title: [Diagnostic value of direct inspection and palpitation by surgeons in intra-operative nodal staging of gastric cancer].
abstract: OBJECTIVE
  Recent imaging modalities such as multi-detector computed tomography, fluorodeoxyglucose positron emission tomography/computed tomography, and magnetic resonance imaging have emerged as promising diagnostic and staging methods in various cancers. However, these modalities lack the diagnostic ability to evaluate tissue elasticity, which could instead be easily estimated by a surgeon through palpitation. To add tissue elasticity to future diagnostic methods, this study was designed to evaluate the ability of surgeons to estimate elasticity by direct inspection and palpitation during intra-operative nodal staging of gastric cancer.
  
  
  METHODS
  Between 2008 and 2009, 57 consecutive patients with gastric cancer underwent curative gastrectomy and all their regional lymph nodes showing metastatic involvement were intra-operatively counted using direct inspection and palpitation by surgeons.
  
  
  RESULTS
  The overall sensitivity, specificity, and accuracy were 63.1%, 86.8%, and 82.8%, respectively. The sensitivity was higher in D1 lymph nodes such as No.6, No.5, No.7, and No.3. The specificity and accuracy were higher in D2 lymph nodes such as No.9, No.11p and No.8a.
  
  
  CONCLUSIONS
  Nodal diagnosis through direct inspection and palpitation by surgeons could be a reliable and accurate method in gastric cancer, comparable to other recent modalities. These data imply that tissue elasticity could be applied as a new modality in the nodal diagnosis of gastric cancer.
authors.affiliation: Dept. of Surgery, Kyoto Prefectural University of Medicine, Japan.
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Ueda
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kubota
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: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D054459:Elasticity Imaging Techniques / Q000379:methods*; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery