Journal List > J Korean Soc Radiol > v.69(5) > 1087328

TOOLS
Kang, Yu, Chung, Kim, Cho, and Kim: Preoperative Multidetector CT Manifestations of Perigastric Lymph Nodes in Patients with Early Gastric Cancer and pN0
Abdominal Radiology

Journal of the Korean Society of Radiology 2013; 69(5): 391-398.

Published online: 8 November 2013

DOI: https://doi.org/10.3348/jksr.2013.69.5.391

Preoperative Multidetector CT Manifestations of Perigastric Lymph Nodes in Patients with Early Gastric Cancer and pN0

Jung-Hyun Kang, MD, Jeong-Sik Yu, MD, Jae-Joon Chung, MD, Joo Hee Kim, MD, Eun-Suk Cho, MD, Ki Whang Kim, MD

Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea.

Corresponding author: Jeong-Sik Yu, MD. Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. Tel. 82-2-2019-3510, Fax. 82-2-3462-5472, yjsrad97@yuhs.ac

Received 28 October 2012       Accepted 25 September 2013

Copyright © 2013 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To find the determinant of lymph node (LN) manifestations on preoperative multidetector CT (MDCT) in early gastric cancer (EGC) patients with pN0.

Materials and Methods

One hundred and eighty-six consecutive patients with pT1pN0, the largest perigastric LN on preoperative MDCT, were categorized into two groups according to 8 different parameters [short (SD) and long diameter (LD) 4/6/8 mm, average attenuation 100 Hounsfield unit, short-to-long diameter-ratio (SLR) 0.7], and correlated with the size, gross type, depth of invasion and microscopic type of their primary lesions by the chi-square test and multiple logistic regression analysis.

Results

When the primary lesion was larger than 3 cm, the LNs were larger in 4 parameters (SD or LD, 4/6 mm; p < 0.05); gross type IIb patients showed smaller LNs in 5 parameters (SD 4/6 mm, LD 4/6/8 mm; p < 0.05); and patients with microscopically-undifferentiated lesions showed larger LNs in SD 4 mm or LD 8 mm by the chi-square test and multiple logistic regression analysis. The depth of invasion showed no significant difference in LN size. No factors revealed significant difference in LN attenuation or SLR.

Conclusion

Benign regional LN enlargement is more frequent in EGC patients with larger size primary lesions or lesion with poor microscopic differentiation. However, this condition is less frequent in gross type IIb patients.

Keywords: Stomach Neoplasm, Lymph Nodes, Neoplasm Staging, Multidetector Computed Tomography

Figures and Tables

Table 1
Gross and Microscopic Features of 186 Enrolled Patients
jksr-69-391-i001

Note.-Numbers are the number of the patients.

WD = well-differentiated, MD = moderately-differentiated, PD = poorly-differentiated, SRC = signet ring cell

Table 2
Grouping of Patients According to MDCT Features of the Largest Lymph Node
jksr-69-391-i002

Note.-Numbers are the number of the patients.

*Patients' data after exclusion of unmeasured lymph nodes (long diameter < 4 mm).

MDCT = multidetector CT

Table 3
Univariated Statistical Results for Relationship between MDCT Features of the Largest Lymph Nodes and Gross-Microscopic Factors of the Primary Lesions in the EGC Patients
jksr-69-391-i003

Note.-Numbers are p-values after chi-square tests.

*Statistically significant results.

AN = attenuation number, EGC = early gastric cancer, HU = Hounsfield unit, MD = moderately-differentiated, MDCT = multidetector CT, PD = poorly-differentiated, SLR = short-to-long diameter-ratio of the lymph node, SRC = signet ring cell, WD = well-differentiated

Table 4
Multiple Logistic Statistical Results for Relationship between MDCT Features of the Largest Lymph Nodes and Gross-Microscopic Factors of the Primary Lesions in the EGC Patients
jksr-69-391-i004

Note.-Numbers are p-values after multiple logistic regression analysis, numbers in parentheses are the odd ratios.

*Statistically significant results.

AN = attenuation number, EGC = early gastric cancer, HU = Hounsfield unit, MD = moderately-differentiated, MDCT = multidetector CT, PD = poorly-differentiated, SLR = short-to-long diameter-ratio of the lymph node, SRC = signet ring cell, WD = well-differentiated

