Validity of Computed Tomographic Study in Preoperative Staging of Gastric Cancer With Reference to Surgical and Histopathologic Results

Abstract

BACKGROUND Gastric carcinoma represents the most common gastric neoplasm accounting for 95% of all gastric tumours and represents a group of aggressive malignancy. Although highly aggressive, the early gastric cancer shows a better prognosis with a 5-year survival rate of more than 90%. There is a wide variation of the prognosis varying from less than 3% to 90% in early gastric cancers. Early diagnosis and accurate staging are therefore very crucial for the choice of an accurate therapeutic approach and also for the good survival rate. This study aims at evaluating the validity of MDCT in staging gastric cancer. MATERIALS AND METHODS Between May 2014 and September 2016, 35 patients (27 males, 8 females), with mean age of 63 years were evaluated. CT was performed using 16 slice and 64 slice CT and Tumour staging and nodal staging was done according to TNM staging put forward by AJCC 7 th edition. All the stages were compared with the gold standard histopathological staging. Site and extent of the lesion and surgery done were also assessed. RESULTS The comparison of tumour and nodal staging to histopathological staging was statistically done by McNemar test, and all the stages of the malignancy showed statistical agreement between the two. The sensitivity, specificity, accuracy and p value of all the T stages and N stages were the statistical parameters assessed. The sensitivity of early gastric cancer (T1 and T2) was comparatively lower than advanced cases (T3 and T4). The sensitivity of staging T1 lesion was 55% whereas it was 93% in staging T3 lesions. The sensitivity of nodal staging was about 70% in all the stages. CONCLUSION CT as a modality in staging gastric cancer helps staging the advanced gastric cancer more accurately than early gastric cancer. Along with the tumour and nodal staging it can also give the details of distant organ metastasis. It can be used in conjunction with other endoscopic methods for accurate preoperative staging.