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Zhu Z, Mao M, Song A, Gong H, Gu J, Dai Y, Feng F. Study on the diagnostic value of MDCT extramural vascular invasion in preoperative N staging of gastric cancer patients. BMC Med Imaging 2024; 24:20. [PMID: 38243288 PMCID: PMC10799446 DOI: 10.1186/s12880-024-01200-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/12/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND To explore the diagnostic value of multidetector computed tomography (MDCT) extramural vascular invasion (EMVI) in preoperative N Staging of gastric cancer patients. METHODS According to the MR-defined EMVI scoring standard of rectal cancer, we developed a 5-point scale scoring system to evaluate the status of CT-detected extramural vascular invasion(ctEMVI), 0-2 points were ctEMVI-negative status, and 3-4 points were positive status for ctEMVI. Patients were divided into ctEMVI positive group and ctEMVI negative group. The correlation between ctEMVI and clinical features was analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of ctEMVI for pathological metastatic lymph nodes and N staging, The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of pathological N staging using ctEMVI and short-axis diameter were generated and compared. RESULTS The occurrence rate of lymphovascular invasion (LVI) and proportion of tumors with a greatest diameter > 6 cm in the ctEMVI positive group was higher than that in the ctEMVI negative group (P < 0.05). Spearman correlation analysis showed a positive correlation between ctEMVI and LVI, N stage, and tumor size (P < 0.05). For ctEMVI scores ≥ 3,The AUC of ctEMVI for diagnosing lymph node metastasis, N stage ≥ N2, and N3 stage were 0.857, 0.802, and 0.758, respectively. The sensitivity, NPV and accuracy of ctEMVI for diagnosing N stage ≥ N2 were superior to those of short-axis diameter (P < 0.05), while sensitivity, specificity, PPV, NPV, and accuracy of ctEMVI for diagnosing N3 stage were superior to those of short-axis diameter (P < 0.05). CONCLUSION ctEMVI has important value in diagnosing metastatic lymph nodes and advanced N staging. As an important imaging marker, ctEMVI can be included in the preoperative imaging evaluation of patients, providing important assistance for clinical guidance and treatment.
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Affiliation(s)
- Zhengqi Zhu
- Department of Radiology, Nantong Tumor Hospital, No. 30, Tongyang North Road, Nantong, Jiangsu Province, 226006, China
| | - Mimi Mao
- Department of Radiology, Nantong Tumor Hospital, No. 30, Tongyang North Road, Nantong, Jiangsu Province, 226006, China
| | - Anyi Song
- Department of Radiology, Nantong Tumor Hospital, No. 30, Tongyang North Road, Nantong, Jiangsu Province, 226006, China
| | - Haipeng Gong
- Department of Radiology, Nantong Tumor Hospital, No. 30, Tongyang North Road, Nantong, Jiangsu Province, 226006, China
| | - Jianan Gu
- Department of Radiology, Nantong Tumor Hospital, No. 30, Tongyang North Road, Nantong, Jiangsu Province, 226006, China
| | - Yongfeng Dai
- Department of Radiology, Nantong Tumor Hospital, No. 30, Tongyang North Road, Nantong, Jiangsu Province, 226006, China
| | - Feng Feng
- Department of Radiology, Nantong Tumor Hospital, No. 30, Tongyang North Road, Nantong, Jiangsu Province, 226006, China.
