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Published on: January 22, 2018
Staging of Gastric Cancer: CT Patterns and Correlation with Pathologic Findings
Francesca Di Gregorio1, Michela Polici1, Emanuela Pilozzi1
1From the Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, AOU Sant'Andrea, Via di Grottarossa 1035-1039, 00189 Rome, Italy (F.D.G., M.P., M.A.G., M.C., M.Z., D.C., E.I., A.L.); and PhD School in Translational Medicine and Oncology, Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology (M.P.), Department of Clinical and Molecular Medicine (E.P.), and Department of Medical and Surgical Sciences, Specialization School of Anatomic Pathology (P.E.K.O.), Sapienza University of Rome, Rome, Italy.
Accurate pretherapy clinical staging of locally advanced gastric adenocarcinoma is crucial. Contrast-enhanced CT aids tumor, nodal, and metastatic staging, but challenges remain in precise TNM classification and differentiating early stages.
Area of Science:
- Radiology
- Oncology
- Gastroenterology
Background:
- Gastric adenocarcinoma often presents at a locally advanced stage.
- Accurate pretherapy clinical staging is essential for effective patient management.
- Contrast-enhanced computed tomography (CT) is the primary imaging modality for staging.
Purpose of the Study:
- To evaluate the role and challenges of contrast-enhanced CT in the pretherapy staging of gastric adenocarcinoma.
- To highlight the importance of accurate TNM staging to guide treatment decisions.
- To discuss the limitations of CT in differentiating specific tumor stages and assessing nodal/metastatic involvement.
Main Methods:
- Review of contrast-enhanced CT protocols for gastric adenocarcinoma staging.
- Discussion of radiologic challenges in T, N, and M staging.
- Analysis of CT accuracy in local staging, particularly T1 vs. T2 differentiation.
- Assessment of CT's variability in N and M staging, including peritoneal involvement.
Main Results:
- CT is the initial choice for tumor (T), nodal (N), and metastatic (M) staging.
- Accurate TNM staging is a significant radiologic challenge, risking under- or overstaging.
- CT accuracy is limited in differentiating T1 and T2 stages and assessing multilayer visualization.
- N staging lacks standardized criteria, and M staging variability depends on metastasis location.
Conclusions:
- Optimized CT protocols are vital for accurate local staging of gastric cancer.
- Radiologists need thorough anatomical knowledge to improve T staging accuracy.
- Laparoscopy is recommended for equivocal peritoneal disease; upfront surgery or perioperative chemotherapy depends on stage and molecular status.
