经腹超声检查对胃癌术前评估的价值

目的探讨经腹超声检查(transabdominalultrasonography,TAUS)对胃癌术前TNM分期和血管生成的评估价值。方法对64例胃癌患者术前行经腹超声检查,其中37例行经腹彩色多普勒超声检查,测定胃癌的彩色多谱勒血管指数(colorDopplervascularityindex,CDVI);并采用抗CD34抗体,通过免疫组织化学染色检测胃癌组织的微血管密度(microvesseldensity,MVD)。结果TAUS对胃癌T分期的判断准确率为56.0%,其中T12/3例,T228.6%,T373.1%,T450.0%;对胃癌淋巴结状况判断的总体准确率为63.3%,对淋巴结转移判断的敏感性和特异性分别为37.9%和100%。TAUS对胃癌N分期的判断准确率为57.1%,其中N0100%,N116.7%,N235.3%;对胃癌远处转移判断的敏感性和特异性分别为58.3%和100%。通过彩色多普勒超声检查测定的胃癌CDVI与血管浸润显著相关(P=0.0418),回归分析同时显示CDVI与MVD呈线性相关(r=0.5628,P<0.01)。结论TAUS可作为胃癌患者术前的常规检查。     

内镜超声检查和多层螺旋CT对胃癌术前T、N分期的比较研究

目的探讨内镜超声(endoscopicultrasonography,EUS)与多层螺旋CT(multi slicespiralCT,MSCT)在胃癌术前T、N分期中的临床应用价值。方法2000年10月至2002年5月,对89例活检证实的胃癌病人术前分别行内镜超声和多层螺旋CT检查,并与手术病理结果对照。结果EUS对胃癌术前T分期的准确率为75.6%,其中T176.5%,T268.8%,T384.4%,T464.7%;MSCT分别79.3%,58.8%,62.5%,90.6%和94.1%。两者差异无统计学意义(P>0.05)。EUS对胃癌术前N分期的准确率为57.5%,其中N095.8%,N145.8%,N232.0%;MSCT分别78.1%,70.8%,75.0%和88.0%。EUS和MSCT对胃癌淋巴结转移的敏感性分别为61.2%和91.8%。EUS对N0分期的准确率显著高于MSCT(P<0.05),MSCT对N和N2分期的准确率及淋巴结转移的敏感性均显著高于EUS(P<0.05,P<0.01,P<0.01)。结论内镜超声检查与多层螺旋CT对胃癌术前TN分期均有较高的准确性。     

MSCT在胃癌术前分期诊断中的应用价值

探讨64层螺旋旋CT(MSCT)诊断胃癌术前分期的应用价值。选取2014年1月—2018年5月收治的287例胃癌患者,分析术前MSCT检查情况与术后病理结果差异。MSCT术前T分期与病理结果一致性好(Kappa=0.727,P<0.05);MSCT术前判断T3和T4准确度分别为89.74%和85.71%,明显高于T₁和T₂(P<0.05);MSCT术前N分期与病理结果一致性好(Kappa=0.692,P<0.05);MSCT术前判断N₀、N₁和N₂的准确度分别为83.97%、75.29%和78.87%,差异无统计学意义(P<0.05);MSCT术前M分期与病理结果一致性极佳(Kappa=0.888,P<0.05);MSCT术前判断M0和M1的准确率分别为96.77%和92.86%,差异无统计学意义(P>0.05)。64层螺旋旋CT能较准确地判断胃癌分期情况,为治疗方案的制定提供依据。     