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Omeroglu S, Gulmez S, Yazici P, Demir U, Guven O, Capkinoglu E, Uzun O, Senger AS, Polat E, Duman M. Clinical significance of the largest histopathological metastatic lymph node size for postoperative course of patients undergoing surgery for gastric cancer. Front Surg 2023; 10:1105189. [PMID: 36874461 PMCID: PMC9982115 DOI: 10.3389/fsurg.2023.1105189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
Aim The aim of this study was to investigate the effect of the largest metastatic lymph node (MLN) size on postoperative outcomes of patients with stage II-III gastric cancer (GC). Methods A total of 163 patients with stage II/III GC who underwent curative surgery were included in this single-center retrospective study. The lymph nodes were counted, each lymph node was analyzed for metastatic involvement by histopathological examination, and the diameter of the largest metastatic lymph node was recorded. The severity of postoperative complications was assessed by Clavien-Dindo classification system. Two groups of 163 patients were defined according to ROC analysis with cut-off value of histopathologically maximum MLN diameter. A comparative analysis of demographic and clinicopathological characteristics of the patients and their postoperative outcomes were performed. Results The median hospital stay was significantly longer in patients with major complications compared to patients without major complications [18 days (IQR: 13-24) vs. 8 days (IQR: 7-11); (p < 0.001)]. The median MLN size was significantly larger in deceased patients compared to survived [1.3 cm (IQR: 0.8-1.6) vs. 0.9 cm (IQR: 0.6-1.2), respectively; (p < 0.001)]. The cut-off value of MLN size predicting mortality was found as 1.05 cm. MLN size ≥1.05 cm had nearly 3.5 times more negative impact on survival. Conclusions The largest metastatic lymph node size had a significant association with survival outcomes. Particularly, MLN size over 1.05 cm was associated with worse survival outcomes. However, the largest MLN was not shown to have any effect on major complications. Further prospective and large-scale studies are required to draw more precise conclusions.
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Affiliation(s)
- Sinan Omeroglu
- Department of General Surgery, University of Health Sciences Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Türkiye
| | - Selcuk Gulmez
- Department of Gastrointestinal Surgery, University of Health Sciences Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Pinar Yazici
- Department of General Surgery, University of Health Sciences Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Türkiye
| | - Uygar Demir
- Department of General Surgery, University of Health Sciences Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Türkiye
| | - Onur Guven
- Department of General Surgery, University of Health Sciences Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Türkiye
| | - Emir Capkinoglu
- Department of General Surgery, University of Health Sciences Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Türkiye
| | - Orhan Uzun
- Department of Gastrointestinal Surgery, University of Health Sciences Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Aziz Serkan Senger
- Department of Gastrointestinal Surgery, University of Health Sciences Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Erdal Polat
- Department of Gastrointestinal Surgery, University of Health Sciences Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Mustafa Duman
- Department of Gastrointestinal Surgery, University of Health Sciences Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
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Zhang Z, Zheng B, Chen W, Xiong H, Jiang C. Accuracy of 18F-FDG PET/CT and CECT for primary staging and diagnosis of recurrent gastric cancer: A meta-analysis. Exp Ther Med 2021; 21:164. [PMID: 33456531 PMCID: PMC7792481 DOI: 10.3892/etm.2020.9595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023] Open
Abstract
Contrast-enhanced computed tomography (CECT) is commonly used for staging and diagnosing recurrent gastric cancer. Recently, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/CT gained popularity as a diagnostic tool owing to advantages including dual functional and anatomical imaging, which may facilitate early diagnosis. The diagnostic performance of 18F-FDG PET/CT and CECT has been assessed in several studies but with variable results. Therefore, the present meta-analysis aimed to evaluate the accuracy of 18F-FDG PET/CT and CECT for primary TNM staging and the diagnosis of recurrent gastric cancers. A systematic search of the PubMed Central, Medline, Scopus, Cochrane and Embase databases from inception until January 2020 was performed. The Quality Assessment of Diagnostic Accuracy Study-2 tool was used to determine the quality of the selected studies. Pooled estimates of sensitivity and specificity were calculated. A total of 58 studies comprising 9,997 patients were included. Most studies had a low risk of bias. The sensitivity and specificity for nodal staging of gastric cancer were 49% (95% CI, 37-61%) and 92% (95% CI, 86-96%) for 18F-FDG PET/CT, respectively, and 67% (95% CI, 57-76%) and 86% (95% CI, 81-89%) for CECT, respectively. For metastasis staging, the sensitivity and specificity were 56% (95% CI, 40-71%) and 97% (95% CI, 87-99%) for 18F-FDG PET/CT, respectively, and 59% (95% CI, 41-75%) and 96% (95% CI, 83-99%) for CECT, respectively. For diagnosing cancer recurrence, the pooled sensitivity and specificity were 81% (95% CI, 72-88%) and 83% (95% CI, 74-89%) for 18F-FDG PET/CT, respectively, and 59% (95% CI, 41-75%) and 96% (95% CI, 83-99%) for CECT, respectively. Both 18F-FDG PET/CT and CECT were deemed highly useful for diagnosing recurrent gastric cancer due to their high sensitivities and specificities. However, these techniques cannot be used to exclude or confirm the presence of lymph node metastases or recurrent gastric cancer tumors, but can be used for the confirmation of distal metastasis.
