Preoperative T staging of gastric cancer by multi-detector row computed tomography

Surgery. 2011 May;149(5):672-9. doi: 10.1016/j.surg.2010.12.003. Epub 2011 Feb 18.


Background and purpose: Preoperative T staging demands high accuracy, because it greatly influences subsequent therapies in advanced gastric cancer.

Patients and methods: 616 patients with gastric cancer underwent multi-detector row computed tomography (MDCT) before operation. The results were compared with operative and pathologic findings. Especially, we evaluated the correlations among the diagnostic accuracy of T staging and various clinicopathologic parameters by focusing on 276 patients who had detectable lesions by MDCT.

Results: The overall diagnostic accuracy of preoperative T staging by MDCT was 90.9% (560/616). For each pathologic T stage, the accuracy was 95% for pT1, 76% for pT2-3, 92% for pT4a, and 75% for pT4b, respectively. Among the 276 patients, 239 (87%) were correctly staged by MDCT whereas 29 (11%) and 8 (3%) were over- or under-staged, respectively. Antral tumors (P = .045), and Borrmann type 1 tumors (P = .0001) were incorrectly T staged by MDCT, whereas differentiated type tumors tended to be over-staged. All patients with positive cytology (n = 12 cases) and peritoneal metastasis (n = 7 cases) diagnosed at laparotomy had been diagnosed as T4a or deeper by MDCT. The 5-year overall survival rates classified by preoperative T staging by MDCT (T1/T2-3/T4a/T4b) were 100%, 89%, 59%, and 31%, respectively, whereas those for each pT stage were 100%, 84%, 59%, and 19%.

Conclusion: Preoperative T staging of gastric cancer by MDCT is highly accurate and could contribute to treatment strategies, particularly in advanced disease.

MeSH terms

  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / pathology*
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging / methods*
  • Preoperative Period
  • Prognosis
  • Retrospective Studies
  • Sensitivity and Specificity
  • Stomach Neoplasms / diagnostic imaging
  • Stomach Neoplasms / pathology*
  • Survival Rate
  • Tomography, Spiral Computed / methods*