腹腔镜术中超声确定胃癌TNM的临床研究

目的:探讨腹腔镜术中超声(LUS)确定胃癌TNM的效果。方法:收集2015年9月—2017年10月青岛市市立医院东院普外科经胃镜病理组织活检证实的118例胃癌患者,患者术前常规评估心肺功能,完善术前准备,手术医师先完成腹腔镜检查,之后通过腹壁上的通道将腹腔镜探头放入腹腔,在腹腔镜图像的指导下进行超声扫描,对肿瘤的TNM分期做出评价。术后对切除标本行病理学分期,对T、N、M分期统计量行一致性分析,对两种方法的符合率进行比较。结果:LUS对胃癌T1～T4分期诊断的灵敏度和特异性分别为75.0%(9/12)、90.65%,75.0%(12/16)、92.16%,71.4%(5/7)、83.61%,92.8%(77/83)、96.67%。对胃癌N0～N3分期诊断的灵敏度及特异性分别为70.6%(24/34)、91.25%,83.3%(40/48)、78.26%,72.4%(21/29)、91.7%,71.43%(5/7)、97.1%。对二者行一致性比较的Kappa值为0.637,结果较为满意。LUS对胃癌远处转移(M)的判断总准确率为99.1%(117/118),其中M0 100%,M1 53.85%。结论:LUS检查对胃癌临床分期准确性较高,能精准分型,并能识别淋巴结远处转移。     

64-MSCT增强扫描评价胃癌患者术前临床TNM分期的价值

目的探讨64排螺旋CT(64-MSCT)增强扫描评价胃癌患者术前临床TNM分期的价值。方法选取2016-07—2019-01间在林州市肿瘤医院接受根治手术的200例胃癌患者,术前均经胃镜及病理检查确诊。以术后病理TNM分期为“金标准”,评价术前64-MSCT增强扫描对胃癌患者临床TNM分期的价值。结果术前64-MSCT增强扫描临床TNM分期中,T、N、M的准确率分别为82.00%、73.00%和97.00%。M的准确率高于T和N分期(P<0.05),且一致性极好(Kappa=0.905,P<0.001)。结论术前64-MSCT增强扫描评估胃癌患者的临床TNM分期准确率较高,对远处转移判断与病理诊断具有高度一致性,有助于临床医师制定治疗方案。     

多层螺旋CT在胃癌术前分期中的临床应用

目的探讨多层螺旋CT（MSCT）在胃癌术前分期中的临床应用价值。方法2004年6月至2006年3月间经胃镜活检确诊为胃癌的患者89例，其中男性49例，女性40例，中位年龄63岁。所有患者均在手术前1周内进行MSCT检查。图像由2位资深放射科医师双盲阅读，术前判断患者的肿瘤TNM分期．并与患者的术后病理结果进行对照比较。结果与术后病理诊断比较，MSCT普通轴位图像结合多平面重建法判断胃壁侵犯程度的总准确率为72．3％，其中T1判断准确率为90．0％，T2为82．8％，T3为69．6％，T4为52．4％；判断淋巴结转移情况的总准确率为53．0％，其中N0判断准确率为44．0％，N1为72．0％，N2为46．4％，N3为2／5。MSCT对有远处转移即M1的患者判断准确率为90．0％。结论MSCT对胃癌患者进行术前TNM分期有较高的准确率，可以为胃癌患者术前提供一种无创且易于被接受的检查方法。     

超声双重造影在胃癌术前TN分期中的价值

目的 在胃癌术前分期中,通过与超声内镜检查(EUS)对比分析超声双重造影(DCUS)检查的价值.方法 选择162例经病理活检证实为胃癌并进行手术切除的患者,手术前5 d内进行EUS及DCUS检查,并进行TNM分期,与术后病理检查结果对照得出正确率,并进行相互比较.结果 本组162例胃癌患者中TNM分期:42例为T1期,49例为T2期,56例为T3期,15例为T4期.DCUS和EUS术前T分期总的正确率分别为77.2%、74.7%(χ2=0.273,P=0.603),而在T3分期上DCUS优于EUS(χ2=5.009,P=0.025);在N分期上两者总的正确率分别为78.4%、57.4%(χ2=16.370,P=0.001),而两者的敏感性和特异性分别为78.4%比49.5%、78.5%比69.2%.在对阳性淋巴结诊断上DCUS的正确率较高(78.4%比49.5%,χ2=17.523,P<0.01),尤其是对低分化腺癌患者阳性淋巴结的诊断正确率较高(81.5%比42.6%,χ2=17.338,P<0.01).结论 DCUS检查在胃癌术前分期中有较好的应用价值,其在预测阳性淋巴结方面,尤其是判断低分化腺癌患者有无淋巴结转移上正确率高于EUS检查.     

