Spiral CT in gastric carcinoma: Comparison with barium study, fiberoptic gastroscopy and histopathology

Propolis Has an Anticancer Effect on Early Stage Colorectal Cancer by Affecting Epithelial Differentiation and Gut Immunity in the Tumor Microenvironment

Colorectal cancer (CRC) is one of the most common cancers and is the second leading cause of cancer-related death in the world. Due to the westernization of diets, young patients with CRC are often diagnosed at advanced stages with an associated poor prognosis. Improved lifestyle choices are one way to minimize CRC risk. Among diet choices is the inclusion of bee propolis, long recognized as a health supplement with anticancer activities. Understanding the effect of propolis on the gut environment is worth exploring, and especially its associated intratumoral immune changes and its anticancer effect on the occurrence and development of CRC. In this study, early stage CRC was induced with 1,2-dimethylhydrazine (DMH) and dextran sulfate sodium (DSS) for one month in an animal model, without and with propolis administration. The phenotypes of early stage CRC were evaluated by X-ray microcomputed tomography and histologic examination. The gut immunity of the tumor microenvironment was assessed by immunohistochemical staining for tumor-infiltrating lymphocytes (TILs) and further comparative quantification. We found that the characteristics of the CRC mice, including the body weight, tumor loading, and tumor dimensions, were significantly changed due to propolis administration. With further propolis administration, the CRC tissues of DMH/DSS-treated mice showed decreased cytokeratin 20 levels, a marker for intestinal epithelium differentiation. Additionally, the signal intensity and density of CD3+ and CD4+ TILs were significantly increased and fewer forkhead box protein P3 (FOXP3) lymphocytes were observed in the lamina propria. In conclusion, we found that propolis, a natural supplement, potentially prevented CRC progression by increasing CD3+ and CD4+ TILs and reducing FOXP3 lymphocytes in the tumor microenvironment of early stage CRC. Our study could suggest a promising role for propolis in complementary medicine as a food supplement to decrease or prevent CRC progression.

Comparison of FLT-PET/CT and CECT in gastric cancer diagnosis

AIM

To date, no data are available on the use of 18-fluorothymidine positron emission tomography/computed tomography (FLT-PET/CT) for preoperative gastric cancer staging. Herein, we attempt to assess the value of FLT-PET/CT for preoperative gastric cancer staging in comparison with contrast-enhanced computed tomography (CECT).

MATERIALS AND METHODS

In a group of 96 gastric cancer patients, 96 FLT-PET/CT, 56 abdominal cavity CECT, and 51 resective operations were done. All three (FLT-PET/CT, CECT, and resective operation) were done in 29 patients. The results of FLT-PET/CT, CECT, and histopathological examinations were used to assess the ability of FLT-PET/CT and CECT to identify primary tumors, regional nodal metastases, and distant abdominal metastases. Assessment of regional lymph nodes was based on SUVmax in FLT-PET/CT and SAD (short-axis diameter) in CECT.

RESULTS

In the group of 56 patients examined with FLT-PET/CT and CECT, identification of the primary tumor was possible in 56 cases (100%) and in 53 cases (94.6%), respectively, (p = 0.013). Using ROC curve, the sensitivity and specificity of FLT-PET/CT in metastatic regional lymph node assessment were higher than those of CECT (p = 0.0033). FLT-PE/CT enabled identification of a greater number of extraregional abdominal metastases than CECT (n = 56; 19 vs. 15, respectively), but the difference was not statistically significant (p > 0.41).

CONCLUSIONS

The ability of FLT-PET/CT to identify primary tumors is greater than that of CECT, and thus FLT-PET/CT was better in evaluating regional nodal metastases. FLT-PET/CT enabled identification of a greater number of abdominal metastases than CECT, but the difference was not statistically significant.

