predictive value, and accuracy were calculated and diagnostic performance measures were assessed using the McNemar test. RESULTS For T staging, EUS showed higher sensitivity (94%) than MDCT and MRI (65 and 76%; p = 0.02 and p = 0.08). MDCT and MRI had significantly higher specificity (91 and 89%) than EUS (60%) (p = 0.0009 and p = 0.003). Adding MRI to MDCT or EUS did not result in significant differences for sensitivity. For N staging, EUS showed higher sensitivity (92%) than MRI and MDCT (69 and 73%; p = 0.01 and p = 0.02). MDCT showed better specificity (81%) than EUS and MRI (58 and 73%; p = 0.03 and p = 0.15). CONCLUSIONS Our prospective study confirmed the leading role of EUS and MDCT in the staging of gastric cancer and did not prove, at present, the value of the clinical use of MRI.
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Affiliation(s)
- Francesco Giganti
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
| | - Elena Orsenigo
- Department of Surgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Department of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Nicoletti
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Luca Albarello
- Pathology Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Annalaura Salerno
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Antonio Esposito
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Maria Chiara Petrone
- Department of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Damiano Chiari
- Department of Surgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Carlo Staudacher
- Department of Surgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Del Maschio
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
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Choi JI, Joo I, Lee JM. State-of-the-art preoperative staging of gastric cancer by MDCT and magnetic resonance imaging. World J Gastroenterol 2014; 20:4546-4557. [PMID: 24782607 PMCID: PMC4000491 DOI: 10.3748/wjg.v20.i16.4546] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/20/2013] [Accepted: 01/15/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer is one of the most common and fatal cancers. The importance of accurate staging for gastric cancer has become more critical due to the recent introduction of less invasive treatment options, such as endoscopic mucosal resection or laparoscopic surgery. The tumor-node-metastasis staging system is the generally accepted staging system for predicting the prognosis of patients with gastric cancer. Multidetector row computed tomography (MDCT) is a widely accepted imaging modality for the preoperative staging of gastric cancer that can simultaneously assess locoregional staging, including the gastric mass, regional lymph nodes, and distant metastasis. The diagnostic performance of MDCT for T- and N-staging has been improved by the technical development of isotropic imaging and 3D reformation. Although magnetic resonance imaging (MRI) was not previously used to evaluate gastric cancer due to the modality’s limitations, the development of high-speed sequences has made MRI a feasible tool for the staging of gastric cancer.
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Caivano R, Rabasco P, Lotumolo A, D' Antuono F, Zandolino A, Villonio A, Macarini L, Guglielmi G, Salvatore M, Cammarota A. Gastric cancer: The role of diffusion weighted imaging in the preoperative staging. Cancer Invest 2014; 32:184-90. [PMID: 24654696 DOI: 10.3109/07357907.2014.896014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Evaluate the role of diffusion-weighted-imaging (DWI) in the diagnosis and staging of gastric carcinoma. MATERIALS AND METHODS A total of 31 patients with gastric adenocarcinoma, which underwent preoperative staging with 3Tesla Magnetic Resonance Imaging (MRI), were enrolled. Two radiologists evaluated the tumor staging in DWI. Results were compared to postsurgical pathologic findings. RESULTS The T factor accuracy of conventional MRI and DWI was 73% and 80% respectively; while the N staging accuracy of conventional MRI and DWI was 80% and 93%, respectively. CONCLUSION DWI and apparent diffusion coefficient (ADC) values showed to be useful in preoperative staging of gastric cancer.
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Affiliation(s)
- R Caivano
- I.R.C.C.S. -C.R.O.B. , Rionero in Vulture (Pz) , Italy ,1
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14
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Cheng J, Wang Y, Deng J, McCarthy RJ, Wang G, Wang H, Ye Y. Discrimination of metastatic lymph nodes in patients with gastric carcinoma using diffusion-weighted imaging. J Magn Reson Imaging 2012; 37:1436-44. [PMID: 23172760 DOI: 10.1002/jmri.23925] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 10/01/2012] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To determine the accuracy of diffusion-weighted imaging (DWI) in discrimination of metastatic lymph nodes (LNs) in gastric carcinoma with rigorous histopathological correlation. MATERIALS AND METHODS With Institutional Review Board (IRB) approval, 28 patients with gastric carcinoma underwent magnetic resonance imaging (MRI) and DWI before surgery. LNs were resected at surgery and thereafter submitted for histopathological analyses. All histopathologically identified LNs (≥ 5 mm) that exactly matched the location and size of nodes on MRI/DWI were submitted to lesion-by-lesion analyses. Short-axis diameter, border irregularity, enhanced patterns, and apparent diffusion coefficient (ADC) values of each LN were recorded. Each measurement was compared between metastatic and benign LNs, confirmed by nodal histopathology. A receiver operating characteristic (ROC) curve was generated to evaluate the capability of morphological and ADC measurements in distinguishing metastatic lymph nodes. RESULTS The median ADC value of metastatic nodes was significantly lower (1.28 × 10(-3) mm(2) /sec; interquartile range, 1.20-1.31) than that of benign (1.55; 1.47-1.73) nodes (P < 0.001). DWI showed greater diagnostic accuracy in determining metastatic nodes (AUC = 0.857) than the combined morphological measurements of short-axis, border irregularity, and enhanced patterns (AUC = 0.746, P = 0.03). Adding ADC values to the combined morphologic criteria demonstrated the greatest predictive power (AUC = 0.889). CONCLUSION DWI may provide great potential in effective discrimination of metastatic LNs in gastric carcinoma.
