Authors: Masaki Ohashi Shinji Morita Takeo Fukagawa Takeyuki Wada Ryoji Kushima Hiroaki Onaya Hitoshi Katai
Publish Date: 2015/11/09
Volume: 40, Issue: 1, Pages: 165-171
Abstract
Preoperative N staging is essential for the best treatment planning in patients with gastric carcinoma The aim of this study was to evaluate the accuracy of preoperative N staging using contrastenhanced multidetector row computed tomography CEMDCT in patients with resectable cT24 gastric carcinomaA total of 218 patients who underwent a gastrectomy with D2 lymphadenectomy for previously untreated cT24 primary gastric carcinoma were studied Preoperative N staging was performed according to the 7th UICC TNM Staging System using prespecified criteria on a 64channel CEMDCT and was compared with postoperative pathologic N stagingIn all 218 patients a distal or total gastrectomy was performed The overall accuracy of the preoperative N staging was 463 101/218 with the proportion of over and understaging being 266 58/218 and 271 59/218 respectively The sensitivity specificity and accuracy for lymph node metastasis ≥pN1 were 791 106/134 500 42/84 and 679 148/218 respectively The sensitivity specificity and accuracy for multiple lymph node metastases ≥pN2 were 802 73/91 685 87/127 and 734 160/218 respectively Multivariate analyses showed that macroscopic type 2 and ≥6 cmsized tumors were associated with preoperative overN staging while macroscopic type 1/3 tumors were associated with underN stagingPreoperative N staging with pinpoint accuracy is difficult However CEMDCT offers a reasonably high sensitivity and specificity for ≥pN2 and may be useful for selecting candidates for neoadjuvant therapies The macroscopic type and size of the primary tumor may affect the accuracy of preoperative N staging
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