Feng Chen's work on translational and clinical imaging

Dr. Feng Chen is a chief medical doctor and the vice chairman of the Department of Radiology in Zhong Da Hospital at Southeast University, Nanjing, China and a senior researcher in the Department of Radiology at the Catholic University of Leuven, Belgium. His main areas of interest are translational imaging research including stroke, tumor angiogenesis, assessment of therapeutic response in solid tumors, and magnetic resonance contrast media. Dr. Feng Chen has published 44 scientific papers in peer-reviewed international journals. He and his colleagues have developed an imaging platform which includes animal models, animal preparations and multiparametric magnetic resonance imaging (MRI) protocols for translational animal imaging research using clinical machines. His MRI findings on rodent stroke are considered to "serve as a model for future laboratory investigations of treatment of acute stroke and unify the approaches developed for clinical studies". He and his colleagues have introduced a novel liver tumor model in rodents, in which a series of studies concerning the antitumor activity of vascular disrupting agents have been successively conducted and assessed by in vivo MRI, especially by diffusion weighted imaging as an imaging biomarker. His goal is to provide valuable references for clinical practice and to contribute to the translation of animal imaging research into patient applications.

Sensitivity of ultrasonography for gastric cancer diagnosis in symptomatic patients

Endoscopy with biopsy sampling is the gold standard used in gastric cancer diagnosis. However, the positive predictive value of signs and symptoms for the diagnosis of carcinomas is quite limited, and, therefore, many patients are subjected to non-diagnostic endoscopies, especially when symptoms are not so specific. This study shows that ultrasonography is sensitive enough for the diagnosis of gastric cancer, and, therefore, use of this technique would further ensure a better selection of patients for endoscopy. The study included 143 patients (86 men and 57 women, with an average age of 68.6 years) who were suspected of having gastric cancer. The diagnostic accuracy of ultrasonography was evaluated in a blind study. The conventional technique was used in all cases. Demographic parameters and a series of other clinical-analytical variables were studied to look for possible gastric cancer predictive factors, which when present would make ultrasonographic results irrelevant. Statistical analysis was done using SPSS 12.0, wherein a value of P < 0.05 was considered to be statistically significant. Of the 143 patients studied, 40 were diagnosed to have gastric cancer. Sonography was able to diagnose 37 cases correctly, while there were three false negative findings and eight false positive findings. This results in 92.5% sensitivity, 92.2% specificity, 82.2% positive predictive value, 96.9% negative predictive value, and a global accuracy of 92.3%. Univariate analysis showed that persistent vomiting (P = 0.021), hemoglobin level of less than 8 g/dl (P = 0.045) and a positive ultrasonography result (P < 0.0001) were associated with a higher frequency of gastric cancer. Multivariate analysis showed that persistent vomiting, with an odds ratio for gastric cancer of 3.68 (95% confidence interval 1.15-11.79; P = 0.039), and a positive ultrasonography result, with an odds ratio for gastric cancer of 117.78 (95% confidence interval 32.45-427.49; P < 0.0001), could be considered as independent predictive factors for gastric cancer. It was concluded that ultrasonography is a very sensitive and specific technique for diagnosing gastric cancer. Gastric cancer was found to be present in just 28% of the patients studied, and their condition was suspect because of the clinical manifestations. Only vomiting and a positive ultrasonography result can be considered as independent predictive factors of gastric cancer.

[Value of spiral computed tomography for the preoperative detection of lymph node involvement in gastric cancer]

BACKGROUND AND OBJECTIVE

Knowledge regarding the presence of metastatic lymph node in gastric cancer is of obvious importance when thinking of neoadjuvant therapy, yet it is full of uncertainty. Computed tomography (CT) is one of the first-line diagnostic tools, in spite of controversial results. We aimed to establish the performance of spiral CT in predicting lymph node involvement in gastric cancer.

PATIENTS AND METHOD

Sixty-two consecutive patients diagnosed of gastric cancer were enrolled in the study. All the patients were examined by CT and imaging results were compared with the corresponding histopathological findings following surgery. We analyzed the sensitivity, specificity, positive and negative reasons, accuracy and efficiency. We also assessed the distribution and number of isolated lymph nodes, the diameter of the largest single nodes and the N distribution according the TNM classification system.

RESULTS

Compared with the histological results, CT achieved a sensitivity of 0.43, specificity of 0.96, an accuracy of 0.55 and an efficiency of 0.67. An in-depth analysis of the histological lymph node size revealed significant differences between the groups with and without lymph node involvement, with an average size of 16.29mm (95% confidence interval, 7.1-15.6) and 10.25mm (95% confidence interval, 4.8-25.5), respectively (p<0.05). We also observed a diminished accuracy for the N1 and N2 groups.

CONCLUSIONS

Spiral CT shows a poor performance for the preoperative evaluation of lymph node involvement. Nevertheless, in case of a positive result, spiral CT is helpful for treatment decision-making in gastric cancer as a first-line staging technique.

A new 3-D diagnosis strategy for duodenal malignant lesions using multidetector row CT, CT virtual duodenoscopy, duodenography, and 3-D multicholangiography

Recent advances in multidetector row computed tomography (MD-CT) technology provide new opportunities for clinical diagnoses of various diseases. Here we assessed CT virtual duodenoscopy, duodenography, and three-dimensional (3D) multicholangiography created by MD-CT for clinical diagnosis of duodenal malignant lesions. The study involved seven cases of periduodenal carcinoma (four ampullary carcinomas, two duodenal carcinomas, one pancreatic carcinoma). Biliary contrast medium was administered intravenously, followed by intravenous administration of an anticholinergic agent and oral administration of effervescent granules for expanding the upper gastrointestinal tract. Following intravenous administration of a nonionic contrast medium, an upper abdominal MD-CT scan was performed in the left lateral position. Scan data were processed on a workstation to create CT virtual duodenoscopy, duodenography, 3D multicholangiography, and various postprocessing images, which were then evaluated for their effectiveness as preoperative diagnostic tools. Carcinoma location and extent were clearly demonstrated as defects or colored low-density areas in 3-D multicholangiography images and as protruding lesions in virtual duodenography and duodenoscopy images. These findings were confirmed using multiplanar or curved planar reformation images. In conclusion, CT virtual duodenoscopy, doudenography, 3-D multicholangiography, and various images created by MD-CT alone provided necessary and adequate preoperative diagnostic information.

Value of spiral computed tomography in preoperative TNM staging for gastric cancer

AIM: To explore the accuracy of spiral computed tomography in the staging of gastric cancer, and to provide clinical guide for the treatment and prognosis analysis.

METHODS: Forty-five patients with gastric cancer received TNM staging by spiral computed tomography before operation. The results were comparatively analyzed with the surgical pathology.

RESULTS: The accuracy of SCT for T stage, N stage and M stage and total TNM staging were 75.6%, 73.3%, 86.7%, and 75.6%, respectively. If the attenuation values of more than or equal to 25 Hu in plain scan, or 70 Hu in arterial phase, or 80 Hu in venous phase were used as a criterion to detect the metastasis-positive lymph nodes, the sensitivity and specificity were 98.4% and 64.0%, respectively.

CONCLUSION: Spiral computed tomography is accurate in the preoperative TNM staging for gastric cancer.

Clinical value of CT three-dimensional imaging in diagnosing gastrointestinal tract diseases

AIM: To discuss the clinical value of CT three-dimensional (3-D) imaging in diagnosing gastrointestinal tract diseases.

METHODS: Three-D imaging findings of 52 patients were retrospectively analyzed. Three-D imaging methods included shaded surface display (SSD), volume rendering (VR), virtual endoscopy (VE) and multiplanar reformatting (MPR). The diagnosis results of CT 3-D were evaluated by comparison with those of endoscopy and/or surgical finding.

RESULTS: Fifty-two patients with gastrointestinal tract diseases were diagnosed by CT 3-D imaging, of whom 50 cases were correctly diagnosed and 2 were misdiagnosed. There were 33 cases of gastric diseases (27 with carcinoma, 5 with peptic ulcer and 1 with leiomyoma) and 19 large intestinal diseases (10 with colon carcinoma, 2 with carcinoma of the rectum, 5 with colon polypus and 2 with tuberculosis of the ileocecal junction). Twenty-two cases with prominent lesions (9 with subsequent hollow lesions), 20 with stenosis of cavity (8 with concomitant prominent lesions) and 10 with hollow lesions (5 with concomitant prominent lesions) were shown in 3-D images. The minimal lesion shown was 1.0 cm × 0.8 cm × 0.5 cm.

CONCLUSION: CT 3-D imaging, a non-invasive examination without pain, can display clearly and directly the lesions of gastrointestinal tract with accurate location and high diagnosis accuracy. It is an important complementary technique to endoscopy.