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Affiliation(s)
- Jin Cheng
- People's Hospital, Peking University, Department of Radiology, Beijing, China
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15
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Lee JY, Choi BI, Son KR, Lee JM, Kim SJ, Park HS, Chang JM, Choi SH, Kim MA, Moon WK. Lymph node metastases from gastric cancer: gadofluorine M and gadopentetate dimeglumine MR imaging in a rabbit model. Radiology 2012; 263:391-400. [PMID: 22517957 DOI: 10.1148/radiol.000102431] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the diagnostic performance of gadofluorine M with that of gadopentetate dimeglumine in the diagnosis of lymph node metastases with magnetic resonance (MR) imaging in a rabbit model of gastric cancer. MATERIALS AND METHODS The study protocol was approved by the institutional animal care committee. VX2 carcinomas were inoculated into the wall of the stomach in 20 rabbits. Gadopentetate dimeglumine-enhanced MR imaging was performed 4-6 weeks after inoculation, and gadofluorine M-enhanced MR imaging was performed approximately 24 hours later. Both MR imaging sets were analyzed separately and independently by four radiologists with respect to confidence level regarding the presence of metastases in lymph nodes and lymph node conspicuity. Statistical analysis was performed by using multiple-reader multiple-case (MRMC) receiver operating characteristic curve analysis and the Wilcoxon signed rank test. RESULTS Metastases were confirmed at pathologic analysis in 32 of 104 lymph nodes from 16 rabbits. The area under the receiver operating characteristic curve (AUC) for confidence regarding the presence of metastases in lymph nodes was significantly greater for gadofluorine M than for gadopentetate dimeglumine (AUC, 0.947 vs 0.894; P = .009). However, most (81%, 25 of 32) metastatic nodes were necrotic, and no significant difference was obtained in nonnecrotic nodes. For lymph node conspicuity, the gadofluorine M MR imaging set was assigned a significantly higher score than was the gadopentetate dimeglumine MR imaging set by all readers (P < .001). CONCLUSION Gadofluorine M showed significantly higher accuracy and better conspicuity than gadopentetate dimeglumine in the diagnosis of metastatic nodes, most of which were necrotic, in this animal model of gastric cancer.
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Affiliation(s)
- Jae Young Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
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16
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Russell MC, Mansfield PF. Surgical approaches to gastric cancer. J Surg Oncol 2012; 107:250-8. [PMID: 22674546 DOI: 10.1002/jso.23180] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 05/14/2012] [Indexed: 12/11/2022]
Abstract
While the incidence of gastric cancer has declined substantially, it remains a major cause of morbidity and mortality. Surgical resection offers the best chance for curative treatment. Despite numerous studies, surgical controversies persist including endoscopic resection, extent of gastric resection, degree of lymphadenectomy, and laparoscopic resection. Balancing the benefits with the risks of surgical morbidity and mortality is essential. This review examines these controversies and provides insight into the surgical management of gastric cancer.
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Affiliation(s)
- Maria C Russell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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17
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Abstract
Gastric adenocarcinoma is one of the most common causes of death worldwide. Surgical resection remains the mainstay of therapy, offering the only chance for complete cure. Resection is based on the principles of obtaining adequate margins, with the extent of lymphadenectomy remaining controversial. Neoadjuvant and adjuvant therapies are used to reduce local recurrence and improve long-term survival. This article reviews the literature and provides a summary of surgical management options and neoadjuvant/adjuvant therapies for gastric adenocarcinoma.
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Affiliation(s)
- Sameer H Patel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365C Clifton Road, Northeast 2nd Floor, Atlanta, GA 30322, USA
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18
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Ha TK, Choi YY, Song SY, Kwon SJ. F18-fluorodeoxyglucose-positron emission tomography and computed tomography is not accurate in preoperative staging of gastric cancer. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81:104-10. [PMID: 22066108 PMCID: PMC3204564 DOI: 10.4174/jkss.2011.81.2.104] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 04/27/2011] [Indexed: 02/08/2023]
Abstract
PURPOSE To investigate the clinical benefits of F18-fluorodeoxyglucose-positron emission tomography and computed tomography ((18)F-FDG-PET/CT) over multi-detector row CT (MDCT) in preoperative staging of gastric cancer. METHODS FDG-PET/CT and MDCT were performed on 78 patients with gastric cancer pathologically diagnosed by endoscopy. The accuracy of radiologic staging retrospectively was compared to pathologic result after curative resection. RESULTS Primary tumors were detected in 51 (65.4%) patients with (18)F-FDG-PET/CT, and 47 (60.3%) patients with MDCT. Regarding detection of lymph node metastasis, the sensitivity of FDG-PET/CT was 51.5% with an accuracy of 71.8%, whereas those of MDCT were 69.7% and 69.2%, respectively. The sensitivity of (18)F-FDG-PET/CT for a primary tumor with signet ring cell carcinoma was lower than that of (18)F-FDG-PET/CT for a primary tumor with non-signet ring cell carcinoma (35.3% vs. 73.8%, P < 0.01). CONCLUSION Due to its low sensitivity, (18)F-FDG-PET/CT alone shows no definite clinical benefit for prediction of lymph node metastasis in preoperative staging of gastric cancer.
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Affiliation(s)
- Tae Kyung Ha
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
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19
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Shen Y, Kang HK, Jeong YY, Heo SH, Han SM, Chen K, Liu Y. Evaluation of early gastric cancer at multidetector CT with multiplanar reformation and virtual endoscopy. Radiographics 2011; 31:189-99. [PMID: 21257941 DOI: 10.1148/rg.311105502] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Early gastric cancer (EGC) is defined as a carcinoma in which invasion is limited to the mucosa and submucosa, regardless of lymph node status and distant metastasis. Recent advances in multidetector computed tomography (CT) with multiplanar reformation (MPR) provide a powerful tool for identifying gastric wall invasion and the perigastric extent of gastric cancer. In addition, MPR images confer advantages in the assessment of both intra- and extraluminal processes of the gastric wall and the evaluation of more distant regions, such as the paraaortic lymph nodes and other abdominal organs. Virtual endoscopy performed after air distention of the stomach can aid in the evaluation of gastric endoluminal morphologic features and the extent of EGC. Moreover, virtual endoscopy helps in detecting subtle mucosal changes and differentiating them from submucosal lesions in the same way as conventional endoscopy. Virtual endoscopy can depict abnormal endoluminal lesions within a wider field of view than can conventional endoscopy, and there are no "blind spots" because retrospective image reformation is available, which provides useful information for preoperative mapping. Multidetector CT with MPR and virtual endoscopy is a powerful, noninvasive tool for the early detection and accurate preoperative staging of EGC.