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Affiliation(s)
- Zhicheng Zhang
- Department of Radiology, The Ninth People's Hospital of Chongqing, Chongqing 400700, P.R. China
| | - Bo Zheng
- Department of Radiology, The Ninth People's Hospital of Chongqing, Chongqing 400700, P.R. China
| | - Wei Chen
- Department of Radiology, The Ninth People's Hospital of Chongqing, Chongqing 400700, P.R. China
| | - Hui Xiong
- Department of Radiology, The Ninth People's Hospital of Chongqing, Chongqing 400700, P.R. China
| | - Caiming Jiang
- Department of Radiology, The Ninth People's Hospital of Chongqing, Chongqing 400700, P.R. China
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4
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The value of multidetector-row computed tomography in lymph node staging of gastric cancer: a preliminary Vietnamese study. Contemp Oncol (Pozn) 2020; 24:125-131. [PMID: 32774138 PMCID: PMC7403761 DOI: 10.5114/wo.2020.97484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/07/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Gastric cancer (GC) is the fourth most common malignant disease in the world, following breast cancer, colorectal cancer, and lung cancer. This study aimed to evaluate the usefulness of multidetector-row computed tomography (MDCT) in identifying the metastatic lymph node of GC. Material and methods A cross-sectional study was performed after receiving approval by the institutional review board. A total of 88 patients with GC, who underwent radical gastrectomy, were examined by MDCT. Categorical variables were compared using Fisher’s exact test. The discriminating ability of lymph node size was determined according to an area under the receiver operating curve(AUROC) analysis, and the optimal cut-off point was determined. Results The proportion of metastatic lymph node patients in the proximal group (32.3%) was significantly higher than that in the distal group (18.4%). T categorisation and lymph node sizes were significantly different between the non-metastatic lymph node and metastatic lymph node groups. The AUROC for lymph node size was 0.738, with an optimal cut-off point of 7.5 mm,producing a sensitivity of 71.5% and a specificity of 70.5%. Conclusions MDCT displayed medium accuracy for the determination of metastatic lymph nodes and N categorisation. Based on our findings, although MDCT is generally the first choice for preoperative assessments in GC patients, other diagnostic modalities should supplement MDCT in order to achieve more precise N staging.
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Chen J, Zhou C, He M, Zhen Z, Wang J, Hu X. A Meta-Analysis And Systematic Review Of Accuracy Of Endoscopic Ultrasound For N Staging Of Gastric Cancers. Cancer Manag Res 2019; 11:8755-8764. [PMID: 31632135 PMCID: PMC6774993 DOI: 10.2147/cmar.s200318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 09/12/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Endoscopic ultrasonography (EUS) is widely used as a staging modality for gastric cancer. However, the results of studies on the use of EUS for N staging in gastric cancer vary. This study aimed at studying the overall diagnostic accuracy of EUS for N staging of gastric cancer. METHODS Published studies were identified through searching the MEDLINE, Web of Science, EMBASE, SpringerLink and ScienceDirect databases. A bivariate random effect model was used to estimate the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). A hierarchical summary receiver operating characteristic curves (HSROC) based on the pooled data was also computed. RESULTS Fifty studies (5223 patients) were included in this analysis. The pooled sensitivity, specificity, PLR, NLR and DOR of EUS for N staging were 0.82 (95% CI 0.78 to 0.85), 0.68 (0.63 to 0.73), 2.6 (2.2 to 3.0), 0.27 (0.22 to 0.32), and 10 (8 to 12), respectively. The area under the HSROC was 0.83. CONCLUSION The EUS may provide a clinically useful tool to guide physicians in the N staging of gastric cancer. However, physicians must note that the EUS has a relatively low specificity.