64层CT三期动态增强扫描对胃癌术前TNM分期的判断价值

目的探讨64层螺旋CT三二期动态增强扫描对胃癌进行术前TNM分期的临床价值．方法回顾性分析2009年5月至2011年5月赣南医学院第一附属医院收治的120例胃癌患者的术前64层螺旋CT三期动态增强扫描资料和术后病理资料,由两名高年资影像科医生采用双盲法进行术前影像学分期。结果术前64层螺旋CT增强扫描对胃癌T分期判断的总体准确率为79．2％（95／120）,其中对T1、T2、T3和T4期判断的准确率分别为66．7％（10／15）、66．7％（14／21）、84．0％（42／50）和85．3％（29／34）。对于单层胃壁结构和多层胃壁结构,CT增强扫描对T分期的准确率分别为59．4％（19／32）和81．8％（72／88）．差异有统计学意义（P〈0．05）。CT增强扫描对N分期判断的总体准确率为73．9％（85／115）,其中对N0N1和N2期判断的准确率分别为75．5％（37／49）、70．3％f26／37）和75．9％（22／29）：对M分期判断的准确率为89．2％（107／120）。结论64层螺旋CTi期动态增强扫描可早期动态观察肿瘤累及侵犯情况、淋巴转移及远处转移的情况．有望成为胃癌术前分期有重要意义的检佥项目之一。     

动态磁共振减影技术对胃癌术前TNM分期的诊断价值

目的 探讨动态磁共振(MRI)减影技术在胃癌术前TNM分期评估中的临床应用价值.方法 运用动态MRI减影技术,对39例胃癌患者进行术前TNM分期诊断.患者术后经病理确诊.将MRI结果与术后病理结果对比.结果 动态MRI对本组胃癌浸润深度(T)的总体诊断准确率为82.1%;对淋巴结转移状况(N)的总体诊断准确率为71.8%;对远处转移(M)的总体诊断准确率为84.6%:TNM分期诊断总的准确率为71.8%.MRI对胃癌术前TNM分期的诊断与术后病理结果有着较高的一致性(Kappa值为0.671～0.763,P<0.05).结论 MRI在显示胃癌侵犯胃壁的深度、淋巴结转移及远处脏器转移方面起着重要的作用,对于胃癌术前临床分期的评估有其独特的优越性.     

多排CT对胃癌术前分期的单中心大宗病例研究

目的:探讨多排CT(multidetector-row CT,MDCT)对胃癌术前分期的价值。方法:对1 311例胃癌病人术前行MDCT检查,并与手术病理结果相对照。结果:MDCT检查对胃癌T分期的判断准确率为75.3%,其中T1期为74.3%,T2~3期为42.9%,T4a期为85.6%,T4b期为81.9%。MDCT检查判断胃癌淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为83.3%、71.8%、81.2%、74.6%和78.6%;对胃癌远处转移的判断分别为70.4%、98.3%、86.9%、95.5%和94.5%;对胃癌肝脏转移的判断分别为74.1%、99.7%、83.3%、99.5%和99.2%;对胃癌腹膜转移的判断分别为54.5%、99.3%、87.1%、96.4%和96.0%;对胃癌远处淋巴结转移的判断分别为76.3%、99.1%、84.1%、98.6%和97.8%。结论:MDCT检查对胃癌术前分期具有较高的临床应用价值,但对胃癌腹膜转移的灵敏度相对偏低,对于腹膜转移概率较大的病人仍需行诊断性腹腔镜检查,以避免不必要的剖腹探查。     

