Korean J Gastrointest Endosc.  2008 Aug;37(2):90-96.

Diagnostic Accuracy of Computed Tomography for the Lymph Node Staging of Endoscopically Resectable Early Gastric Cancer

Affiliations
  • 1Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea. osbbang@hanmail.net
  • 2Department of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
  • 3Department of Pathology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS: Accurate staging of the lymph nodes (LNs) before endoscopic mucosal resection (EMR) is important. We evaluated the accuracy of CT for LN staging in patients the endoscopically resectable early gastric cancer (EGC).
METHODS
The medical records of 155 EGCs patients who had undergone an operation were analyzed. The pre-operatively performed multidetector CT scans and the post-operative histopathologic findings were reviewed for comparing the LN staging with that using the Japanese classification system. Endoscopically resectable EGC was defined as EGC without LN metastasis and also the EGC that satisfied the EMR criteria according to the Japanese guideline.
RESULTS
The diagnostic efficacy of CT for LN staging of all the enrolled EGC patients was as follow: accuracy 65.2%, overstaging rate 29.7%, understaging rate 5.2%. The overall accuracy and the overstaging rate of CT for LN staging of endoscopically resectable EGC were as follows: EGC without LN metastasis [69.8% (97/139), 30.2% (42/139)], EGC satisfying extended criteria [72.5% (58/80), 27.5% (22/80)] and EGC satisfying limited criteria [79.2% (19/24), 20.8% (5/24)]. The accuracy of the EMR criteria for predicting node negative EGC were as follows: the extended criteria 98.8% (79/80), the limited criteria 100% (24/24).
CONCLUSIONS
Our study showed that prediction of LN metastasis before EMR according to CT staging had limited value due to the tendency of overestimation. Therefore, we should preferentially consider the treatment strategy according to the EMR criteria.

Keyword

Early gastric cancer; Computed tomography; Endoscopic mucosal resection; Neoplasm staging
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