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Affiliation(s)
- Jiafei Chen
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Chaoyang Zhou
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Min He
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Zhiming Zhen
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Jie Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Xiaofei Hu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
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You JM, Kim TU, Kim S, Lee NK, Lee JW, Ryu H, Kim JH, Hong SB, Jeon TY, Park DY. Preoperative N stage evaluation in advanced gastric cancer patients using multidetector CT: can the sum of the diameters of metastatic LNs be used for N stage evaluation? Clin Radiol 2019; 74:782-789. [PMID: 31378300 DOI: 10.1016/j.crad.2019.06.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 06/28/2019] [Indexed: 12/23/2022]
Abstract
AIM To compare the diagnostic performance of total counts of metastatic lymph nodes (LN-sum) and conventional multidetector (MD) computed tomography (CT) staging in the nodal evaluation of advanced gastric cancer (AGC) patients. MATERIALS AND METHODS In total, 127 consecutive patients who underwent preoperative MDCT and gastrectomy for AGC were identified. Metastatic LNs on MDCT were defined as LNs with a short axis ≥8 mm, marked or heterogeneous enhancement, and morphological features (central necrosis, round shape, clustering). The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the N-stage using LN-sum and conventional MDCT staging were generated and compared. In addition, metastatic LN counts between the MDCT and the histopathological examinations and correlation between LN-sum and histopathological nodal status were analysed. RESULTS The total counts of metastatic LNs on MDCT was significantly smaller than those detected in histopathological assessments (p<0.0001). LN-sum showed significant correlation with the pathological N stage and the number of metastatic LNs (rho=0.69, 0.73, p<0.0001). The areas under the receiver operating characteristic curve were 0.896, and 0.835, for N stage ≥N2 and N3, with cut-off values of 12.5 and 23.5 mm, respectively. LN-sum provided better diagnostic performance than conventional MDCT staging for discriminating N0-2 versus N3; sensitivity, accuracy, PPV and NPV of LN-sum were significantly higher (80.4 versus 52.2%, 81.1 versus 68.5%, 71.2 versus 57.1%, and 88 versus 74.1%). CONCLUSION LN-sum may be sufficiently useful in assessing the N3 stage of AGC and may help to plan appropriate therapy for AGC patients.
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Affiliation(s)
- J M You
- Department of Radiology, Medical Research Institute, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea
| | - T U Kim
- Department of Radiology, Medical Research Institute, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea.
| | - S Kim
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Medical Research Institute, Busan, Republic of Korea
| | - N K Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Medical Research Institute, Busan, Republic of Korea
| | - J W Lee
- Department of Radiology, Medical Research Institute, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea
| | - H Ryu
- Department of Radiology, Medical Research Institute, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea
| | - J H Kim
- Department of Radiology, Medical Research Institute, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea
| | - S B Hong
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Medical Research Institute, Busan, Republic of Korea
| | - T Y Jeon
- Department of Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Medical Research Institute, Busan, Republic of Korea
| | - D Y Park
- Department of Pathology, Pusan National University Hospital, Pusan National University School of Medicine, Medical Research Institute, Busan, Republic of Korea
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Zhou Z, Liu Y, Meng K, Guan W, He J, Liu S, Zhou Z. Application of spectral CT imaging in evaluating lymph node metastasis in patients with gastric cancers: initial findings. Acta Radiol 2019; 60:415-424. [PMID: 29979106 DOI: 10.1177/0284185118786076] [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: 12/19/2022]
Abstract
BACKGROUND Traditional computed tomography (CT) can predict the lymph node metastasis of gastric cancers with moderate accuracy; however, investigation of spectral CT imaging in this field is still limited. PURPOSE To explore the application of spectral CT imaging in evaluating lymph node metastasis in patients with gastric cancers. MATERIAL AND METHODS Twenty-four patients with gastric cancers prospectively underwent spectral CT imaging in the arterial phase. The short and long diameters, material concentrations, and CT values were measured and compared between lymph nodes with and without metastasis. The diagnostic performance of the CT index in identifying metastatic lymph nodes was analyzed with receiver operating characteristic (ROC) analysis. RESULTS A total of 102 lymph nodes (77 metastatic, 25 non-metastatic) were detected on spectral CT imaging with the reference of postoperative pathologic exanimation. The short and long diameters, water/fat concentrations, CT value, and ratio between lymph nodes vs. tumors of metastatic lymph nodes were significantly higher than those of non-metastatic ones (all P < 0.05). With a cut-off of 0.785, the CT ratio of lymph node/tumor on 70-keV monochromatic images yielded an accuracy of 81.4% in differentiating lymph nodes with and without metastasis. CONCLUSION Spectral CT imaging detects lymph nodes more clearly, and the CT ratio of lymph node/tumor on 70-keV monochromatic images holds great potential in differentiating lymph nodes with and without metastasis, which is more accurate than size measurement.
