title: The role of CT and staging laparoscopy in the staging of gastric cancer.
abstract: OBJECTIVE
  To assess the relative roles of computed tomography (CT) and diagnostic laparoscopy in the staging process of patients with potentially curable gastric cancer.
  
  
  METHODS
  Fifty-two patients underwent laparoscopy and CT as part of staging; 36 patients underwent surgery without laparoscopy. Pathological findings at laparoscopy or surgery were compared with initial CT reports, and analysis of the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was performed.
  
  
  RESULTS
  Of the patients who underwent laparoscopy and CT, six were staged as positive for peritoneal disease (PD), of which five (83%) were positive for PD at laparoscopy. Forty-six patients were reported at CT as negative for PD, of which 40 (87%) were negative at laparoscopy. Of 36 patients with no advanced disease at CT, who had surgery without diagnostic laparoscopy, nine (25%) were positive at surgery for PD. The overall sensitivity of CT for PD was therefore 25%, the specificity was 99%, the PPV was 86%, and the NPV was 83%.
  
  
  CONCLUSIONS
  CT is not sufficiently sensitive to detect or exclude PD in patients with gastric cancer, although is highly specific. Staging laparoscopy is an essential adjunct to imaging in all patients being considered for curative surgery for gastric cancer.
authors.affiliation: Leeds Teaching Hospitals, Great George Street, Leeds, UK. sjburbidge@gmail.com
authors.forename: S
authors.initials: S
authors.lastname: Burbidge
authors.forename: K
authors.initials: K
authors.lastname: Mahady
authors.forename: K
authors.initials: K
authors.lastname: Naik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D004739:England; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media