Study On The Correlation Between Spiral CT Features And Operative Pathology, Histological Differentiation In Gastric Carcinoma

Background and Purpose: Gastric cancer is the most familiar malignant carcinoma, with high incidence rate, high death rate and bad prognosis. The invasion and metastasis of cancer is the major cause of death from gastric cancer. Compared with endoscopic ultrasonography (EUS) and magnetic resonance(MR), spiral CT is the imaging technique used mainly for the staging of gastric cancer, by reason of abundant diagnostic experience, accurate diagnosis, high clinical practicable value and the most clinical widespread rate. In recent years, the study on the staging of gastric cancer with spiral CT has become the hotspot. Triphasic spiral CT with water filling method and hypotonic agent can reveal the invasion and metastasis of gastric cancer and perform the preoperative staging of gastric cancer accurately and roundly.There were many reports about evaluating the accuracy of staging of gastric cancer, but there has no report with regard to the correlation between spiral CT features and operative pathology and histological differentiation. The purpose of our study was to evaluate the accuracy of TNM staging in gastric cancer with triphasic spiral CT, sum up all kinds of spiral CT features involved in tumor thickness, size, enhancement, serosal invasion, lymph node metastasis, distant organ metastasis,discuss the correlation between spiral CT features and operative pathologic staging and histological differentiation. According to imaging findings, the histopathologic characters can be speculated, and consequently direct operative option, constitute therapeutic project and evaluate prognosis.Methods: A total of 57 patients with established diagnosis of gastric cancer were evaluated with triphasic spiral CT with water filling method and hypotonic agent. Spiral CT findings were compared with operative pathologic staging and histological differentiation.Results: l.on spiral CT, gastric cancer with thickness of > 15mm, size of >50mm and multilayered/asymmetric enhancement in the arterial phase numerously were poorly differentiated cancer, the probability of invasion and metastasis was obvious higher, the staging numerously was III+IV.2. on spiral CT, gastric cancer with plastic stomach, invasion to adjacent structures and distant organ metastasis overall were poorly differentiated cancer.3. on spiral CT, gastric cancer with lymph node metastasis, distant lymph node metastasis and III+IV staging, the probability of poorly differentiated cancer was 76.92%, 84.62% and 84.62% respectively.4.on spiral CT, gastric cancer with thickness of < 15mm, size of <50mm and single-layered /symmetric enhancement in the arterial phase numerously were well-moderately differentiated cancer, the probability of invasion and metastasis was obviously lower, the staging numerously was I + II.5. on spiral CT, gastric cancer with no lymph node metastasis, adjacent lymph node metastasis and I + II staging, the probability of well-moderately differentiated cancer was 61.11%, 51.61% and 77.78% respectively.6. on spiral CT, the different features between poorly differentiated gastric cancer and well-moderately differentiated gastric cancer were statistically significant (P<0.05).7. The accuracy of TNM staging of spiral CT in gastric cancer was 80.70%, correlated with operative pathology and histological differentiation (P<0.05).Conclusion: 1. Spiral CT features which included tumor thickness, size,enhancement pattern, serosal invasion, invasion to adjacent structures, lymph node metastasis and distant organs metastasis were correlated with operative pathology and histological differentiation(P<0.05).2. Spiral CT in staging of gastric cancer was correlated with operative pathology and histologic differentiation (PO.05).3. The preoperative histopathologic evaluation with triphasic spiral CT is useful in directing clinical therapy of gastric cancer, giving help to direct operative option, constitute therapeutic project and evaluating prognosis. Among them, the evaluation of poorly differentiated gastric cancer with spiral CT looks more important. Due to the higher bad degree, much more tendency to metastasis and worse prognosis, poorly differentiated gastric cancer must be resected more extensively during operation, the all-round therapeutic project and succedent investigation after operation should be emphasized.