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Affiliation(s)
- Zhuping Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, PR China
| | - Yu Liu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, PR China
| | - Kui Meng
- Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, PR China
| | - Wenxian Guan
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, PR China
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, PR China
| | - Song Liu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, PR China
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, PR China
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Chen CF, Zhang YL, Cai ZL, Sun SM, Lu XF, Lin HY, Liang WQ, Yuan MH, Zeng D. Predictive Value of Preoperative Multidetector-Row Computed Tomography for Axillary Lymph Nodes Metastasis in Patients With Breast Cancer. Front Oncol 2019; 8:666. [PMID: 30671386 PMCID: PMC6331431 DOI: 10.3389/fonc.2018.00666] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 12/17/2018] [Indexed: 02/05/2023] Open
Abstract
Introduction: Axillary lymph nodes (ALN) status is an essential component in tumor staging and treatment planning for patients with breast cancer. The aim of present study was to evaluate the predictive value of preoperative multidetector-row computed tomography (MDCT) for ALN metastasis in breast cancer patients. Methods: A total of 148 cases underwent preoperative MDCT examination and ALN surgery were eligible for the study. Logistic regression analysis of MDCT variates was used to estimate independent predictive factors for ALN metastasis. The prediction of ALN metastasis was determined with MDCT variates through receiver operating characteristic (ROC) analysis. Results: Among the 148 cases, 61 (41.2%) cases had ALN metastasis. The cortical thickness in metastatic ALN was significantly thicker than that in non-metastatic ALN (7.5 ± 5.0 mm vs. 2.6 ± 2.8 mm, P < 0.001). Multi-logistic regression analysis indicated that cortical thickness of >3 mm (OR: 12.32, 95% CI: 4.50–33.75, P < 0.001) and non-fatty hilum (OR: 5.38, 95% CI: 1.51–19.19, P = 0.009) were independent predictors for ALN metastasis. The sensitivity, specificity and AUC of MDCT for ALN metastasis prediction based on combined-variated analysis were 85.3%, 87.4%, and 0.893 (95% CI: 0.832–0.938, P < 0.001), respectively. Conclusions: Cortical thickness (>3 mm) and non-fatty hilum of MDCT were independent predictors for ALN metastasis. MDCT is a potent imaging tool for predicting ALN metastasis in breast cancer. Future prospective study on the value of contrast enhanced MDCT in preoperative ALN evaluation is warranted.
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Affiliation(s)
- Chun-Fa Chen
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yu-Ling Zhang
- Department of Information, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Ze-Long Cai
- Department of Medical Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shu-Ming Sun
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xiao-Feng Lu
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Hao-Yu Lin
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Wei-Quan Liang
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Ming-Heng Yuan
- Cancer Research Center, Shantou University Medical College, Shantou, China
| | - De Zeng
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
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9
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Seeruttun SR, Cheung WY, Wang W, Fang C, Liu ZM, Li JQ, Wu T, Wang J, Liang C, Zhou ZW. Identification of molecular biomarkers for the diagnosis of gastric cancer and lymph-node metastasis. Gastroenterol Rep (Oxf) 2018; 7:57-66. [PMID: 30792867 PMCID: PMC6375354 DOI: 10.1093/gastro/goy023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/02/2018] [Accepted: 06/06/2018] [Indexed: 12/26/2022] Open
Abstract
Background and objective Biomarkers are important tools for prompt diagnosis of cancer. This study aimed to identify reliable biomarkers for clinical applications in the diagnosis of gastric cancer and lymph-node (LN) metastasis. Methods Between 1 December 2014 and 31 December 2015, we prospectively collected samples of gastric-cancer tissues, corresponding matched-pair normal gastric mucosa, and their peri-gastric metastatic and non-metastatic LNs to identify quantitatively reliable genes using quantitative real-time polymerase chain reaction. Relative quantity (RQ) was used to calculate the mRNA expression levels of our target genes. Statistics were calculated using one-way analysis of variance (ANOVA) and Tukey’s multiple comparison test. Analytical graphs were plotted using GraphPad Prism. Results Of nine assessed genes, the mRNA levels of inhibin beta A (INHBA) and secreted phosphoprotein 1 (SPP1) were most consistently highly expressed in tumor tissues by 15.4- and 15.6-fold, respectively, as compared with normal tissues (P < 0.001), with 91.3% sensitivity and 95.7% specificity (receiver operating characteristic [ROC] curve area = 0.974) for the former and 82.6% sensitivity and 87.0% specificity (ROC curve area = 0.924) for the latter. Further analysis revealed no differentiating significance of SPP1 mRNA expression between metastatic and non-metastatic LNs (P = 0.470). In contrast, the INHBA mRNA level was up-regulated 4.1-fold in metastatic LNs (P < 0.001), with 80.0% sensitivity and 81.5% specificity (ROC curve area = 0.857), and was also able to successfully differentiate between more severe disease conditions, T3 and T4 (P = 0.003), M0 and M1 (P = 0.043) and different histological variants (intestinal type vs diffuse type, P = 0.019). Conclusions Our results showed that INHBA was the most optimally reliable biomarker for diagnosing gastric cancer and LN metastasis.
