title: Evaluation of lymph node metastasis in patients with gastric cancer: a comparison of the directionality of lymph node metastasis and the total number of metastatic lymph nodes.
abstract: OBJECTIVE
  The clinical impact of the directionality of lymph node (LN) metastasis was assessed in comparison with the staging by the Japanese Classification of Gastric Carcinoma (JCGC), a numerical LN staging system.
  
  
  METHODS
  Two hundred forty-one gastric cancer patients who were diagnosed pathologically to have LN metastasis, and 54 patients who underwent preoperative multidetector-row computed tomography (MDCT) with an image thickness of 1 mm were classified into three groups (unidirectional [Uni-], bidirectional [Bi-], and tridirectional [Tri-] groups) depending on the directionality of their LN metastasis.
  
  
  RESULTS
  The prognosis of the Uni-group was better than that of the Bi- or the Tri-group when assessed on the basis of the pathological findings of metastatic LN and also the preoperative MDCT findings. The exact preoperative evaluation was 70.2 % for the directionality system and 61.7 % for the JCGC system, respectively. The stages were less frequently underestimated by the directionality system than the JCGC system (P < 0.02, 19.1 vs. 34.0 %), and the staging could be more precisely performed by both systems in combination.
  
  
  CONCLUSIONS
  More precise preoperative evaluation of disease stage could be obtained by the directionality system and the JCGC system in combination.
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 602-8566 Kyoto, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Kitagawa
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Murayama
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kuriu
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ikoma
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nakanishi
authors.forename: Toshiya
authors.initials: T
authors.lastname: Ochiai
authors.forename: Yukihito
authors.initials: Y
authors.lastname: Kokuba
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Sonoyama
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate