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The Consistency of the TNM Staging and the Longest Diameter Measurement(RECIST Standard)of Gastric Cancer Evaluated by MSCT and Histopathology

Author: HuZiLong
Tutor: ZhaoQun;LiYong
School: Hebei Medical University
Course: Surgery
Keywords: Gastric cancer multi-slice spiral CT TNM staging RECIST longest diameter pathology
CLC: R735.2
Type: Master's thesis
Year: 2014
Downloads: 5
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Abstract


Objective: Gastric cancer is one of the most common cancersworldwide. The quantity of new cases and deaths of gastric cancer accountsfor about8percent of new cancers. Accurate assessment of clinical staging ofgastric cancer is significant to the individualized treatment plan, evaluation oftreatment efficacy and assessment of prognosis. Whether the clinical andpathological staging is accurate or not is crucial to the guide of the treatment.Currently, resection and preoperative chemotherapy are the curative optionavailable for patients with gastric cancer. But there is no consensus standardfor clinical staging and assessment of preoperative chemotherapy. The TNMstaging and the longest diameter measurement (RESIST standard)of gastriccancer are used by most doctors. Although the multislice Spiral ComputedTomography is the chief way in assessment of gastric cancer, it has manylimitations and disadvantages. This research is to probe into the consistency ofthe TNM staging and the longest diameter measurement (RESIST standard)of gastric cancer concluded from MSCT (Multislice Spiral ComputedTomography) scanning and histopathological findings.Methods: Select clinical data of153cases of gastric cancer patientswho confirmed by gastroscope pathology from January2012to march2013inThe Fourth Hospital of Hebei Medical University,125cases were male and28female, age range is24~79, the average age was59.9±9.75.All patientsunderwent MSCT enhanced scan. Tumor at gastric Cardia:48cases, gastricbody:28cases, gastric antrum:50cases. Borrmann I:7cases, Borrmann II:52cases, Borrmann III:83cases, Borrmann IV:11cases. All patients underwentMSCT enhanced scan. The TNM staging and the longest diametermeasurement are evaluated by experienced Radiologists and be compared with the results of pathology after the surgeon.Results:1T-staging: Kappa value of the consistency comparison was0.556. Theoverall accuracy rate was71.2%. The accuracies of T1, T2, T3, T4were66.7%,64.5%,57.4%,84.1%. The Sensitivities were33.3%,68.9%,72.9%,77.3%. The specificities were98.6%,91.1%,82.8%,85.9%. Theaccuracies of T-staging of tumor at gastric Cardia, gastric body, gastricantrum were62.5%,71.4%,70.0%. The accuracies of T-staging ofBorrmann I, Borrmann II, Borrmann III, Borrmann IV were71.4%,76.9%,69.9%,63.6%.2N-staging: Kappa value of the consistency comparison was0.284. Theoverall accuracy rate was47.7%. The accuracies of N0, N1, N2, N3were54.5%,41%,42.8%,39.1%. The Sensitivities were85.7%,3.3%,15.7%,25%. The specificities were98.6%,91.1%,82.8%,85.9%. The accuraciesof N-staging of tumor at gastric Cardia, gastric body, gastric antrum were45.8%,50%,48%. The accuracies of N-staging of Borrmann I, BorrmannII, Borrmann III, Borrmann IV were28.6%(2/7),38.5%(20/52),55.4%(46/83),45.5%(5/11). The accuracies of abdominal lymph node group,pper pylorus node group, lower pylorus node group, Pancreas and spleennode group were53.4%,40.5%,42.7%,45.0%.3M-staging: Kappa value of the consistency comparison was0.893. Theaccuracy of M1staging by MSCT was100%. The sensitivity was81.8%(9/11), the specificity was100%. Nine patients of M1stagingdiagnosed by MSCT because of liver metastasis, retroperitoneal lymphnode metastasis, ascites, Pelvic, mesentery, omentum seeding metastasis,as well as13,14,16group node metastasis. There were2cases which aremissed diagnosis because of the abdominal metastasis without ascites.4TNM-staging: Kappa value of the consistency comparison was0.573. Theoverall accuracy rate was66.7%. The accuracies of Stage I, Stage II,Stage III, Stage IV were75%,35.6%,90.6%,100%. The Sensitivities were70.5%,77.8%,59.3%,81.8%. The specificities were93.3%,69.8%, 92.9%,100%.5The longest diameters of tumors acquired by MSCT and postoperativetumor measurement:32mm-181mm(68.83mm±40.62mm)、22mm-160mm(64.21mm±36.19mm). The2groups were tested using the Fisher ExactTest, in which P=0.969, indicating that there was no significant differencebetween the data in2groups. Divided the data into2groups according toBorrmann I, II, III, IV. The average differences of Borrmann I, II, III, IVwere3.5mm,3.1mm,4.7mm,6.9mm.Conclusions:1MSCT is reliable in evaluating the T staging of gastric cancer, but theaccuracy is low at evaluating the T3staging, which indicated that MSCT isnot sensitive enough to evaluate violations serosa. And there are still somelimitations in detecting whether the cancer invades the adjacent organs.Different position of tumor in stomach and different Borrmann type showno differences in evaluating the T staging.2MSCT is far from satisfactory at evaluating the lymph node metastasis ofgastric cancer. The accuracy is not ideal. It has shown that there is nodifference for different position of tumor in stomach. But the accuracy ofevaluating the N staging for Borrmann III and Borrmann IV gastric cancerand abdominal lymph node group is higher than the others.3MSCT is reliable in evaluating the M staging of gastric cancer. It issensitive in evaluating the liver metastasis and retroperitoneal lymph nodemetastasis. But it is not sensitive enough to evaluate the abdominalmetastasis without ascites and omentum metastasis nodules.4There is no significant difference between the MSCT and postoperativetumor measurement to measure the longest diameters of tumors. But thelarger the tumor is, the greater the deviation is. MSCT is more reliable atmeasuring the longest diameters of Borrmann I and II gastric cancer.

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CLC: > Medicine, health > Oncology > Gastrointestinal Cancer > Gastric neoplasms
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