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Affiliation(s)
- Yulan Shen
- Department of Diagnostic Radiology, Shanghai Jiao Tong University Medical School, Rui Jin Hospital, China
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20
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Abstract
A more differentiated therapy regimen for gastric carcinoma requires more precise preoperative staging. In patients with early gastric cancer (EGC), especially in cases with carcinoma confined to mucosa, endoscopic resection (ER) is usually performed to avoid unnecessary surgical procedures. To achieve R0 resection for locally advanced gastric cancer (AGC), neoadjuvant treatments have been investigated. Clinical staging of gastric cancer has been greatly improved by advances in imaging techniques, such as endoscopic ultrasonography (EUS), transabdominal ultrasonography (TAUS), multi-slice spiral CT (MSCT), magnetic resonance imaging (MRI), positron emission tomography (PET), combined PET-CT scans, and laparoscopic staging. This paper aims to summarize the recent advances in preoperative staging of gastric cancer.
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Hassan H, Vilmann P, Sharma V. Impact of EUS-guided FNA on management of gastric carcinoma. Gastrointest Endosc 2010; 71:500-4. [PMID: 20189507 DOI: 10.1016/j.gie.2009.10.044] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 10/20/2009] [Indexed: 12/26/2022]
Abstract
BACKGROUND EUS is an integral part of the pretherapeutic evaluation program for patients with upper GI cancer. OBJECTIVE To evaluate the impact of EUS-guided FNA on the clinical management of patients with gastric cancer. DESIGN The study included patients with confirmed gastric carcinoma who were referred to the Department of Surgical Gastroenterology, Gentofte Hospital, Copenhagen University, Copenhagen, Denmark, during a 6-year period (2001-2007). SETTING The patients underwent standard pretherapeutic evaluation. If no signs of incurability were detected, the patients were offered EUS and EUS-guided FNA. EUS-guided FNA was performed when lymph nodes or lesions were considered to be distant metastases. A board of surgeons was asked to evaluate the management of the patients after the results obtained by EUS-guided FNA were revealed. PATIENTS This study involved 234 patients with gastric carcinoma. INTERVENTION EUS-guided FNA. MAIN OUTCOME MEASUREMENTS Number of patients with distant metastasis diagnosed by EUS-guided FNA, with the avoidance of unnecessary surgery. RESULTS A total of 81 consecutive patients underwent EUS-guided FNA. Ninety-nine lesions were targeted, and 61 (62%) of these lesions were found to be malignant. In 38 of 81 patients (42%) distant metastases were confirmed by EUS-guided FNA. As judged by the board of surgeons, EUS-guided FNA changed the management plan in 34 of 234 patients (15%). LIMITATION The positive EUS-guided FNA diagnoses were not surgically verified. CONCLUSION EUS-guided FNA is a very important modality and should be integrated as a routine procedure in the preoperative staging algorithm of gastric cancer.
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Affiliation(s)
- Hazem Hassan
- Department of Surgical Gastroenterology, Gentofte Hospital, Copenhagen University, Hellerup, Denmark
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22
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Kim IY, Kim SW, Shin HC, Lee MS, Jeong DJ, Kim CJ, Kim YT. MRI of gastric carcinoma: Results of T and N-staging in an in vitro study. World J Gastroenterol 2009; 15:3992-8. [PMID: 19705493 PMCID: PMC2731948 DOI: 10.3748/wjg.15.3992] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [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 determine the accuracy of 1.5-T magnetic resonance imaging (MRI) in the evaluation of gastric wall invasion and perigastric lymph node metastasis in gastric adenocarcinoma.
METHODS: Twenty resected gastric specimens containing 20 tumors were studied with a 1.5-T MR system using a commercial head surface coil. MR scanning was performed with a T1 weighted image (TR/TE = 500/20), and a T2 weighted image (TR/TE = 2500/90). MR findings were compared with pathologic findings.
RESULTS: A T1-weighted image demonstrated three layers in the normal gastric wall. All of the gastric tumors were well demonstrated by lesions and location. In a MRI findings of gastric wall invasion, there was 1 case of T1, 7 of T2, 11 of T3. Pathologic results of resected specimens included 3 cases of pT1, 4 of pT2, and 12 of pT3. The accuracy of T staging with MRI was 74% (14 of 19). MRI findings of lymph node metastasis included 6 cases of N0, 13 cases of N1. The accuracy of the N staging with MRI was 47% (9 of 19).
CONCLUSION: MRI has a high diagnostic accuracy in the evaluation of the T staging of gastric cancer in vitro and thus potentially enables preoperative histopathologic staging.
