Clinical value of multidetector row computed tomography in detecting lymph node metastasis of early gastric cancer.
OBJECTIVE
To evaluate the clinical value of multidetector row computed tomography (MDCT) as a pre-operative staging tool for lymph node metastasis in patients with early gastric cancer (EGC).


METHODS
In 278 consecutive patients with EGC, lymph node metastasis was evaluated pre-operatively with MDCT at a slice thickness of 2.5mm (n=57), 5.0mm (n=188), or 7.5mm (n=33).


RESULTS
Overall accuracy of nodal category from N0 to N3 was 86% for MDCT and 95% for operative assessment. Regarding accuracy in detecting at least one metastatic lymph node, area under curves (AUC) of receiver operating characteristics for 2.5, 5.0, and 7.5-mm slices and assessment during surgery were 0.87, 0.67 and 0.47, and 0.70, which were significantly different (P<0.0001). MDCT image with 2.5-mm could discriminate the presence of lymph node metastasis with diagnostic accuracy: sensitivity 80%; specificity 92%; positive predictive value (PPV) 50%; negative predictive value (NPV) 98%, whereas assessment during surgery was as follows: sensitivity 65%; specificity 98%; PPV 72%; and NPV 97%.


CONCLUSIONS
These results suggest that pre-operative assessment with MDCT using thinner slices may detect at least one lymph node metastasis as accurately as assessment during surgery for patients with EGC.
Shinohara
T
T
Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Ohyama
S
S
Yamaguchi
T
T
Muto
T
T
Kohno
A
A
Kato
Y
Y
Urashima
M
M
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation* / Q000379:methods*