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Affiliation(s)
- Sharvesh Raj Seeruttun
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, P.R. China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Wing Yan Cheung
- Division of Life Science, Center for Cancer Research and State Key Lab for Molecular Neuroscience, Hong Kong University of Science and Technology, Hong Kong, P.R. China.,Fok Ying Tung Research Institute, Hong Kong University of Science and Technology, Hong Kong, P.R. China
| | - Wei Wang
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, P.R. China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Cheng Fang
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, P.R. China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Zhi-Min Liu
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, P.R. China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Jin-Qing Li
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, P.R. China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Ting Wu
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, P.R. China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Jun Wang
- Division of Life Science, Center for Cancer Research and State Key Lab for Molecular Neuroscience, Hong Kong University of Science and Technology, Hong Kong, P.R. China.,Fok Ying Tung Research Institute, Hong Kong University of Science and Technology, Hong Kong, P.R. China
| | - Chun Liang
- Division of Life Science, Center for Cancer Research and State Key Lab for Molecular Neuroscience, Hong Kong University of Science and Technology, Hong Kong, P.R. China.,Fok Ying Tung Research Institute, Hong Kong University of Science and Technology, Hong Kong, P.R. China.,Biomedical Research Institute, Shenzhen-Peking University- Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong, P.R. China
| | - Zhi-Wei Zhou
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, P.R. China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
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10
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Kim DJ, Kim W. Is Lymph Node Size a Reliable Factor for Estimating Lymph Node Metastasis in Early Gastric Cancer? J Gastric Cancer 2017; 18:20-29. [PMID: 29629217 PMCID: PMC5881007 DOI: 10.5230/jgc.2018.18.e1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/29/2017] [Accepted: 11/28/2017] [Indexed: 12/16/2022] Open
Abstract
Purpose Pre-operative lymph node (LN) size is a valuable parameter for determining treatment strategy for gastric cancer. However, a correlation between LN size and metastasis has not been established. Materials and Methods Thirty-six LN-positive (LNP) and matched 36 LN-negative (LNN) patients were included, and pathology slides of the LNs of these patients were reviewed. All the LNs were measured along the long-axis (LA) and short-axis (SA), manually. Results Average retrieved LNs were 37.3±19.8 and 40.5±11.6 in the LNN and LNP groups, respectively. In total 2,800 LNs, including 136 metastatic LNs (MLNs) and 2,664 non-metastatic LNs (nMLNs), were evaluated. Mean length was significantly more in MLNs along both, the LA and SA (MLN_LA vs. nMLN_LA: 4.97±3.84 vs. 3.37±2.40 mm, MLN_SA vs. nMLN_SA: 3.86±3.19 vs. 2.43±1.59 mm; P<0.001). However, 92.6% (126/136) and 95.6% (130/136) of MLNs were <10 mm along the LA and SA, respectively. In addition, only 22.2% of the LNP group exhibited an MLN as the largest LN. Conclusions Pre-operative multi-detector computed tomography has limited ability in estimating the presence of metastasis in LNs because most MLNs are less than 10 mm, and only a small proportion of the LNP group exhibits an MLN as the largest MLN.
