Evaluation Of 64-Row Contrast-Enhanced Helical Computed Tomography For Preoperative T And N Staging In Gastric Carcinoma

Objective The aim of this study was to evaluate the accuracy of preoperative T and N staging using contrast-enhanced 64-row computed tomography in patients with gastric carcinoma.Methods We retrospectively investigated the medical records of 111 patients with gastric carcinoma who underwent radical surgery by the same therapy group in the Gastrointestinal Surgery Department,the First Affiliated Hospital of Fujian Medical University,between January 2016 and December 2016.Preoperative T and N staging was performed according to pre-specified criteria on a 64-row Contrast-Enhanced Computed Tomography and was compared with postoperative pathologic T and N staging,then the overall accuracy,over-staging rate,under-staging rate and the respective sensitivity,specificity,positive predictive value,negative predictive value,accuracy of each T staging and N staging were calculated.Single variate analysis was performed to pick out the relative factors of over-T and under-T staging,over-N and under-N staging with statistical significance from gender,age,BMI,smoking or not,discovery mode,with hypertension or not,with diabetes mellitus or not,lesion size,Macroscopic type,early gastric carcinoma VS advanced gastric carcinoma,Histologic type,transverse lesion location,Longitudinal lesion location,p N staging,c N staging,p T staging,c T staging.Then the picked factors would be conducted on multivariate analysis to confirm if such factors were the independent risk factors of over-T and under-T staging,over-N and under-N staging.Results Postoperative pathological T-taging distributed as following: p T1 a,n=1;p T1 b,n=19;p T2,n=10;p T3,n=24,p T4 a,n=23;p T4 b,n=34.The overall accuracy of preoperative T staging was 68.5%(76/111)with the proportion of over-and under-staging being 13.5%(15/111)and 18.0%(20/111),respectively.The accuracy of each postoperative pathological T-taging was p T1 a 100%(1/1),p T1 b 52.6%(10/19),p T2 50.0%(5/10),p T3 66.7%(16/24),p T4 a 78.3%(18/23),p T4 b 76.5%(26/34).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy of ?p T1 a,?p T1 b,?p T2,?p T3,?p T4 a,?p T4 b was 95.5%(106/111),-(0/0),100%(106/106),0(0/5)?95.5%(106/111);93.6%(103/110)?100%(1/1)?100%(103/103)?12.5%(1/8),93.7%(104/111);98.9%(90/91),85.0%(17/20),96.8%(90/93),94.4%(17/18),96.4%(107/111);98.8%(80/81),86.7%(26/30),95.2%(80/84),96.3%(26/27),95.5%(106/111),87.7%(50/57),83.3%(45/54),84.7%(50/59),86.5%(45/52),85.6%(95/111);76.5%(26/34),94.8%(73/77),89.7%(26/29),89.0%(73/82),89.2%(99/111).Postoperative pathological N-taging distributed as following: p N0,n=35;p N1,n=19;p N2,n=25;p N3 a,n=21;p N3 b,n=11.The overall accuracy of preoperative N staging was 59.5%(66/111),with the proportion of over-and under-staging being 28.8%(32/111)and 15.3%(17/111),respectively.The accuracy of each postoperative pathological N-taging was p N0 60.0%(21/35);p N1 47.4%(9/19);p N2 40.0%(10/25);p N3 a 66.7%(14/21);p N3 b 72.7%(8/11).The sensitivity?specificity?positive predictive value,negative predictive value?accuracy of ?p N1??p N2??p N3a??p N3 b was 90.8%(69/76),60.0%(21/35),83.1%(69/83),75.0%(21/28),81.1%(90/111);78.9%(45/57),72.2%(39/54),75.0%(45/60),76.5%(39/51),75.7%(84/111);87.5%(28/32),82.3%(65/79),66.7%(28/42),94.2%(65/69),83.8%(93/111);72.7%(8/11),91.0%(91/100),47.1%(8/17),86.2%(81/94),89.2%(99/111).Multivariate analysis showed that middle third lesion position was the independent risk factor of under-T staging,lesion diameter?6cm?macroscopic type II in advanced Gastric Carcinoma were the independent risk factors of over-N staging,lesion diameter ? 6cm was the independent risk factors of under-N staging.Conclusion Preoperative TN staging with pinpoint accuracy is difficult,with high proportion of over-staging and under-staging,especially for N staging.However,there is high sensitivity,specificity and accuracy when distinguishing a given case whether higher than a certain T and N staging,which can provide important reference for clinician when making treatment decisions.Middle third lesion position is the independent risk factor of under-T staging,lesion diameter?6cm?macroscopic type II in advanced Gastric Carcinoma were the independent risk factors of over-N staging,lesion diameter?6cm was the independent risk factors of under-N staging.