超声内镜在胃癌术前诊断中的应用分析

目的探讨超声内镜(EUS)在胃癌术前TN分期中的应用经验。方法术后病理检查证实为胃癌而且使用超声内镜进行了术前TN分期的患者352例,对其资料进行回顾性分析。结果 EUS胃癌术前T分期总正确率为81.25%,其中T1为85.58%,T2为73.91%,T3为82.14%,T4为83.33%,与术后病理结果比较具有高度一致性(Kappa系数为0.75)。EUS对胃癌术前N分期总的正确率为52.84%,其中N0为85.56%,N1为56.69%,N2为28.09%,N3为26.09%,与术后病理结果比较具有一般一致性(Kappa系数为0.33)。将病变部位分为贲门、胃底、胃体、胃窦、幽门,不同部位之间的检测正确率比较,差异无统计学意义(P0.05)。结论EUS在胃癌术前诊断中具有临床意义,其中T分期可为合理制定治疗方案提供依据,N分期准确性有待提高。     

Prognostic Factors and Availability of D2 Lymph Node Dissection for the Patients with Stage II Gastric Cancer: Comparative Analysis of Subgroups in Stage II

BACKGROUND: According to the fifth edition of the UICC TNM classification, stage II gastric cancer has three subgroups: T1N2M0, T2N1M0, and T3N0M0. This study was designed to investigate the prognosis of stage II gastric cancer according to the T and N category to verify the accuracy of TNM staging for stage II and to determine the prognostic factors for patients with stage II gastric cancer by subgroup. METHODS: Clinicopathologic data from 326 patients with stage II gastric cancer were studied. We stratified the patients into T2N1 and T3N0 groups and performed comparative analysis between the two groups as well as univariate and multivariate survival analyses for each group. RESULTS: The five-year survival rate for patients with T2N1 disease was 75.6%, whereas for patients with T3N0 disease it was 68.3%. There was no significant difference in survival between T2N1 and T3N0 groups (p = 0.174). Univariate survival analysis showed that age, gender, histological type, and the extent of lymph node dissection were significant prognostic factors for stage II gastric cancer. However, multivariate analysis demonstrated that only gender and the extent of lymph node dissection were significant variables. Among these variables, gender was an independent prognostic factor for survival only in the T2N1 group. On the other hand, the extent of lymph node dissection was an independent prognostic factor in the T3N0 group, not in the T2N1 group. CONCLUSIONS: There was no significant difference in survival between the T2N1 and the T3N0 groups. Thus, our data support the accuracy of the TNM staging classification for stage II gastric cancer. We found a significant survival benefit with D2 dissection for T3N0 but not T2N1. However, before recommending limited lymph node dissection for T2N1 stage disease, development of a preoperative method for prediction of depth of invasion and lymph node status is needed.     

A Prospective Validation Study to Diagnose Serosal Invasion and Nodal Metastases of Gastric Cancer by Multidetector-row CT

Background

Multidetector-row CT (MDCT) may provide accurate preoperative staging of resectable gastric cancer. However, the standard methods and criteria to diagnose the T and N stages to select the patients who are good candidates for neoadjuvant chemotherapy have not been established yet.

Methods

The aim of this prospective study was to evaluate the accuracy of MDCT to diagnose the serosal invasion and nodal metastases of gastric cancer. Patients who had gastric adenocarcinoma underwent MDCT scanning using a standardized method. The T and N stage were diagnosed by prespecified criteria. The analyses were performed in the patients who had cN0–2 and M0 tumors and underwent curative gastrectomy as a primary treatment. The accuracy was calculated by comparing the results of MDCT with the histopathological findings.