CT gastrography

The rapid dissemination of multidetector-row computed tomographic (CT) technology will make faster and more accurate gastric imagining available. Two-dimensional multiplanar reconstruction and CT gastrography including virtual gastroscopy and transparency rendering using volume rendering are types of interactive two- and three-dimensional medical imaging tools. It provides multiplanar cross-sectional imaging, gastroscopic viewing, and upper gastrointestinal series imaging in the same data acquisition. Two-dimensional multiplanar reconstruction provides accurate staging of gastric cancer and extraluminal information such as lymphadenopathy and distant metastasis. Virtual gastroscopy detects subtle mucosal changes and differentiates them from submucosal lesions in the same way as gastroscopy. Transparency rendering provides global orientation of the focal findings in the stomach in the same way as upper gastrointestinal series findings and provides useful information for preoperative mapping. Thus, CT gastrography is a promising method for evaluating gastric lesion despite its limitations.

Early gastric cancer: virtual gastroscopy

Gastric cancer is one of the most common cancers and one of the most frequent causes of cancer-related deaths worldwide. Early detection and accurate preoperative staging of early gastric cancer (ECG) offers the best prognosis and is essential for planning optimal therapy such as endoscopic mucosal resection or gastric resection. Recent advances in computed tomographic technology and three-dimensional imaging software have enabled more accurate gastric imaging. Virtual gastroscopy (VG) is helpful in the detection and evaluation of EGC in the same way as gastroscopy. VG has a wider field of view than conventional gastroscopy, the angle of the virtual cancer can be adjusted omnidirectionally, and it has no blind point because retrospective reconstruction is available. Thus, VG is a promising method for evaluating gastric lesions despite its limitations. This report describes the clinical usefulness of VG with multidetector row computed tomography for EGC and axial computed tomography.

The role of surgery in patients with advanced gastric cancer

Surgery remains the mainstay of treatment with curative intent for established gastric cancer. Patient selection is critical to achieving satisfactory outcomes, and involves careful assessment of both patient fitness and disease stage. Staging techniques have multiplied and become much more sensitive in recent years. Current best practice involves a combination of spiral CT scan, Endoscopic ultrasound, PET scanning and laparoscopy. Only a minority of patients progress to potentially curative surgery after staging and fitness assessment in Western centres. Conventional treatment involves a distal subtotal gastrectomy or total gastrectomy depending on the site of the lesion. Innovative techniques include the Merendino operation, and pylorus and nerve sparing gastrectomies for earlier stage disease in the proximal and distal stomach, respectively. There is evidence of nutritional and quality of life benefit in the first 2 years after surgery from formation of a gastric substitute reservoir. Laparoscopic resection is well established in Japan and is developing rapidly elsewhere but its role and outcomes are not yet well defined. Radical lymph node dissection remains controversial: randomised trial evidence of overall benefit is lacking, but expert series have produced excellent results, and there are indications of a sub-group benefit for patients with stage II and III disease. The increased morbidity and mortality associated with radical dissection appear to be largely attributable to pancreatic and splenic resection together with limitations in Unit expertise. Surgical palliation has become less important in recent years as interventional radiology and endoscopy techniques have been developed for the same purposes. Overall mortality and survival results have improved dramatically over the last 20 years, but interpretation of these figures is made difficult by major changes in staging and case selection. The chances of long-term survival are, however, clearly much greater, and those of peri-operative death much less for an individual patient accepted for surgery in 2006 than they would have been in 1986.

Multidetector-row CT duodenography in familial adenomatous polyposis: a pilot study

AIM

To investigate the feasibility of using multidetector-row computed tomography (CT) duodenography to stage duodenal polyposis in patients with familial adenomatous polyposis.

MATERIALS AND METHODS

Six patients underwent multidetector-row CT duodenography before upper gastrointestinal endoscopy. A single-blinded radiologist used a surface shaded three-dimensional endoluminal fly though and two-dimensional axial and multiplanar reformats to assign a score for maximum polyp size and number based on the Spigelman classification. Comparison was made with the corresponding Spigelman scores obtained from subsequent endoscopy.