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Affiliation(s)
- Dong Jin Kim
- Department of Surgery, The Catholic University of Korea St. Paul's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Wook Kim
- Department of Surgery, The Catholic University of Korea Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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11
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Luo M, Lv Y, Guo X, Song H, Su G, Chen B. Value and impact factors of multidetector computed tomography in diagnosis of preoperative lymph node metastasis in gastric cancer: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7769. [PMID: 28816957 PMCID: PMC5571694 DOI: 10.1097/md.0000000000007769] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Multidetector computed tomography (MDCT) exhibited wide ranges of sensitivities and specificities for lymph node assessment of gastric cancer (GC) in several individual studies. This present meta-analysis was carried out to evaluate the value of MDCT in diagnosis of preoperative lymph node metastasis (LNM) and to explore the impact factors that might explain the heterogeneity of its diagnostic accuracy in GC. METHODS A comprehensive search was conducted to collect all the relevant studies about the value of MDCT in assessing LNM of GC within the PubMed, Cochrane library and Embase databases up to Feb 2, 2016. Two investigators independently screened the studies, extracted data, and evaluated the quality of included studies. The sensitivity, specificity, and area under ROC curve (AUC) were pooled to estimate the overall accuracy of MDCT. Meta-regression and subgroup analysis were carried out to identify the possible factors influencing the heterogeneity of the accuracy. RESULTS A total of 27 studies with 6519 subjects were finally included. Overall, the pooled sensitivity, specificity, and AUC were 0.67 (95% CI: 0.56-0.77), 0.86 (95% CI: 0.81-0.90), and 0.86 (95% CI: 0.83-0.89), respectively. Meta-regression revealed that MDCT section thickness, proportion of serosal invasion, and publication year were the main significant impact factors in sensitivity, and MDCT section thickness, multiplanar reformation (MPR), and reference standard were the main significant impact factors in specificity. After the included studies were divided into 2 groups (Group A: studies with proportion of serosa-invasive GC subjects ≥50%; Group B: studies with proportion of serosa-invasive GC subjects <50%), the pooled sensitivity in Group A was significantly higher than in Group B (0.84 [95% CI: 0.75-0.90] vs 0.55 [95% CI: 0.41-0.68], P < .01). For early gastric cancer (EGC), the pooled sensitivity, specificity, and AUC were 0.34 (95% CI: 0.15-0.61), 0.91 (95% CI: 0.84-0.95), and 0.83 (95% CI: 0.80-0.86), respectively. CONCLUSION To summarize, MDCT tends to be adequate to assess preoperative LNM in serosa-invasive GC, but insufficient for non-serosa-invasive GC (particularly for EGC) owing to its low sensitivity. Proportion of serosa-invasive GC subjects, MDCT section thickness, MPR, and reference standard are the main factors influencing its diagnostic accuracy.
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Affiliation(s)
- Mingxu Luo
- Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian
| | - You Lv
- Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian
| | - Xiuyu Guo
- Department of Radiology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian
| | - Hongmei Song
- Department of Oncology, Renmin Hospital of Shiyan, Hubei University of Medicine, Shiyan, Hubei, China
| | - Guoqiang Su
- Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian
| | - Bo Chen
- Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian
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12
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Lee SL, Lee HH, Ku YM, Jeon HM. Usefulness of Two-Dimensional Values Measured Using Preoperative Multidetector Computed Tomography in Predicting Lymph Node Metastasis of Gastric Cancer. Ann Surg Oncol 2015; 22 Suppl 3:S786-93. [PMID: 25986871 DOI: 10.1245/s10434-015-4621-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Multidetector computed tomography (MDCT) is essential for the prediction of lymph node (LN) metastasis in gastric cancer. However, the measurement method and size criteria for metastatic LNs using MDCT are unclear. METHODS MDCTs of gastric cancer patients who underwent surgery and had pathological staging were reviewed by radiologists. The two-dimensional cutoff values for LNs with suspected metastasis were calculated, and clinicopathological data were analyzed using those cutoff values. RESULTS The total number of enrolled patients was 327. The cutoff values of the maximal area with metastatic LNs were obtained significantly at stations 3, 4, and 6, and those values were 112.09, 33.79, and 85.88 mm(2), respectively. The common cutoff value was 112.09 mm(2), and the area under the curve was 0.617 (P = 0.002). The overall survival rate of the patients with LNs less than 112.09 mm(2) was significantly better than those with LNs greater than 112.09 mm(2) (P < 0.001). In multivariate analysis, the maximal LN area was an independent prognostic factor (adjusted hazard ratio, 1.697 [95% confidence interval 1.116-2.582]). CONCLUSIONS Using two-dimensional values for LNs measured by MDCT is a practical method of predicting metastatic LNs in gastric cancer. The maximal LN area value would be useful in both the preoperative staging and prognosis prediction of gastric cancer.
