Predicting perigastric lymph node metastasis in gastric cancer with CT perfusion imaging: A prospective analysis

Sun, Zongqiong; Li, Jie; Wang, Teng; Xie, Zhen; Jin, Lei; Hu, Shudong

doi:10.1016/j.ejrad.2019.108753

Cited by 9 publications

(3 citation statements)

References 22 publications

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“…While there are still no widely recognized criteria for the diagnosis of lymph node metastasis of GC by CT (20), CT remains an important means to diagnose lymph node metastasis in GC patients. Many studies have explored the agreement of preoperative CT diagnosis and postoperative pathological results, although the results are quite controversial (21)(22)(23)(24). Based on the literature (8), metastatic lymph nodes in our current study were identified by short diameter >5 mm or shortlong diameter ratio ≥0.7.…”

Section: Discussionmentioning

confidence: 99%

Value of multiphase contrast-enhanced CT with three-dimensional reconstruction in detecting depth of infiltration, lymph node metastasis, and extramural vascular invasion of gastric cancer

Wang¹,

Zhong²,

Zhou³

et al. 2021

J Gastrointest Oncol

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Background: Multiphase contrast-enhanced computed tomography (CECT) can reveal the location, morphology, size, and enhancement pattern of gastric cancer (GC), whereas the three-dimensional reconstruction (3DR) technique can better display the relationships of the lesions with surrounding structures, the feeding vessels, and lymph node metastasis. Here, we investigated the value of multi-phase CECT with 3DR in detecting depth of infiltration, lymph node metastasis, and extramural vascular invasion (EMVI) of GC. Methods: The clinical and imaging data of 132 GC patients admitted to the Chongqing Hospital of Traditional Chinese Medicine and the Third Affiliated Hospital of Chongqing Medical University during the period from January 2012 to October 2019 were collected. All patients received plain and multiphase contrast-enhanced CT scans. The agreement between the results of preoperative CT evaluation and the surgical/pathological findings was compared.Results: (I) CT findings of GC of 3 differentiation levels: on the multiphase CECT, the peak enhancement percentage was highest in the portal venous phase. the CT values significantly differed among the arterial, portal venous, and equilibrium phases (P<0.05); the differences in the arterial, portal venous, and equilibrium phases were statistically significant among the well-, moderately, and poorly differentiated groups (all P<0.05); finally, the difference in the equilibrium phase was statistically significant between the well-and moderately differentiated groups (P<0.05). (II) Preoperative CT and postoperative pathology had good consistency in T staging (Kappa =0.667). (III) The Kappa values between the preoperative CT-diagnosed lymph node metastasis and postoperative pathologically showing an increasing consistency with the increase of CT enhancement differences. (IV) Preoperative CT and postoperative pathology had good consistency in N staging (Kappa =0.779). (V) Preoperative CT in displaying arterial supply to the stomach. The rate of positive EMVI was 32.6% (43/132) on preoperative CT. The positive EMVI diagnosed by preoperative CT was correlated with tumor size, growth pattern, tissue differentiation degree, T stage, and N stage (all P<0.05).Conclusions: Multiphase CECT combined with 3DR has high diagnostic performance in detecting the depth of infiltration, lymph node metastasis, and EMVI of GC.

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Section: Discussionmentioning

confidence: 99%

Value of multiphase contrast-enhanced CT with three-dimensional reconstruction in detecting depth of infiltration, lymph node metastasis, and extramural vascular invasion of gastric cancer

Wang¹,

Zhong²,

Zhou³

et al. 2021

J Gastrointest Oncol

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“… 2 , 3 Therefore, lymph node (LN) status is closely associated with the prognosis of GC patients. 4 , 5 The 5-year postoperative survival rate of patients with N0 GC is 72.5%, while it decreases significantly in those with N1 (57.0%), N2 (41.6%) and N3 (23.3%) GC. 6 Thus, assessing the LN status perioperatively can help determine the optimal therapeutic regimen.…”

Section: Introductionmentioning

confidence: 98%

A Pilot Study of Prognostic Value of Metastatic Lymph Node Count and Size in Patients with Different Stages of Gastric Carcinoma

