Value and necessity of pelvic CT in gastric cancer staging: an observational study

The value and necessity of pelvic computed tomography (CT) examination in gastric cancer (GC) staging is unknown and the recommendations are unclear in guidelines. The objective of this study was to evaluate the value and necessity of pelvic CT in routine GC staging.

We reviewed the medical records of GC patients proved by endoscopic biopsy who received abdominopelvic CT examination before treatments at our institution from January 2013 through July 2017. The pathology findings seen in the pelvis were classified into two categories as metastatic disease or not. These findings were further categorized as isolated pelvis metastasis or not, and isolated pelvis metastasis was defined as the presence of pelvis metastasis without any other sites of metastasis on CT scan.

A total of 227 GC patients received abdominopelvic CT examinations at our institution. Of the patients, 22.0% (n = 50) had findings in the pelvis, and the most common was ascites (8.8%, n = 20). The metastatic diseases in pelvis were found in 2.2% (n = 5) of all patients, including peritoneal thickening with nodules, left adnexal solid masses, bladder wall mass, bone lesions, and lymphatic spread. The isolated pelvis metastasis was found in 1.3% (n = 3) of patients.

Our results indicated that CT of the pelvis has a negligible yield in GC staging. In consideration of health care cost, radiation dose and radiologist fatigue, the pelvic CT performed as a routine staging tool for GC is unnecessary and not a wise choice in our setting.