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Affiliation(s)
- Su Lim Lee
- Department of Radiology, 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.
| | - 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
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13
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Tokunaga M, Sugisawa N, Tanizawa Y, Bando E, Kawamura T, Terashima M. The impact of preoperative lymph node size on long-term outcome following curative gastrectomy for gastric cancer. Ann Surg Oncol 2012; 20:1598-603. [PMID: 23117474 DOI: 10.1245/s10434-012-2699-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Indexed: 01/11/2023]
Abstract
BACKGROUND Multidetector-row computed tomography (MDCT) is widely used to predict pathological nodal status. However, an appropriate nodal size cutoff value to predict pathological nodal status has not been determined, and the impact of preoperative lymph node size on long-term outcomes is unclear. METHODS This study included 137 gastric cancer patients with nodal involvement who underwent R0 gastrectomy between September 2002 and December 2006. Lymph nodes with a short-axis diameter of 10 mm or more as measured by MDCT were regarded as metastasized. An appropriate cutoff value with a high positive predictive value (PPV) and high specificity also was identified, and the subsequent clinicopathological characteristics and long-term outcomes were investigated. RESULTS A cutoff value of 15 mm was found to be appropriate for grouping patients into large (≥15 mm) and small (<15 mm) lymph node metastasis (LLNM and SLNM) groups, with a high PPV (98.6 %) and specificity (99.8 %). There were no differences in clinicopathological characteristics between the groups except for pathological nodal status. In the LLNM group, the 5-year survival rate was 55 %, which was significantly lower than in the SLNM group (73.2 %; P = 0.008). After stratification by tumor depth, the same trend was observed in patients with pT3 disease (46.8 % vs. 72.7 %; P = 0.015) and those with pT4 disease (14.3 % vs. 64.8 %; P = 0.035). CONCLUSIONS Gastric cancer patients with lymph nodes measuring 15 mm or more preoperatively have worse long-term outcomes. These patients would therefore be suitable candidates for future clinical trials investigating the efficacy of neoadjuvant chemotherapies.
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Affiliation(s)
- Masanori Tokunaga
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan.
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Yan C, Zhu ZG, Yan M, Zhang H, Pan ZL, Chen J, Xiang M, Chen MM, Liu BY, Lin YZ. Clinicopathological characteristics and computed tomography features of mucinous gastric carcinoma. J Int Med Res 2011; 39:291-301. [PMID: 21672333 DOI: 10.1177/147323001103900132] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This study investigated the clinicopathological characteristics of mucinous gastric carcinoma (MGC) and assessed whether multidetector-row computed tomography (MDCT) could differentiate MGC from non-mucinous gastric carcinoma (NGC). Clinicopathological data from 542 patients with gastric carcinoma (23 MGC, 519 NGC), who underwent pre-operative MDCT examination and curative or palliative gastrectomy, were analysed. Only seven of the 23 patients with MGC were correctly diagnosed pre-operatively by endoscopic biopsy. The MGC patients had larger tumours, a higher frequency of lymph node metastases, were more likely to have tumours of tumour, node, metastasis stages III and IV, and were less likely to have a curative resection than NGC patients. In addition, five MGC patients had calcifications in the thickened gastric wall. In conclusion, MGC is rare and is detected mostly at an advanced stage. The diagnostic sensitivity of MGC by endoscopic biopsy was relatively low, whereas MDCT was helpful in distinguishing MGC from NGC.
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Affiliation(s)
- C Yan
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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