Abstract:
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Purpose: The cause of the poor prognosis of the patients with proximal-third
gastric carcinoma (PGC) when compared with that of patients with more distally
located gastric carcinoma (DGC) must consist in an anatomical characteristic,
the fact that the posterior wall of the fundus and subcardial portion (gastric
bare area, GBA) is not covered by the visceral peritoneum. To date there has
been very little radiologic literature looking at the CT evaluation of surgical
prognostic factors in gastric carcinoma with GBA invasion.
Methods and Materials: We assessed thin slice images in 68 consecutive patients
with biopsy proven PGC using a multi-detector helical CT system (Sensation 4,
Siemens). We evaluate the accuracy of multi-detector helical CT in identifying the
following prognostic factors: the site of the tumor in relation to the GBA and
the peritoneal reflection, the maximum depth of tumor extramural spread into
subphrenic fat, the presence of adenopathy in GBA or subphrenic retroperitoneal
space. All 68 patients underwent surgical resection and each surgical specimen
was axially sectioned. Multi-detector Helical CT findings were compared with
the pathology examination of each tumor bearing slice.
Results: Multi-detector Helical CT correctly identified all 32 tumors with GBA
invasion and correctly identified all 5 patients with tumor extension within
2.0cm of the edge of the gastric wall. Multi-detector Helical CT correctly
predicted the relationship of the tumor to the peritoneal reflection
(gastrophrenic ligament) in 60 of 68 patients and identified 25 patients with
gastrophrenic ligament invasion by tumor. The maximum depth of tumor
infiltration was correct to within 1cm of the histology measurements in 20 of
the 28 patients with tumor infiltration into subphrenic fat. Multi-detector
Helical CT correctly identified 12 of the 16 patients with metastatic lymph
node greater than 1cm in GBA or subphrenic retroperitoneal space.
Conclusion: Multi-detector Helical CT may be of value in assessing the
important surgical prognostic risk factors of GBA invasion by PGC. Preoperative
identification of patients at risk of incomplete surgical resection and lymph
node metastasis may allow targeting of such patients for the most appropriate
preoperative adjuvant therapy. (B.W., P.M. received financial support for this
study from National Science Foundation.)
Wu MD, B,
Bare Area Invasion by Gastric Carcinoma: Multi-detector Helical CT Evaluation of Surgical Prognostic Factors. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3103316.html