Preoperative computed tomographic(CT) scanning of the abdomen was done in 70 patients with gastric adenocarcinoma operated on between 1989 and 1991, and its radiologic accuracy was retrospectively assessed comparing to operative and pathologic
findings
in views of depth of gastric wall invasion, lymph node involvement, adjacent organ invasion or distant metastases.
Gastric wall thickness on CT scan was well correlated with depth of pathologic tumor invasion, and its overall incidence greater than 10 mm in thickness was 87% of cases.
The sensitivity, specificity, and accuracy rate of abdominal CT scanning for regional lymph node involvement were 86%, 59% and 76% respectively, for gastric serosal invasion were 96%, 76% and 89% respectively, and for direct mesocolon invasion
were
71%,
91% and 87% respectively.
Although specificity of CT scanning for direct invasions of lesser or greater omentum, pancreas, liver or colon and distant hepatic metastases were at least 85% or more, its overall sensitivity was approximately 50%.
Thirty eight patients(54%) were correctly staged with CT scan, 11 patients(16%) understaged. and 21 patients(30%) overstaged comparing to pathologic stage, mainly owing to inaccurate assessment of gastric wall thickness, lymph node enlargement or
pancreatic invasions.
Curative resection could be performed in 50 patients(71%), and palliative resection in 13 patients(19%), so overall resection rate was 90% of cases.
These results showed that although preoperative CT scan alone does not accurately displayed the true extent of disease in patients with gastric carcinoma, it can provide valuable information in predicting surgical resectability.
|