J Korean Gastric Cancer Assoc.  2006 Dec;6(4):263-269.

Causes of Under-staging in Patients with Gastric Cancer That was Proven to be Unresectable after a Laparotomy: Correlation with CT Findings

• Yoon HJ
• Shin JH
• Chung HY
• Kim GC
• Yu W

Abstract

PURPOSE: The aim of this study was to investigate the causes of under-staging in patients with advanced gastric cancer that was proven to be unresectable after a laparotomy.
MATERIALS AND METHODS
We retrospectively analyzed 25 gastric cancer patients who had undergone a diagnostic laparotomy between 2001 and 2005. For the preoperative evaluation, spiral CT and multidetector-row CT were performed. We analyzed the clinicopathologic features of patients and compared the image findings and the results of surgery. The causes of under-staging were divided into 3 groups; patient factor, CT factor, and interpretation factor.
RESULTS
Grossly, there were 12 cases of Borrmann type-III tumors and 13 cases of Borrmann type-IV tumors. The most frequent histologic type was poorly differentiated adenocarcinomas (8 cases) and signet ring cell carcinomas (7 cases). There were 13 cases of adjacent organ invasion, and the pancreas was the most frequently invaded organ (9 cases). There were 17 cases of peritoneal metastasis, and 3 cases of distant lymph node metastasis. For the cause of under-staging, there were four cases of patient factor, 19 cases of interpretation factor, and 9 cases of CT factor. In three cases, the cause of under-staging could not be identified.
CONCLUSION
CT interpretation factor was the most frequent cause of under-staging in the preoperative diagnosis with gastric cancer patients. Therefore, more cautious CT interpretation is necessary to avoid unnecessary laparotomies in gastric cancer patients.

Keyword

Gastric cancer; Under-staging; Unresectable; Abdominal CT

MeSH Terms

Adenocarcinoma
Carcinoma, Signet Ring Cell
Diagnosis
Humans
Laparotomy*
Lymph Nodes
Neoplasm Metastasis
Pancreas
Retrospective Studies
Stomach Neoplasms*
Tomography, Spiral Computed
Tomography, X-Ray Computed