Gao¹,

Wang²,

Tang³

et al. 2022

CMAR

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Background The correlation between the preoperative lymph node count (LNC) on multidetector computed tomography (MDCT) and the prognosis of gastric carcinoma (GC) remains to be defined. This research aims to evaluate the prognostic value of LNC on MDCT in GC patients based on tumor-node-metastasis (TNM) staging, using different size criteria for counting. Methods The clinical data of 126 patients with gastric adenocarcinoma undergoing gastrectomy were retrospectively analyzed. Lymph nodes greater than 8mm and 5mm on MDCT were counted and recorded. The prognostic implications of LNC on MDCT for patient survival were analyzed according to different size criteria for counting and tumor TNM staging. Results When 8mm was used as the counting criterion, LNC on MDCT had no significant effect on the overall survival (OS) of the entire cohort. In addition, the OS of T1–T2 GC patients with LNC on MDCT ≥1 was significantly worse than that of patients with LNC on MDCT <1. When 5mm was used as the counting criterion, LNC on MDCT was found to be significantly associated with the OS of the entire cohort. In the subgroup analysis, patients with relatively advanced (T3-T4, N+ and III) GC with LNC on MDCT >7 showed a significantly worse OS than those with LNC on MDCT ≤7. LNC on MDCT >7 with 5mm as the counting criterion and Stage III were independent risk factors for adverse prognosis. Conclusion The prognostic value of LNC on MDCT based on different size criteria varies in patients with different stages of GC. LNC of a smaller size (5mm) on MDCT may be a prognostic factor for patients with relatively advanced GC.

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“…Typically, cancer cells invade the lymph nodes (LNs) and proliferate within the lymphatic system, causing corresponding LNs enlargement. In some studies, metastatic LNs were defined as those with a diameter > 10 mm along the short axis or a short/long axis diameter ratio of 0.75 on computed tomography (CT) [ 3 , 4 ]. The diagnosis of N category is only based on the number of positive nodes according to the 8th Edition of the AJCC Cancer TNM Classification [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical implications of micro lymph node metastasis for patients with gastric cancer

Tian,

Pang,

Yang

et al. 2023

BMC Cancer

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Background Lymph node size is considered as a criterion for possible lymph node metastasis in imageology. Micro lymph nodes are easily overlooked by surgeons and pathologists. This study investigated the influencing factors and prognosis of micro lymph node metastasis in gastric cancer. Methods 191 eligible gastric cancer patients who underwent D2 lymphadenectomy from June 2016 to June 2017 in the Third Surgery Department at the Fourth Hospital of Hebei Medical University were retrospectively analyzed. Specimens were resected en bloc and the postoperative retrieval of micro lymph nodes was carried out by the operating surgeon for each lymph node station. Micro lymph nodes were submitted for pathological examination separately. According to the results of pathological results, patients were divided into the “micro-LNM (micro lymph node metastasis)” group (N = 85) and the “non micro-LNM” group (N = 106). Results The total number of lymph nodes retrieved was 10,954, of which 2998 (27.37%) were micro lymph nodes. A total of 85 (44.50%) gastric cancer patients had been proven to have micro lymph node metastasis. The mean number of micro lymph nodes retrieved was 15.7. The rate of micro lymph node metastasis was 8.1% (242/2998). Undifferentiated carcinoma (90.6% vs. 56.6%, P = 0.034) and more advanced Pathological N category (P < 0.001) were significantly related to micro lymph node metastasis. The patients with micro lymph node metastasis had a poor prognosis (HR for OS of 2.199, 95% CI = 1.335–3.622, P = 0.002). For the stage III patients, micro lymph node metastasis was associated with shorter 5-year OS (15.6% vs. 43.6%, P = 0.0004). Conclusions Micro lymph node metastasis is an independent risk factor for poor prognosis in gastric cancer patients. Micro lymph node metastasis appears to be a supplement to N category in order to obtain more accurate pathological staging.

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Predicting perigastric lymph node metastasis in gastric cancer with CT perfusion imaging: A prospective analysis

Cited by 9 publications

References 22 publications

Value of multiphase contrast-enhanced CT with three-dimensional reconstruction in detecting depth of infiltration, lymph node metastasis, and extramural vascular invasion of gastric cancer

Value of multiphase contrast-enhanced CT with three-dimensional reconstruction in detecting depth of infiltration, lymph node metastasis, and extramural vascular invasion of gastric cancer

A Pilot Study of Prognostic Value of Metastatic Lymph Node Count and Size in Patients with Different Stages of Gastric Carcinoma

Clinical implications of micro lymph node metastasis for patients with gastric cancer

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