RESULTS

CT duodenography was technically successful in five of six patients. The CT derived Spigelman score based on maximum polyp size was accurate in all five patients. The CT derived Spigelman score based on polyp number was accurate in only two cases: Polyp number was overestimated in one patient and underestimated in a further two. In retrospect, fine carpeting of tiny duodenal polyps was poorly visualized with CT.

CONCLUSIONS

CT duodenography is technically feasible and accurately predicts maximum polyp size but CT estimates of polyp number are relatively inaccurate. CT duodenography potentially has a useful role for duodenal surveillance in those patients intolerant of conventional endoscopy.

Laparoscopic resection of submucosal tumor in gastric fundus

AIM: Laparoscopic resection of the submucosal tumors on the gastric fundus, especially when they are on the posterior wall and next to the esophagocardiac junction (ECJ), is both difficult and time-consuming. Furthermore, it can lead to the inadvertent esophagus stenosis and injury to spleen. In order to solve these problems, wedge gastrectomy was adopted for the submucosal tumor on the anterior wall and the greater curvature of the gastric fundus, and laparoscopically extraluminal resection of the gastric fundus was designed for the submucosal tumor on the posterior wall of the gastric fundus and next to ECJ.

METHODS: Retrospective analysis was made in 32 cases, including 23 male and 9 female with an average age of 55 (range 36-78). Laparoscopic wedge gastrectomy had been carried out in 11 cases of submucosal tumor on the anterior wall of the gastric fundus and 6 on the greater gastric curvature. And laparoscopically extraluminal resection of the gastric fundus had been carried out on 15 cases on the posterior wall.

RESULTS: The mean operative time and intra-operative bleeding and postoperative hospital stay were (56.3±19.4 min), (53.1±30.1 mL), (4.7±0.5 d) respectively. Within 36 hours post-operation, 78.1% of all the patients resumed their gastrointestinal function and began to eat something and ambulated. The pathological diagnosis included mesen-chymoma of low malignancy (3 cases), leiomyoma (21 cases), mesenchymoma (7 cases), and neurofibroma (1 case). All the procedures were completed successfully with no apparent tumor focus left and no complication or conversion to open surgery happened.

CONCLUSION: The adopted and newly designed procedure can avoid the abdominal cavity contamination, the injury to spleen and the esophageal stenosis. And there is no limit to the range of gastric resection. Therefore, the procedure is both safe and effective.

Usefulness of three-dimensional, multidetector row CT (virtual gastroscopy and multiplanar reconstruction) in the evaluation of gastric cancer: a comparison with conventional endoscopy, EUS, and histopathology

BACKGROUND

The aim of this study was to assess the role of three-dimensional multidetector row CT for detection, precise localization, and staging of gastric cancer by comparison with conventional endoscopy, EUS, and histopathology.

METHODS

Sixty-three patients with gastric cancer (31 early stage, 32 advanced) were evaluated by EGD with biopsies, EUS, and three-dimensional multidetector row CT between January 2003 to August 2003. Three-dimensional multidetector row CT findings were analyzed by a single radiologist blinded to the endoscopic findings. Among 63 patients, the findings were confirmed in 48 at surgery or by EMR. In the remaining cases, the findings were confirmed by EGD and biopsy specimen. The accuracy of three-dimensional multidetector row CT for detection, localization, and staging of gastric cancer was determined, compared with endoscopy, EUS, and histopathology.

RESULTS

Among the 63 patients, there were 67 gastric cancers. The overall accuracy of three-dimensional multidetector row CT for detection of gastric lesions was 94% (63/67), with accuracies of 96.7% (30/31) and 100% (32/32) for detection of, respectively, early and advanced stage gastric cancer. The overall accuracy, sensitivity, and specificity for EUS and three-dimensional multidetector row CT in the pre-operative determination of depth of invasion (T stage) were, respectively, 87.5%, 82.4%, and 96%; and 83.3%, 69.1%, and 94.4%. The accuracy, sensitivity, and specificity of EUS and three-dimensional multidetector row CT for lymph node staging was, respectively, 79.1%, 57%, and 89.5%; and 75%, 57.4%, and 89.3%.

CONCLUSIONS

Three-dimensional multidetector row CT, along with virtual gastroscopy is a promising method for pre-operative evaluation of gastric cancer.