A Comparison Study Of Evaluation Of Preoperative Lymph Node Metastasis With 256-slice Spiral CT And Pathological N Staging In Gastric Cancer

Objective:In this study, we use 256 slice spiral CT(MDCT) in preoperative to identify regional lymph node of gastric cancer in which period of N staging on base of American Cancer Association(AJCC) of the 7th edition of the TNM.And we put the result compare with postoperative pathologic in order to explore the value of preoperative in N staging of gastric cancer.Methods:We use 256 slice spiral CT producted by Philips company to scan patients which diagnosed as gastric cancer in our hospital.Before scanning,we advised patients to hold their breath in the scaning process and water filling method was apillied to all patients in three phases enhanced scan, once scan was completed to reduce respiratory motion artifact.We count the patient’s genders, ages, areas of gastric cancer growth and pathological types.According to the shape of lymph node, MPR multi-dimensional reconstruction was apillied. Each lymph node of the long diameter and short diameter was measured,and we also recorded the number and location of lymph nodes,Two methods was appllied to evaluate the N staging of each patient in preoperation.One method is T.Satio’s N staging criteria,anthoer is D’Elia’s lymph node evaluation methods of gastric cancer,and then we put the result compare with postoperative pathological respectively.Result:We collected a total of 132 cases of gastric cancer, We have discovered that the total number of lymph node was 759 and the number of lymphatic metastasis was 618 which have been proved by pathology, the number of the pathological stage in N0 staging was 22 cases, N1 staging was 33 cases,N2 staging was34 cases, N3 staging was 43 cases. T.Satio’s method which lymph node metastasis in gastric cancer was assessed by using individual cut-off values for each lymph node region by individual defined value for N staging, his method was used in our study,the result that N0-3 staging accuracy was 68.2%,70.6%, 57.6%, 69.8%in turn, the total N staging of accuracy was 66.7%, kappa value was about 0.55, The consistency was medium. Using Elia ’D’s standard for N staging, the accuracy of N0-3 staging was 63.6%, 58.8%, 54.5%, 48.8%, and, the total accuracy of N staging was 55.3%, the Kappa value was about 0.41,the consistency was medium.Conclusion:1, Compare T.Satio’s method which lymph node metastasis in gastric cancer was assessed by using individual cut-off values for each lymph node region by individual defined value for N staging with Elia ’D’s standard for N staging was no significant difference in N0,N1 and N2 staging.2, But the use of T.Satio’s staging criteria for gastric cancer N has a good advantage in N3 staging compared with Elia’D’s standard.3,The consistency was medium compared with the result of postoperative pathological N staging for two methods which was used in the assessment of lymph node metastasis by MDCT.The result of MDCT assessment have a good agreement with pathology,MDCT can be used in evaluating N staging of gastric cancer in preoperative.