The Comparative Study Between Preoperative Staging And Postoperative Pathology Of Gastric Cancer

Objective To explore the consistency between Preoperative TNM staging and postoperative pathology of gastric cancer and analyses the reasons. To provides certain guiding significance for planning therapeutic strategies and assessing the prognosis of the disease. Methods During the period of June 2009 to December 2009,in general department and oncology department, 120 patients with gastric carcinoma confirmed by gastroscope ,biopsy and pathology were selected , none of them underwent chemotherapeutics or radiotherapy before operation and other special treatment. we made the staging for every patient preoperation and postoperation pathological results according the TNM criteria. the preoperative TNM staging were compared with surgical and pathological results by analysis the consistency of T-staging,N-staging and M-staging. The data were analysed by software SPSS13.0,chi-square test and correlation test were used to compare the differences between different groups. the difference was considered significant if the P value was below 0.05. Results 1.The sensitivity and specificity for the preoperative T1 to T4 staging of gastric cancer was 61.54%(8/13),90.65%;72.22%(13/18),92.16%;86.44%(51/59),83.61%;76.67%(23/30),96.67% respectively; the total accuracy of preoperative T-staging was 79.17%. The sensitivity and specificity for the preoperative N0 to N3 staging of gastric cancer was 69.70%(23/33),91.25%;72.73%(32/44),78.26%;72.41%(22/33),91.67%;71.43%(5/7),97.17% respectively; the total accuracy of preoperative N-staging was 71.68%;The sensitivity and specificity for the preoperative of M0 and M1 was 100%(107/107),53.85%(7/13)respectively; the total accuracy of preoperative was 95.00%(114/120). The sensitivity and specificity for the preoperative I to IV staging of gastric cancer was 75%(10/15), 96.94%;77.78%(21/27),90.70%;82.35%(42/51),82.26%;60.00%(12/20),94.17% respectively; The total accuracy of preoperative TNM staging for 113 patients was 75.22%(85/113).2. Comparing the consistency of preoperative T-staging and postoperative pathological results, the Kappa value was 0.700,the consistency was considerable. Comparing the case of stratified, the consistency of T1 staging was the lowest(P>0.05),there was no significant difference. Comparing the consistency of preoperative N-staging and postoperative pathological results, the Kappa value was 0.591, the consistency was considerable. Comparing the case of stratified, the consistency of N0 and N3 was lower; Comparing the consistency of preoperative M-staging and postoperative staging, the Kappa value was 0.675,the consistency was quite satisfied. Comparing the overall preoperative and postoperative TNM staging, the Kappa value was 0.637, the consistency is quite satisfied. Conclusions The preoperative imaging examination mainly by multi-slice spiral CT can effectively determine the depth of invasion of gastric cancer and lymph node metastasis, it can be more accurate for making preoperative TNM staging, which is valuable for the choice of individual treatment programs. But there is still the tendency of over staging and under staging. Multi-slice spiral CT combined with EUS can improve the accuracy of preoperative staging of gastric cancer , which is good for the choice of treatment programs and prognosis.