Feasibility of Differentiating T3 from T4a Gastric Cancer in Different Lauren Classification by Determining Serosa Invasion: Diagnostic Performance of High Enhanced Serosa Sign

Overview

Journal Chin J Cancer Res

Specialty Oncology

Date 2018 Jun 5

PMID 29861611

Citations 1

Authors

Rui-Jia Sun

Lei Tang

Ying Chen

Xiao-Ting Li

Yu Sun

Zi-Yu Li

Ying-Shi Sun

Affiliations

Soon will be listed here.

Abstract

Objective: To study the value of high enhanced serosa sign on contrast-enhanced computed tomography (CT) in differentiating T3 from T4a gastric cancer in different Lauren classification.

Methods: This study included 276 consecutive patients with surgically confirmed pT3 or pT4a gastric cancers. The pre-operative CT images were reviewed by two radiologists blinded. The demonstration of the high enhanced serosa on CT between T3 and T4a was compared with chi-square test. The diagnostic performance of this sign on CT in the differentiation of T4a from T3 in different Lauren classification was calculated.

Results: The accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the judgement of serosa invasion using the high enhanced serosa sign on CT was 74.6%, 63.7%, 83.6%, 76.0% and 73.8% by one radiologist and 76.4%, 66.1%, 84.9%, 78.1% and 75.4% by the other radiologist. Compared to the intestinal-type, the sensitivity of the judgement of serosa invasion using the high enhanced serosa sign on CT in diffuse-type was significant higher (80% in both readers), while the specificity trended to be lower (65.9% and 80.5%, respectively). There is no significant difference in the accuracy of diagnosis between intestinal-type and diffuse-type of gastric cancers (the P-values of two radiologists were 0.968, 0.591, respectively). The combination of the high enhanced serosa sign with conventional CT signs is significant different in diagnosis of T3 and T4a (P<0.001). The diagnostic accuracy was increased in both radiologists after the combination. The two readers achieved substantial agreement, with Kappa coefficient of 0.63, P<0.001.

Conclusions: The high enhanced serosa sign on CT is associated with serosa involvement. The sensitivity of the judgement of serosa invasion using this sign on CT in diffuse-type was significant higher than that in intestinal-type.

Citing Articles

Usefulness of histologic differences and perivascular infiltration for preoperative T staging of advanced gastric cancer using computed tomography.

Kim J, Chung W, Lee H, An J, Son J Jpn J Radiol. 2019; 37(12):817-825.

PMID: 31625013 DOI: 10.1007/s11604-019-00887-3.

References

Flucke U, Monig S, Baldus S, Zirbes T, Bollschweiler E, Thiele J . Differences between biopsy- or specimen-related Laurén and World Health Organization classification in gastric cancer. World J Surg. 2002; 26(2):137-40. DOI: 10.1007/s00268-001-0195-0. View

Kim B, Oh S, Yook J, Kim B . Signet ring cell type and other histologic types: differing clinical course and prognosis in T1 gastric cancer. Surgery. 2014; 155(6):1030-5. DOI: 10.1016/j.surg.2013.08.016. View

Kim T, Kim S, Lee J, Lee N, Jeon T, Park D . MDCT features in the differentiation of T4a gastric cancer from less-advanced gastric cancer: significance of the hyperattenuating serosa sign. Br J Radiol. 2013; 86(1029):20130290. PMC: 3755399. DOI: 10.1259/bjr.20130290. View

Liu S, Wang H, Guan W, Pan L, Zhou Z, Yu H . Preoperative apparent diffusion coefficient value of gastric cancer by diffusion-weighted imaging: Correlations with postoperative TNM staging. J Magn Reson Imaging. 2015; 42(3):837-43. DOI: 10.1002/jmri.24841. View

Kim J, Shin S, Heo S, Choi Y, Lim H, Park Y . Diagnostic performance of 64-section CT using CT gastrography in preoperative T staging of gastric cancer according to 7th edition of AJCC cancer staging manual. Eur Radiol. 2011; 22(3):654-62. DOI: 10.1007/s00330-011-2283-3. View

Shimizu K, Ito K, Matsunaga N, Shimizu A, Kawakami Y . Diagnosis of gastric cancer with MDCT using the water-filling method and multiplanar reconstruction: CT-histologic correlation. AJR Am J Roentgenol. 2005; 185(5):1152-8. DOI: 10.2214/AJR.04.0651. View

