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Preoperative Staging of Gastric Adenocarcinoma: Comparison of Helical CT and Endoscopic US¹

¹ From the Departments of Diagnostic and Interventional Radiology (C.R.H., F.W., R.R., C.D., G.A.), General Surgery (H.H.), Interdisciplinary Endoscopy (S.B.), and Pathology (C.S.) and Institute for Mathematics and Computer Science in Medicine (V.S.), University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. From the 2000 RSNA scientific assembly. Received July 22, 2002; revision requested September 26; final revision received May 22, 2003; accepted June 16. Address correspondence to C.R.H. (e-mail: c.habermann@uke.uni-hamburg.de).

PURPOSE: To compare the performance of helical computed tomography (CT) and endoscopic ultrasonography (US) in the preoperative staging of gastric cancer.

MATERIALS AND METHODS: Fifty-one consecutive patients with a primary malignant gastric tumor (stage T2–T4) were preoperatively evaluated with both helical CT and endoscopic US within 3 days. Each tumor was staged according to the TNM classification system with both modalities. All patients subsequently underwent surgery. Results of CT and endoscopic US were compared with histologic staging of tumor invasion depth and regional lymph node metastasis. For comparison of CT and endoscopic US data, the marginal homogeneity test was used, and a P value of less than .05 was determined to indicate statistical significance.

RESULTS: In comparison with histologic results, CT achieved correct T staging in 39 patients (76%) and correct N staging in 35 patients (70%). The corresponding results for endoscopic US achieved correct T staging in 44 patients (86%) and correct N staging in 45 patients (90%). There was no significant difference between T staging (P = .55) and N staging (P > .99). Because of challenging detection of wall layers, correct T staging was difficult for CT and endoscopic US in the differentiation of T2 and T3 lesions.

CONCLUSION: Compared with endoscopic US, helical CT focused on the stomach provides valuable results regarding T and N staging in patients with gastric cancer.

© RSNA, 2004

Index terms: Computed tomography (CT), helical, 728.12115 • Stomach, CT, 728.12115 • Stomach, diseases, 728.321

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