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Kwee RM, Kwee TC. Imaging in assessing lymph node status in gastric cancer. Gastric Cancer 2009; 12:6-22. [PMID: 19390927 DOI: 10.1007/s10120-008-0492-5] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Accepted: 11/10/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Accurate assessment of lymph node status is of crucial importance for appropriate treatment planning and determining prognosis in patients with gastric cancer. The aim of this study was to systematically review the current role of imaging in assessing lymph node (LN) status in gastric cancer. METHODS A systematic literature search was performed in the PubMed/MEDLINE and Embase databases. The methodological quality and diagnostic performance of the included studies was assessed. RESULTS Six abdominal ultrasonography (AUS) studies, 30 endoscopic ultrasonography (EUS) studies, 10 multidetectorrow computed tomography (MDCT) studies, 3 conventional magnetic resonance imaging (MRI) studies, 4 (18)F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) studies, and 1 FDG-PET/CT fusion study were included. In general, the included studies had moderate methodological quality. The sensitivity and specificity of AUS varied between 12.2% and 80.0% (median, 39.9%) and 56.3% and 100% (median, 81.8%). The sensitivity and specificity of EUS varied between 16.7% and 95.3% (median, 70.8%) and 48.4% and 100% (median, 84.6%). The sensitivity and specificity of MDCT varied between 62.5% and 91.9% (median, 80.0%) and 50.0% and 87.9% (median, 77.8%). The sensitivity and specificity of MRI varied between 54.6% and 85.3% (median, 68.8%) and 50.0% and 100% (median, 75.0%). The sensitivity and specificity of FDG-PET varied between 33.3% and 64.6% (median, 34.3%) and 85.7% and 97.0% (median, 93.2%). The sensitivity and specificity of the FDG-PET/CT fusion study were 54.7% and 92.2%. For all the imaging modalities, there were no significant differences between the mean sensitivities and specificities of high- and low-quality studies. CONCLUSION AUS, EUS, MDCT, conventional MRI, and FDG-PET cannot reliably be used to confirm or exclude the presence of LN metastasis. The performance of highresolution PET/CT fusion and functional MRI techniques still has to be determined.
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Affiliation(s)
- Robert Michael Kwee
- Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands
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24
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Abstract
Worldwide, gastric cancer is one of the top three leading causes of cancer mortality, but incidence and presentation vary geographically. Currently, surgery is the only possible cure. Nodal status is an important prognostic indicator for gastric cancer, and despite results of randomized controlled trials, debate continues over the importance of aggressive lymphadenectomy.
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Affiliation(s)
- Natalie G Coburn
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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25
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Tokuhara T, Tanigawa N, Matsuki M, Nomura E, Mabuchi H, Lee SW, Tatsumi Y, Nishimura H, Yoshinaka R, Kurisu Y, Narabayashi I. Evaluation of lymph node metastases in gastric cancer using magnetic resonance imaging with ultrasmall superparamagnetic iron oxide (USPIO): diagnostic performance in post-contrast images using new diagnostic criteria. Gastric Cancer 2009; 11:194-200. [PMID: 19132480 DOI: 10.1007/s10120-008-0480-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 08/23/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND We assessed the value of magnetic resonance imaging (MRI), using ultrasmall superparamagnetic iron oxide (USPIO) with new diagnostic criteria, in the evaluation of regional lymph node metastases in gastric cancer. METHODS Thirty-one patients with gastric cancer were enrolled. 1000 lymph nodes were dissected during surgery, and of these, 519 nodes (51.9%) were identified by currently used MRI imaging analysis. We evaluated lymph nodes on USPIO-post-contrast T2*-weighted images using the following two criteria: (1) we diagnosed the nodes on T2*-weighted images according to conventional criteria, where a node having an overall low signal intensity (pattern A) was nonmetastatic, while a node having partial (pattern B) or overall (pattern C) high signal intensity was metastatic; (2) we subdivided pattern B nodes on T1-weighted images using the new criteria, in which a node for which the high-intensity area on T2*-weighted images was not defined as adipose tissue on T1-weighted images (pattern B1) was metastatic, while a node for which the high-intensity area was defined as adipose tissue (pattern B2) was nonmetastatic. RESULTS (1) The results using the conventional criteria were 96.2% sensitivity, 92.5% specificity, 76.3% positive predictive value (PPV), 99.0% negative predictive value (NPV), and 93.3% accuracy. (2) The results using the new criteria were 96.2% sensitivity, 98.3% specificity, 90.1% PPV, 99.0% NPV, and 97.1% accuracy. CONCLUSION The assessment of lymph node metastases from USPIO-post-contrast MRI alone using the new criteria was useful in the diagnosis of regional lymph node metastases in gastric cancer.
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Affiliation(s)
- Takaya Tokuhara
- Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
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26
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Heye T, Kuntz C, Düx M, Encke J, Palmowski M, Autschbach F, Volke F, Kauffmann GW, Grenacher L. CT and endoscopic ultrasound in comparison to endoluminal MRI: preliminary results in staging gastric carcinoma. Eur J Radiol 2008; 70:336-41. [PMID: 18337043 DOI: 10.1016/j.ejrad.2008.01.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 12/17/2007] [Accepted: 01/22/2008] [Indexed: 01/03/2023]
Abstract
PURPOSE To prospectively compare diagnostic parameters of a newly developed endoluminal MRI (endo-MRI) concept with endoscopic ultrasound (EUS) and hydro-computer tomography (Hydro-CT) in T-staging of gastric carcinoma on one patient collective. MATERIAL AND METHODS 28 consecutive patients (11 females, 17 males, age range 46-87 years, median 67 years) referred for surgery due to a gastric malignancy were included. Preoperative staging by EUS was performed in 14 cases and by Hydro-CT in 14 cases within a time frame of 2 weeks. Ex vivo endo-MRI examination of gastric specimens was performed directly after gastrectomy within a time interval of 2-3h. EUS data were acquired from the clinical setting whereas Hydro-CT and endo-MRI data were evaluated in blinded fashion by two experienced radiologists and one surgeon well experienced in EUS on gastric carcinomas. RESULTS Histopathology resulted in 4 pT1, 17 pT2, 3 pT3 and 2 pT4 carcinomas with 2 gastric lymphomas which were excluded. Overall accuracy for endo-MRI was 75% for T-Staging of the 26 carcinomas. EUS achieved 42.9% accuracy; endo-MRI in this subgroup was accurate in 71.4%. Hydro-CT was correct in 28.6%, accuracy for endo-MRI in this subgroup was 71.4%. CONCLUSION The direct comparison of all three modalities on one patient collective shows that endo-MRI is able to achieve adequate staging results in comparison with clinically accepted methods like EUS and Hydro-CT in classifying the extent of tumor invasion into the gastric wall. However the comparison is limited as we compared in vivo routine clinical data with experimental ex vivo data. Future investigations need to show if the potential of endo-MRI can be transferred into a clinical in vivo setting.