Results

A total of 315 patients were analyzed. The overall diagnostic accuracy (95 % confidence interval) of T staging was 71.4 % (225 of 315, 66.2–76.1). The accuracy, sensitivity, and specificity for serosal invasion were 85.7 % (81.4–89.1), 54.5 % (42.6–66.0), and 94.0 % (90.3–96.3), respectively. The false-positive rate for serosal invasion was 6.0 % (2.9–7.7). The overall diagnostic accuracy of N staging was 75.9 % (239 of 315, 70.9–80.3). The accuracy, sensitivity, and specificity for nodal metastases were 81.3 % (76.6–85.2), 46.4 % (36.8–56.3), and 96.8 % (93.5–98.4), respectively. The false-positive rate for nodal metastases was 3.2 % (1.6–6.5 %).

Conclusions

These results suggest that MDCT provides an accurate diagnosis with high specificity and a low false-positive rate and can be used to select the patients who are candidates for preoperative chemotherapy.     

Endoscopic ultrasonography in the preoperative staging of gastric cancer

BACKGROUND: Endoscopic ultrasonography (EUS) is a standard procedure in the preoperative staging of patients with gastric carcinomas. Herein we present our experience with EUS and discuss the results and their implications for surgical therapy. METHODS: A total of 116 patients with histologically confirmed gastric adenocarcinoma were referred to EUS and classified prospectively by the TNM system. The results of the preoperative endosonographic staging were compared with the definitive histopathological results after the operation. RESULTS: The overall accuracy of EUS for determination of the T stage was 78%. The accuracy for the T1 and T2 stages was 80% and 63%, respectively. With 20% and 30%, there was a relatively high rate of overstaging in these cases. The accuracy for T3 and T4 tumors was 95% and 83%, respectively. The accuracy of EUS for determination of the N stage was 77%, with a sensitivity of 91% and a specificity of 84%. Resectability was predicted correctly with a sensitivity of 94% and a specificity of 83%. CONCLUSIONS: Generally accepted standards for the therapy of advanced gastric carcinomas do not exist. In cases where the therapeutic strategy is surgical exploration, no preoperative staging is necessary. In cases with differentiated treatment strategies, the accuracy of EUS is not sufficient for the selection of patients for endoscopic resection. Its accuracy for submucosal cancer invasion and for the detection of lymph node metastases needs to be further enhanced. If only multimodal therapy is considered, EUS staging seems to be absolutely mandatory. Patients classified preoperatively as T1 to T3 can be operated on primarily with sufficient security. In patients where radical resection of the tumor seems doubtful, we recommend that a diagnostic laparoscopy be performed to confirm the diagnosis.     

Clinical Correlation of Endoscopic Ultrasonography with Pathologic Stage and Outcome in Patients Undergoing Curative Resection for Gastric Cancer

Background Endoscopic ultrasonography (EUS) is considered valuable for preoperative staging of gastric cancer and defining patient eligibility for enrollment in neoadjuvant protocols. The aim of this study was to correlate EUS staging with pathologic evaluation and outcome in patients undergoing curative R0 resection for gastric cancer. Methods All patients who underwent preoperative clinical assessment of T/N stage with EUS and subsequent R0 resection for gastric adenocarcinoma between 1993 and 2003 were identified from a prospective database. Patients who received neoadjuvant chemotherapy were excluded. Clinical staging results from preoperative EUS were compared with postoperative pathologic staging results and correlated with clinical outcome. Results Two hundred twenty-five patients with gastric cancer underwent EUS followed by R0 resection, without preoperative chemotherapy. The accuracy of the individual EUS T stage was 57% (127 of 223) and was 50% for N stage (110 of 218). Although EUS was less able to predict outcome according to individual T stage, patients with lesions ≤T2 on EUS had a significantly better outcome than patients with lesions ≥T3. Preoperative assessment of risk was not predicted by EUS N stage alone. Patients identified as high risk on EUS and those with a combination of serosal invasion and nodal disease had both the highest concordance with pathology and a significantly worse outcome (P = .02). Conclusions The concordance between EUS and pathologic results was lower than expected for individual T and N stages. Patients with lesions ≤T2 had a significantly better prognosis than patients with more advanced lesions. Individual EUS N stage has limited value in preoperative risk assessment. Combined assessment of serosal invasion and nodal positivity on EUS identifies 77% of patients at risk for death from gastric cancer after curative resection.     

