Comparative Study in N-staging of Gastric Cancer

Purpose:To assess the accuracy of dynamic MSCT(multislice CT),MRI(magnetic resonance imaging)and endoscopic ultrasonography(EUS)in the preoperative TNM staging of gastric cancer to evaluate the relationship between CT perfusion imaging and clinicopathological features in gastric adenocarcinoma.Materials and Methods:MSCT was performed in 291 cases of gastric cancer diagnosed by biopsy prior to operation,among which 72 cases were preoperatively evaluated with both MSCT and EUS.Both MR and MSCT were performed in 48 cases of consecutive gastric cancer one week prior to the operation.Each tumor was staged according to the TNM classification system with both modalities.Results:In comparison with histological results,the accuracy for T-staging detected with MSCT was 80.0%:65.8% for T1,61.5% for T2,88% for T3 and 85% for T4.The accuracy of MSCT in N staging was 72.2%(N0 75%,N1 68.7%,N2 83.3%,respectively).In comparison study of MSCT and EUS,the accuracy for N staging of EUS、MSCT and combination study was 63.8%,76.4% and 86.1% respectively.EUS was a little bit higher than MSCT in N0(P0.05),while MSCT was much higher than EUS in N2(P0.01),however the accuracies of the two methods were not significantly different from each other in N1(P0.05).The sensitivity,specificity and accuracy of N staging were 62.8%,69.2% and 64.5% for MR,82.8%,76.9% and 81.4% for MSCT,revealing no significant difference between them in N0,N1 and N2(P0.05).But nevertheless the overall accuracy of MSCT in N staging was different from that of MR(P0.05).Conclusion:Dynamic enhanced MSCT scan plays a very important role in TNM staging with its clear demarcation of the enlargement of LN.