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Affiliation(s)
- Tobias Heye
- Department of Diagnostic Radiology, University Hospital, Heidelberg, Germany.
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27
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Chen BB, Liang PC, Liu KL, Hsiao JK, Huang JC, Wong JM, Lee PH, Shun CT, Ming-Tsang Y. Preoperative diagnosis of gastric tumors by three-dimensional multidetector row ct and double contrast barium meal study: correlation with surgical and histologic results. J Formos Med Assoc 2008; 106:943-52. [PMID: 18063516 DOI: 10.1016/s0929-6646(08)60065-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Abstract
BACKGROUND/PURPOSE Recent three-dimensional multidetector row computed tomography (3D MDCT) can provide detailed images of a gastric tumor, including its general contour, location and depth. We therefore evaluated the efficacy of MDCT in the differential diagnosis and staging of gastric tumors in patients prepared for surgery. METHODS Seventy-nine patients with gastric tumors identified by gastric optical endoscopy were admitted for preoperative evaluation. All patients received double-contrast barium meal (DCBM) study and abdominal MDCT with 3D reconstruction before surgery. We compared the accuracy of MDCT with DCBM study in detecting and differentiating gastric tumors. In addition, the MDCT findings were correlated with surgical and pathologic results in gastric cancers for Borrmann type, T and N stages. RESULTS Among the 79 patients with gastric tumors, there were 24 cases of early gastric cancer, 40 cases of advanced gastric cancer, 12 cases of gastrointestinal stromal tumor, and three cases of gastric lymphoma. Both MDCT and DCBM were very accurate in picking up the lesions (100%). The diagnostic accuracies of MDCT and DCBM were similar (94% vs. 96%) in differentiating mucosal and submucosal lesions as well as classification of Borrmann type in advanced gastric cancer (70% vs. 63%). In 64 patients with gastric cancers, there was good correlation between MDCT images and pathology in 73% of T staging and 69% of N staging. CONCLUSION MDCT has a similar high accuracy in the preoperative diagnosis of different gastric tumors compared with DCBM and provides additional information including tumor depth, lymph node and hepatic metastasis. Therefore, MDCT may be used as a primary tool for preoperative tumor diagnosis and staging.
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Affiliation(s)
- Bang-Bin Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
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28
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Abstract
The study is to determine the optimal MRI bowel preparation regime for visualization of the stomach anatomy. Eight healthy volunteers were asked to take water, 75% barium and blueberry juice. The image quality and tolerance of different stomach distension regime were evaluated. Blueberry juice gave the best distension, but the signal intensity was not very homogeneous. Taking into account the image quality, tolerability and adverse effects, it is concluded that water is the most desirable oral contrast for MR stomach imaging.
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Affiliation(s)
- W W M Lam
- Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR.
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29
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Jensen EH, Tuttle TM. Preoperative Staging and Postoperative Surveillance for Gastric Cancer. Surg Oncol Clin N Am 2007; 16:329-42. [PMID: 17560516 DOI: 10.1016/j.soc.2007.03.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Physicians must consider multiple factors when determining the most appropriate preoperative imaging strategy for gastric cancer. Health care resources are not unlimited, and the use of multiple expensive imaging techniques that do not alter treatment decisions is not recommended. With this in mind, EGD and CT scan alone should form the basis for preoperative evaluation, with further imaging considered only in selected cases. Based on the reviewed literature, we do not recommend routine surveillance imaging after curative surgery for gastric cancer. We agree with current NCCN guidelines that recommend history and physical examination every 4 to 6 months for 3 years, followed by yearly examinations. Imaging studies and endoscopy should be selectively performed in symptomatic patients.
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Affiliation(s)
- Eric H Jensen
- Division of Surgical Oncology, University of Minnesota Medical Center, MMC 195, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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30
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Palmowski M, Grenacher L, Kuntz C, Heye T, Dux M. Magnetic resonance imaging for local staging of gastric carcinoma: results of an in vitro study. J Comput Assist Tomogr 2007; 30:896-902. [PMID: 17082692 DOI: 10.1097/01.rct.0000224624.17574.27] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Preoperative staging of gastric carcinoma is limited by the fact that available imaging modalities do not enable accurate evaluation of the depth of infiltration of the gastric wall. The aim of this study was to evaluate the efficiency of conventional magnetic resonance imaging (MRI) in local staging of gastric carcinoma. METHODS Sixty-five specimens of patients with proven gastric carcinoma were examined immediately after gastrectomy. Examination was performed with a 1-T MRI and included T1-weighted, T2-weighted, and opposed phase images. Images were analyzed for the number of visible wall layers and their signal intensity characteristics, for tumor localization and depth of infiltration. T-stage was classified according to the TNM system. Finally, the staging by MRI was compared with the histopathological staging of the specimens. RESULTS The mucosal, submucosal, and proper muscle layers could be differentiated by the typical signal intensities. Depiction of the subserosa or serosa was not possible. In 65 specimens, 67 carcinomas were found by the pathologist. Sixty-four of 67 (96%) histologically proven carcinomas were correctly localized by MRI; T-staging accuracy was 50% only, mainly because of overstaging pT2 tumors as T3. CONCLUSIONS MRI enables differentiation of gastric wall layers and, therefore, technically allows the evaluation of the local tumor stage of gastric carcinomas. However, infiltration of the subserosal and serosal layer cannot be proved accurately. Overstaging pT2 tumors is one of the most predominant problems. Yet further technical developments in high-resolution imaging of the gastric wall may improve T-staging in the near future and overcome today's staging limitations.
