Jixin Mei, Song Wang, Yan Luo, Ming xie, Jingqi Wang, xiaoMing qiu
Department of Radiology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi City 435000, China
Objective: To study and compare the N-stage results of 64-slice enhanced CT and the postoperative pathological staging results of patients with gastric cancer before surgery, and to explore the diagnostic value of enhanced CT in preoperative N staging of gastric cancer. Method: Preoperative enhanced CT and postoperative pathological results of 56 patients undergoing radical gastrectomy for gastric cancer in the gastrointestinal colorectal anus surgery from Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University from December 2016 to December 2017 were studied. Patient enrollment criteria: Patients with confirmed gastric cancer by gastroscopy and pathology, patients with complete CT examination and preoperative paraffin pathological results, and patients without neoadjuvant chemoradiation before surgery. All patients underwent radical gastrectomy within one week after CT examination, and it achieved complete resection of the margin (>4 cm). The lymph node dissection range is D2. All specimens in the operation were fixed by formalin in 30 minutes in vitro and delivered to the pathology department. Then, the staff of the pathology department made a slice and embedded it in paraffin, and continued the process of HE staining. Finally, the treated sections were diagnosed under the microscope by the pathologist. CT images of all cases were independently assessed by two radiologists with years of experience using D’Elia’s gastric cancer lymph node assessment method. The pathological sections of all patients were independently observed by two senior pathologists and their respective N staging results were calculated. Based on the postoperative pathological results of the pa- thologist, the N-stage diagnosis of preoperative enhanced CT and the postoperative pathological N-stage diagnosis were compared. The consistency check was carried out using SPSS 22.0 software, which is the kappa test. Through comparison and statistical results,
the accuracy of enhanced CT in preoperative N staging was explored.
Result: The overall accuracy of enhanced CT for preoperative N staging was 69.6% (39/56). In the 17 cases of N-stage mis-
diagnosis prior to enhanced CT surgery, ten cases were understage (58.8%), and seven cases were overstage (41.2%). The accuracy of enhanced CT diagnosis of N0 staging was 71.4% (10/14), and all 4 cases misdiagnosed were overstage (28.6%). The accuracy of the N1 staging was 72.7% (8/11). Two of the three cases of misdiagnosis were understage (18.1%). One case was overstage (9.2%). The accuracy of the N2 staging is 60.0% (9/15), Five cases are understage (33.3%) and one is overstage (6.7%). The accuracy of N3 staging was 75.0% (12/16), and 4 cases were understage (25.0%). The consistency test was performed with postoperative pathological diagnosis as the gold standard, and the kappa value was 0.603. For the N-stage assessment of gastric cancer, the CT findings and the postoperative pathological results are in good agreement.
Conclusion: The overall accuracy of enhanced CT examination for preoperative N staging was 69.6%, and the kappa test value was 0.603. The diagnosis results are in good agreement with the postoperative pathological diagnosis results. It has diagnostic value for the preoperative N-stage evaluation of gastric cancer and can be used for clinical guidance treatment.
Enhanced CT, gastric cancer, N staging, consistency test