Endoscopic ultrasonography for gastric cancer

BACKGROUND: This study aimed to evaluate the utility and shortcomings of endoscopic ultrasound (EUS) in tumor node metastasis (TNM) staging of gastric cancer and its influence on treatment. METHODS: The series included 126 patients (65 men and 44 women) with gastric cancer who underwent EUS from July 1997 to June 2003 at the National University Hospital, Singapore. The final analysis included 109 patients ranging in age from 29 to 97 years (mean, 63.13 years). RESULTS: EUS staging for primary disease: Specimen histology was available for 102 of the 109 patients who underwent surgery. The accuracy was 79% for T1, 73.9% for T2, 85.7% for T3, and 72.7% for T4. The overall accuracy was 80.4%. EUS staging for nodes: The sensitivity of EUS for detecting nodal disease was 74.2% for N0, 78% for N1, 53.8% for N2, and 50% for N3. Overall, the N staging by EUS showed a sensitivity of 82.8%, a specificity of 74.2%, a positive predictive value of 85.4%, a negative predictive value of 70.2%, and an accuracy of 77.7%. Radical gastrectomy was proposed for 95 patients on the basis of the staging with EUS and computed tomography (CT) scan, and 87 patients (91.6%) underwent the surgery. Preoperative staging accurately predicted the operative strategy for 89% of the patients. No significant predictor for accuracy was achieved by performing a logistic regression analysis for the correct staging of T stage using EUS and adjusting for tumor location (middle part/distal third/whole stomach vs proximal/cardioesophageal) (p = 0.873), operator (p = 0.546), and subject's sequence (initial 50 vs last 50 cases) (p = 0.06). CONCLUSION: Ultrasound is the most accurate and reliable method for the preoperative staging of gastric carcinomas, and it is mandatory if a tailored therapeutic approach is planned according to stage.     

pN3M0 Gastric Cancer: the Category that Allows the Sub-Classification of Stage-IV Gastric Cancer (IVa and IVb)

BACKGROUND: Since the publication of the fifth edition of the UICC TNM classification, the rate of curative surgical resection for stage-IV gastric cancer has increased. It is related to the N3 category, which was the prior pN1 or pN2 in the fourth UICC TNM staging system and now pN3 in the fifth. We performed a retrospective analysis to determine whether the prognosis of N3M0 gastric cancer is different from that of other stage-IV gastric cancer; this may support sub-division of this disease. METHODS: We analyzed 422 patients with stage-IV gastric cancer who underwent gastric resection from 1983 to 2002 at Korea University Hospital. Clinical and pathological characteristics as well as survival of the patients were evaluated retrospectively according to the TNM categories. RESULTS: The 5-year survival rate for those with N3M0 gastric cancer was 10.5%; this was influenced by depth of invasion (P = 0.001). According to the survival analysis in patients with stage-IV subtypes, the mean survival time was 25.6 months for T1-3N3M0, 24.7 months for T4N1-2M0, 10.0 months for T4N3M0, and 13.6 months for anyT anyNM1. Thus, the survival of patients with T4N3M0 and M1 stage disease was significantly shorter than that of patients with T1-3N3M0 and T4N1-2M0 stage disease (P = 0.000). CONCLUSIONS: Sub-classification of stage-IV gastric cancer into IVa (T1-3N3M0, T4N1-2M0) and IVb (T4N3M0, anyT anyNM1) may be helpful to predict the outcome of patients with stage-IV gastric cancer.