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Affiliation(s)
- Moritz Palmowski
- Department of Diagnostic Radiology, Ruprecht-Karls University, 69120 Heidelberg, Germany.
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Clark CJ, Thirlby RC, Picozzi V, Schembre DB, Cummings FP, Lin E. Current problems in surgery: gastric cancer. Curr Probl Surg 2006; 43:566-670. [PMID: 17000267 DOI: 10.1067/j.cpsurg.2006.06.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Clancy J Clark
- Department of General Surgery, Virginia Mason Medical Center, Seattle, Washington, USA
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Zhong L, Li L, Sun JH, Xu JR. Preoperative diagnosis of gastric cancer using 2-D magnetic resonance imaging with 3-D reconstruction techniques. ACTA ACUST UNITED AC 2006; 6:159-64. [PMID: 16246223 DOI: 10.1111/j.1443-9573.2005.00224.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the clinical value of 2-D magnetic resonance imaging (MRI) with 3-D reconstruction techniques for the preoperative diagnosis and TNM-staging of gastric cancer. METHODS Using a Philips Gyroscan NT 1.0T superconductive unit, MRI using the water-filling method was performed in 15 patients with suspected gastric cancers. The 2-D MRI sequences included TSE-T1WI, TSE-T2WI and fat suppression (SPIR). The source images of magnetic resonance hydrography (heavily TSE-T2WI sequence) were reconstructed using the Philips EasyVision viewing workstation. Four 3-D postprocessing algorithms, including maximum intensity projection, surface shaded viewing, volume rendering and virtual endoscopy, were performed and compared with the results of a barium study and endoscopy. All 15 patients with 16 gastric cancers had their diagnosis confirmed by postoperative pathological findings. RESULTS 2-D MRI and 3-D reconstruction images were successfully obtained for all 15 patients. The maximum intensity projection, surface shaded viewing, and volume rendering images corresponded to the upper gastrointestinal series findings, and the virtual endoscopy images corresponded to the gastroscopic views. In 16 gastric lesions, MRI correctly diagnosed 14 (87.5%) advanced gastric cancers, and the tumor location, size and classification were also accurately identified. The accuracy of MRI for determining the preoperative TNM stage was 64.3% (9/14), and there was significant correlation between these results and those from the histopathological studies (P < 0.01). Based on T, N and M factors, the staging accuracy of MRI was 71.4% (10/14), 57.1% (8/14) and 85.7% (12/14), respectively. CONCLUSIONS 2-D MRI with 3-D reconstruction is an effective method for the preoperative diagnosis and TNM staging of gastric cancer. However, the detection of early cancers or benign lesions and N-staging should be further studied.
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Affiliation(s)
- Liang Zhong
- Department of Radiology, Renji Hospital, Shanghai Second Medical University, Shanghai, China.
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Abstract
The role of computed tomography (CT) in the preoperative staging of gastric cancer, even if controversial, may be fundamental for evaluating the local extent and nodal involvement of the disease, especially in locally advanced cases. However, previous results of CT staging have not been satisfactory for predicting the invasive depth of the tumor or possible nodal metastases. Recently introduced multidetector row CT (MDCT) and three-dimensional (3D) imaging are expected to overcome the limitations in cancer staging by offering rapid and accurate information for space perception, detailed hemodynamics, and real-time 3D processing of volumetric data sets. In particular, virtual endoscopic imaging may be helpful for detecting early gastric cancer. In our experience, T and N stagings of gastric cancer were improved with 3D MDCT when using volume rendering and virtual endoscopic imaging compared with conventional axial two-dimensional (2D) CT (accuracy of T staging with 3D vs. 2D CT images, 84% vs. 77%; accuracy of N staging, 63% vs. 61% with 3D vs. 2D images, respectively). In particular, the detection rate of early gastric cancer was markedly increased up to 96% when using 3D MDCT. Therefore, we believe that 3D MDCT of the stomach may enhance the performance of CT in the preoperative evaluation of patients who have gastric cancer by offering easy early detection of lesions and accurate tumor staging through the 3D imaging process.
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Affiliation(s)
- A Y Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-Dong, Songpa-Ku, Seoul 138-736, Korea.
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Kim HJ, Kim AY, Oh ST, Kim JS, Kim KW, Kim PN, Lee MG, Ha HK. Gastric cancer staging at multi-detector row CT gastrography: comparison of transverse and volumetric CT scanning. Radiology 2005; 236:879-85. [PMID: 16020558 DOI: 10.1148/radiol.2363041101] [Citation(s) in RCA: 184] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To prospectively evaluate the accuracy of multi-detector row computed tomography (CT) gastrography for preoperative staging of gastric cancer, with pathologic and surgical results as the reference standard. MATERIALS AND METHODS This study was approved by the institutional review board, and patients gave written informed consent. One hundred six patients (72 male, 34 female; mean age, 56 years) with endoscopically proved gastric cancer underwent unenhanced and contrast material-enhanced multi-detector row CT gastrography, with effervescent granules used as oral contrast material. Two experienced radiologists independently evaluated the depth of tumor invasion into the gastric wall (tumor staging), the involvement of regional lymph nodes (nodal staging), and the presence or absence of metastasis (metastatic staging) on transverse and volumetric CT images, which included images produced with multiplanar reformation and a virtual endoscopic technique. TNM staging of each tumor was compared with the pathologic and surgical results. Diagnostic accuracy in TNM staging was analyzed. RESULTS Gastric cancer was detected in 92 (87%) of 106 study patients with transverse CT imaging and in 104 (98%) with volumetric CT imaging. The overall accuracy of the tumor staging was 77% with transverse CT imaging and 84% with volumetric CT imaging (P < .001). The overall accuracy for lymph node staging was 62% with transverse CT imaging and 64% with volumetric CT imaging (P = .057). For staging of metastases, there was no difference between transverse and volumetric CT imaging (86% for both) (P > .99). CONCLUSION Multi-detector row CT gastrography with multiplanar reformation and virtual endoscopy, compared with transverse CT imaging, can improve the accuracy of preoperative staging of gastric cancer. This difference was significant for tumor staging but not for the staging of lymph nodes and metastases.
