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(Radiology. 2000;217:409-414.)
© RSNA, 2000

Gastrointestinal Imaging

Overlooked Gastric Carcinoma: Pitfalls in Upper Gastrointestinal Radiology1

Noboru Shindoh, MD, Takashi Nakagawa, MD, Yutaka Ozaki, MD, Shinsuke Kyogoku, MD, Yukiharu Sumi, MD and Hitoshi Katayama, MD

1 From the Department of Radiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba 279-0021, Japan. From the 1998 RSNA scientific assembly. Received September 29, 1999; revision requested December 9; revision received February 3, 2000; accepted February 7. Address correspondence to N.S. (e-mail: shindoh@pop16.odn.ne.jp).

PURPOSE: To evaluate the reasons for misdiagnosis of gastric carcinoma at upper gastrointestinal radiography.

MATERIALS AND METHODS: Upper gastrointestinal radiographs obtained within 3 years prior to diagnosis of gastric carcinoma in 336 patients were selected. Two radiologists who were initially blinded and then unblinded to the diagnosis reviewed the radiographs. Decisions were made by means of consensus. The reason for misdiagnosis was classified as perceptual error when the lesion was identified correctly at the blinded review, as possible perceptual error when the lesion was identified only at the unblinded review, and as technical error when the lesion could not be identified at either review and technical deficiencies were thought to be the cause.

RESULTS: Twenty-four patients underwent upper gastrointestinal radiography within 3 years prior to diagnosis of 27 carcinomas. The reason for misdiagnosis was classified as perceptual error in 11, as possible perceptual error in four, and as technical error in five lesions. In the remaining seven lesions, the lesion could not be identified at either review, and technical deficiencies were not thought to be the cause. The most common overlooked finding was depression (10 of 15), and the most common presumed technical error was incomplete compression study (seven of 11).

CONCLUSION: Careful attention should be paid to detect limited barium pooling during double-contrast studies to avoid overlooking depressions.

Index terms: Diagnostic radiology, observer performance, 70.123 • Endoscopy, 70.126 • Gastrointestinal tract, radiography, 70.123 • Radiography, comparative studies, 70.123 • Stomach, neoplasms, 70.321




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