Zhang X, Tang L, Sun Y, Li Z, Ji J, Li X . Sandwich sign of Borrmann type 4 gastric cancer on diffusion-weighted magnetic resonance imaging. Eur J Radiol. 2011; 81(10):2481-6. DOI: 10.1016/j.ejrad.2011.10.021. View

Caivano R, Rabasco P, Lotumolo A, D Antuono F, Zandolino A, Villonio A . Gastric cancer: The role of diffusion weighted imaging in the preoperative staging. Cancer Invest. 2014; 32(5):184-90. DOI: 10.3109/07357907.2014.896014. View

Choi J, Park Y, Jung D, Son S, Ahn S, Park D . Clinical Relevance of the Tumor Location-Modified Lauren Classification System of Gastric Cancer. J Gastric Cancer. 2015; 15(3):183-90. PMC: 4604333. DOI: 10.5230/jgc.2015.15.3.183. View

10.

LAUREN P . THE TWO HISTOLOGICAL MAIN TYPES OF GASTRIC CARCINOMA: DIFFUSE AND SO-CALLED INTESTINAL-TYPE CARCINOMA. AN ATTEMPT AT A HISTO-CLINICAL CLASSIFICATION. Acta Pathol Microbiol Scand. 1965; 64:31-49. DOI: 10.1111/apm.1965.64.1.31. View

11.

Washington K . 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol. 2010; 17(12):3077-9. DOI: 10.1245/s10434-010-1362-z. View

12.

Ma J, Shen H, Kapesa L, Zeng S . Lauren classification and individualized chemotherapy in gastric cancer. Oncol Lett. 2016; 11(5):2959-2964. PMC: 4840723. DOI: 10.3892/ol.2016.4337. View

13.

Yoshikawa T, Sasako M, Yamamoto S, Sano T, Imamura H, Fujitani K . Phase II study of neoadjuvant chemotherapy and extended surgery for locally advanced gastric cancer. Br J Surg. 2009; 96(9):1015-22. DOI: 10.1002/bjs.6665. View

14.

Hasegawa S, Yoshikawa T, Shirai J, Fujikawa H, Cho H, Doiuchi T . A prospective validation study to diagnose serosal invasion and nodal metastases of gastric cancer by multidetector-row CT. Ann Surg Oncol. 2012; 20(6):2016-22. DOI: 10.1245/s10434-012-2817-1. View

15.

Qiu M, Cai M, Zhang D, Wang Z, Wang D, Li Y . Clinicopathological characteristics and prognostic analysis of Lauren classification in gastric adenocarcinoma in China. J Transl Med. 2013; 11:58. PMC: 3600019. DOI: 10.1186/1479-5876-11-58. View

16.

Tsurumaru D, Miyasaka M, Nishimuta Y, Asayama Y, Nishie A, Kawanami S . Differentiation of early gastric cancer with ulceration and resectable advanced gastric cancer using multiphasic dynamic multidetector CT. Eur Radiol. 2015; 26(5):1330-7. DOI: 10.1007/s00330-015-3938-2. View

17.

Li Z, Li Z, Jia S, Bu Z, Zhang L, Wu X . Depth of tumor invasion and tumor-occupied portions of stomach are predictive factors of intra-abdominal metastasis. Chin J Cancer Res. 2017; 29(2):109-117. PMC: 5422412. DOI: 10.21147/j.issn.1000-9604.2017.02.03. View

18.

Polkowski W, van Sandick J, Offerhaus G, Ten Kate F, Mulder J, Obertop H . Prognostic value of Laurén classification and c-erbB-2 oncogene overexpression in adenocarcinoma of the esophagus and gastroesophageal junction. Ann Surg Oncol. 1999; 6(3):290-7. DOI: 10.1007/s10434-999-0290-2. View

19.

Ott K, Lordick F, Herrmann K, Krause B, Schuhmacher C, Siewert J . The new credo: induction chemotherapy in locally advanced gastric cancer: consequences for surgical strategies. Gastric Cancer. 2008; 11(1):1-9. DOI: 10.1007/s10120-007-0448-1. View

20.

Giganti F, Ambrosi A, Chiari D, Orsenigo E, Esposito A, Mazza E . Apparent diffusion coefficient by diffusion-weighted magnetic resonance imaging as a sole biomarker for staging and prognosis of gastric cancer. Chin J Cancer Res. 2017; 29(2):118-126. PMC: 5422413. DOI: 10.21147/j.issn.1000-9604.2017.02.04. View