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Affiliation(s)
- Hye Jin Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-dong, Songpa-ku, Seoul 138-736, Korea
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Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM. Gastric adenocarcinoma: review and considerations for future directions. Ann Surg 2005; 241:27-39. [PMID: 15621988 PMCID: PMC1356843 DOI: 10.1097/01.sla.0000149300.28588.23] [Citation(s) in RCA: 482] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This update reviews the epidemiology and surgical management, and the controversies of gastric adenocarcinoma. We provide the relevance of outcome data to surgical decision-making and discuss the application of gene-expression analysis to clinical practice. SUMMARY BACKGROUND DATA Gastric cancer mortality rates have remained relatively unchanged over the past 30 years, and gastric cancer continues to be one of the leading causes of cancer-related death. Well-conducted studies have stimulated changes to surgical decision-making and technique. Microarray studies linked to predictive outcome models are poised to advance our understanding of the biologic behavior of gastric cancer and improve surgical management and outcome. METHODS We performed a review of the English gastric adenocarcinoma medical literature (1980-2003). This review included epidemiology, pathology and staging, surgical management, issues and controversies in management, prognostic variables, and the application of outcome models to gastric cancer. The results of DNA microarray analysis in various cancers and its predictive abilities in gastric cancer are considered. RESULTS Prognostic studies have provided valuable data to better the understanding of gastric cancer. These studies have contributed to improved surgical technique, more accurate pathologic characterization, and the identification of clinically useful prognostic markers. The application of microarray analysis linked to predictive models will provide a molecular understanding of the biology driving gastric cancer. CONCLUSIONS Predictive models generate important information allowing a logical evolution in the surgical and pathologic understanding and therapy for gastric cancer. However, a greater understanding of the molecular changes associated with gastric cancer is needed to guide surgical and medical therapy.
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Affiliation(s)
- Bryan J Dicken
- Department of Surgery, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
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Ajaj W, Goyen M, Herrmann B, Massing S, Goehde S, Lauenstein T, Ruehm SG. Measuring tongue volumes and visualizing the chewing and swallowing process using real-time TrueFISP imaging--initial clinical experience in healthy volunteers and patients with acromegaly. Eur Radiol 2004; 15:913-8. [PMID: 15627180 DOI: 10.1007/s00330-004-2596-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2004] [Revised: 10/29/2004] [Accepted: 11/12/2004] [Indexed: 11/28/2022]
Abstract
This study assessed both two-dimensional (2D) TrueFISP imaging for quantifying tongue volume and real-time TrueFISP imaging for evaluating chewing and swallowing in healthy volunteers and patients with acromegaly. In 50 healthy volunteers, tongue volumes were measured using a 2D TrueFISP sequence. Chewing and swallowing were visualized using a real-time TrueFISP sequence. Ten patients with acromegaly were examined twice with the same magnetic resonance imaging protocol: once prior to therapy and a second time 6 months after therapy. Prior to therapy, healthy volunteers had an average tongue volume of 140 ml for men and 90 ml for women, and patients with acromegaly had an average tongue volume of 180 ml for men and 145 ml for women. However, 6 months after therapy the mean tongue volumes in patients with acromegaly had decreased to 154 ml in the men and to 125 ml in the women. The chewing and swallowing process was normal in all volunteers. Prior to therapy, just two patients showed a chewing and swallowing pathology, which disappeared after therapy. Patients with acromegaly had larger tongue volumes than healthy volunteers, and TrueFISP imaging proved feasible for visualizing chewing and swallowing in real time and is capable of detecting possible pathologies. Furthermore, TrueFISP imaging can be used to monitor therapeutic approaches in patients with acromegaly.
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Affiliation(s)
- W Ajaj
- Department of Diagnostic and Interventional Radiology, University Hospital, Essen, Germany.
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Ajaj W, Lauenstein T, Papanikolaou N, Holtmann G, Goehde SC, Ruehm SG, Debatin JF. Real-time high-resolution MRI for the assessment of gastric motility: pre- and postpharmacological stimuli. J Magn Reson Imaging 2004; 19:453-8. [PMID: 15065169 DOI: 10.1002/jmri.20029] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To determine the practicality of MRI using a new real-time sequence for the assessment of gastric motion, and quantify the effects of motility-modifying substances. MATERIALS AND METHODS Six healthy volunteers ingested 400 mL of a high-calorie liquid nutrient. Two-dimensional real-time TrueFISP sequences were acquired for up to 30 minutes following the ingestion. The acquisition plane was chosen parallel to the axis of the gastric antrum. The examination was performed on three separate days with and without i.v. administration of 10 mg metoclopramide or 20 mg scopolamine. A motility index was calculated for each real-time data set. RESULTS Delineation of the gastric lumen proved easy and robust. The intravenous application of motility-modifying agents resulted in significant changes in the motility index. The administration of metoclopramide resulted in an average increase of the index by a factor of 1.5, whereas the application of scopolamine led to a decrease of the index by a factor of 3.0. CONCLUSION TrueFISP MRI performed well in depicting the gastric lumen and assessing gastric motility. Furthermore, we were able to evaluate and quantify the effect of motility-modifying agents. The noninvasive nature of MRI makes this imaging modality an attractive alternative to conventional invasive diagnostic tools for gastric motility disorders and monitoring of therapy.
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Affiliation(s)
- Waleed Ajaj
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany.