References

1. Coburn NG. Lymph nodes and gastric cancer. J Surg Oncol. 2009; 99:199–206.
2. Soetikno R, Kaltenbach T, Yeh R, Gotoda T. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol. 2005; 23:4490–4498.
3. Brennan MF. Current status of surgery for gastric cancer: a review. Gastric Cancer. 2005; 8:64–70.
4. Hur J, Park MS, Lee JH, Lim JS, Yu JS, Hong YJ, et al. Diagnostic accuracy of multidetector row computed tomography in T- and N staging of gastric cancer with histopathologic correlation. J Comput Assist Tomogr. 2006; 30:372–377.
5. Kim YN, Choi D, Kim SH, Kim MJ, Lee SJ, Lee WJ, et al. Gastric cancer staging at isotropic MDCT including coronal and sagittal MPR images: endoscopically diagnosed early vs. advanced gastric cancer. Abdom Imaging. 2009; 34:26–34.
6. Fukuya T, Honda H, Hayashi T, Kaneko K, Tateshi Y, Ro T, et al. Lymph-node metastases: efficacy for detection with helical CT in patients with gastric cancer. Radiology. 1995; 197:705–711.
7. Park HS, Kim YJ, Ko SY, Yoo MW, Lee KY, Jung SI, et al. Benign regional lymph nodes in gastric cancer on multidetector row CT. Acta Radiol. 2012; 53:501–507.
8. Seto Y, Nagawa H, Muto T. Impact of lymph node metastasis on survival with early gastric cancer. World J Surg. 1997; 21:186–189. discussion 190.
9. Yasuda K, Shiraishi N, Suematsu T, Yamaguchi K, Adachi Y, Kitano S. Rate of detection of lymph node metastasis is correlated with the depth of submucosal invasion in early stage gastric carcinoma. Cancer. 1999; 85:2119–2123.
10. Hyung WJ, Cheong JH, Kim J, Chen J, Choi SH, Noh SH. Analyses of prognostic factors and gastric cancer specific survival rate in early gastric cancer patients and its clinical implication. J Korean Surg Soc. 2003; 65:309–315.
11. Lim KH, Chung HY, Yu W. Prognosis of early gastric cancer: impact of lymph node metastasis. J Korean Surg Soc. 2003; 65:18–22.
12. Noh SH, Hyung WJ, Cheong JH. Minimally invasive treatment for gastric cancer: approaches and selection process. J Surg Oncol. 2005; 90:188–193. discussion 193-194.
13. Tsujitani S, Oka S, Saito H, Kondo A, Ikeguchi M, Maeta M, et al. Less invasive surgery for early gastric cancer based on the low probability of lymph node metastasis. Surgery. 1999; 125:148–154.
14. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000; 3:219–225.
15. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011; 14:113–123.
16. D'Elia F, Zingarelli A, Palli D, Grani M. Hydro-dynamic CT preoperative staging of gastric cancer: correlation with pathological findings. A prospective study of 107 cases. Eur Radiol. 2000; 10:1877–1885.
17. Kim HJ, Kim AY, Oh ST, Kim JS, Kim KW, Kim PN, et al. Gastric cancer staging at multi-detector row CT gastrography: comparison of transverse and volumetric CT scanning. Radiology. 2005; 236:879–885.
18. Chen CY, Hsu JS, Wu DC, Kang WY, Hsieh JS, Jaw TS, et al. Gastric cancer: preoperative local staging with 3D multi-detector row CT--correlation with surgical and histopathologic results. Radiology. 2007; 242:472–482.
19. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008; 454:436–444.
20. Porta C, Larghi P, Rimoldi M, Totaro MG, Allavena P, Mantovani A, et al. Cellular and molecular pathways linking inflammation and cancer. Immunobiology. 2009; 214:761–777.
21. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002; 420:860–867.
22. Colotta F, Allavena P, Sica A, Garlanda C, Mantovani A. Cancer-related inflammation, the seventh hallmark of cancer: links to genetic instability. Carcinogenesis. 2009; 30:1073–1081.
23. Roviello F, Rossi S, Marrelli D, Pedrazzani C, Corso G, Vindigni C, et al. Number of lymph node metastases and its prognostic significance in early gastric cancer: a multicenter Italian study. J Surg Oncol. 2006; 94:275–280. discussion 274.
24. Kim DY, Joo JK, Ryu SY, Kim YJ, Kim SK. Factors related to lymph node metastasis and surgical strategy used to treat early gastric carcinoma. World J Gastroenterol. 2004; 10:737–740.
25. Namieno T, Koito K, Higashi T, Sato N, Uchino J. General pattern of lymph node metastasis in early gastric carcinoma. World J Surg. 1996; 20:996–1000.
26. Yamao T, Shirao K, Ono H, Kondo H, Saito D, Yamaguchi H, et al. Risk factors for lymph node metastasis from intramucosal gastric carcinoma. Cancer. 1996; 77:602–606.
27. Kitamura K, Yamaguchi T, Taniguchi H, Hagiwara A, Sawai K, Takahashi T. Analysis of lymph node metastasis in early gastric cancer: rationale of limited surgery. J Surg Oncol. 1997; 64:42–47.
28. Lo SS, Wu CW, Chen JH, Li AF, Hsieh MC, Shen KH, et al. Surgical results of early gastric cancer and proposing a treatment strategy. Ann Surg Oncol. 2007; 14:340–347.
29. Okabayashi T, Kobayashi M, Nishimori I, Sugimoto T, Namikawa T, Onishi S, et al. Clinicopathological features and medical management of early gastric cancer. Am J Surg. 2008; 195:229–232.
TOOLS
Similar articles