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Yan C, Zhu ZG, Yu YY, Ji J, Zhang Y, Ji YB, Yan M, Chen J, Liu BY, Yin HR, Lin YZ. Expression of vascular endothelial growth factor C and chemokine receptor CCR7 in gastric carcinoma and their values in predicting lymph node metastasis. World J Gastroenterol 2004; 10:783-90. [PMID: 15040017 PMCID: PMC4726993 DOI: 10.3748/wjg.v10.i6.783] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To study the expression of vascular endothelial growth factor C (VEGF-C) and chemokine receptor CCR7 in gastric carcinoma and to investigate their associations with lymph node metastasis of gastric carcinoma and their values in predicting lymph node metastasis.
METHODS: The expression of VEGF-C and CCR7 in gastric carcinoma tissues obtained from 118 patients who underwent curative gastrectomy was examined by immunohistochemistry. Among these patients, 39 patients underwent multi-slice spiral CT (MSCT) examination.
RESULTS: VEGF-C and CCR7 were positively expressed in 52.5 and 53.4% of patients. VEGF-C expression was more frequently found in tumors with lymph node metastasis than those without it (P < 0.001). VEGF-C expression was also closely related to lymphatic invasion (P < 0.001), vascular invasion (P < 0.01), and TNM stage (P < 0.001). However, there was no significant correlation between VEGF-C expression and age at surgery, gender, tumor size, tumor location, Lauren classification, and depth of invasion. CCR7 expression was significantly higher in patients with lymph node metastasis compared with those without lymph node metastasis (P < 0.001) and was also associated with tumor size (P < 0.01), depth of invasion (P < 0.001), lymphatic invasion (P < 0.001), and TNM stage (P < 0.001). However, the presence of CCR7 had no correlation to age at surgery, gender, tumor location, Lauren classification, and vascular invasion. Among the 39 patients who underwent MSCT examination, only CCR7 expression was related to lymph node metastasis determined by MSCT (P < 0.05). In the current retrospective study, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of VEGF-C and CCR7 expression in the diagnosis of lymph node metastasis for patients with gastric carcinoma were 73.8%, 70.2%, 72.6%, 71.4% and 72.0%, and 82.0%, 77.2%, 79.4%, 80.0% and 79.7%, respectively. After subdivision according to the combination of VEGF-C and CCR7 expression, receiver operating characteristic (ROC) analysis showed that the accuracy of the combined examination of VEGF-C and CCR7 expression in predicting lymph node metastasis was relatively high (area under ROC curve [Az] = 0.83).
CONCLUSION: The expression of VEGF-C and CCR7 is related to lymph node metastasis of gastric carcinoma and both of them may become new targets for the treatment of gastric carcinoma. Furthermore, the combined examination of VEGF-C and CCR7 expression in endoscopic biopsy specimens may be useful in predicting lymph node metastasis of gastric carcinoma and deciding the extent of surgical lymph node resection.
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Affiliation(s)
- Chao Yan
- Department of General Surgery, Ruijin Hospital, Shanghai Second Medical University, Shanghai, China
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Lauenstein TC, Vogt FM, Herborn CU, DeGreiff A, Debatin JF, Holtmann G. Time-resolved three-dimensional MR imaging of gastric emptying modified by IV administration of erythromycin. AJR Am J Roentgenol 2003; 180:1305-10. [PMID: 12704042 DOI: 10.2214/ajr.180.5.1801305] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of our study was to assess the effect of IV erythromycin on gastric emptying and subsequent small-bowel filling using three-dimensional (3D) MR imaging in both healthy subjects and patients with functional dyspepsia. SUBJECTS AND METHODS Six healthy volunteers and six patients with symptoms of functional dyspepsia ingested 10 mL of gadopentetate dimeglumine mixed into 500 mL of a liquid nutrient. On two separate days, gastric emptying was determined using 3D volume measurements that were obtained every 5 min for as long as 25 min on 3D T1-weighted gradient-echo MR imaging with and without the use of IV erythromycin. Gastric volumes and filling of the small bowel were quantified on the 3D data sets using semiautomatic software. RESULTS Delineation of the bright gastric lumen proved easy. After 25 min, a significant decrease in gastric volumes could be seen in examinations performed with and without erythromycin. In healthy volunteers, gastric volumes decreased significantly more after the administration of erythromycin. In three patients with functional dyspepsia, MR imaging revealed reduced rates of gastric emptying. The administration of erythromycin resulted in a significantly faster rate of gastric emptying in two of those three patients. CONCLUSION Three-dimensional MR imaging is a feasible method of assessing gastric volumes and diagnosing delayed gastric emptying. In patients with reduced rates of gastric emptying, 3D MR imaging may be an appropriate tool with which to monitor therapeutic approaches, such as the use of prokinetic agents like erythromycin.
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Affiliation(s)
- Thomas C Lauenstein
- Department of Diagnostic Radiology, University Hospital Essen, Hufelandstrasse 55, D-45122 Essen, Germany
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Abstract
Gastric carcinoma is one of the leading causes of cancer mortality worldwide. Accurate preoperative staging of gastric cancer is important in planning the most effective therapy toward cure or palliation. This article reviews the radiologic diagnosis and staging of gastric cancer.
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Affiliation(s)
- Mehtap Tunaci
- Department of Radiology, Istanbul Faculty of Medicine, 34390 Capa, Istanbul, Turkey.
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Abstract
In this study, we evaluated and compared the value of spiral computed tomography, transabdominal ultrasonography, laparoscopy, and laparoscopic ultrasonography in staging gastric cancer in 37 patients; there was a special interest in the additional information provided by laparoscopic ultrasonography. Although laparoscopy was unreliable or hindered by adhesions in 11% of the patients, the benefit of laparoscopy for staging was evident especially for the detection of peritoneal carcinomatosis that was missed by the other diagnostic modalities. Laparoscopic ultrasonography did not change the stage of the disease nor the decision whether to proceed with laparotomy for any of the patients. The decision whether to proceed with laparotomy was correctly predicted in 95% of the cases.
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