Use of enhanced ct to diagnose lymph node metastasis in patients with resectable advanced gastric carcinoma

Abstract

Abstract Background: Computed tomography (CT) has uncertain value in determining preoperative lymph node metastasis (LNM) in patients with advanced gastric carcinoma (AGC). This study aimed to determine the ability of enhanced CT to diagnose LNM in patients with resectable AGC. Methods: Eighty-five AGC patients who received enhanced CT, gastrectomy, and lymph node (LN) dissection were examined. Patients were divided into two groups based on postoperative pathological examinations: a LN positive group (n=32) and a LN negative group (n=53). LNs were examined using preoperative enhanced CT, and axial diameters and enhanced CT values were recorded to enable comparisons with pathological results. Results: In the LN-positive group, the number of positive LNs was 359 based on CT and 135 based on pathology. In the LN-negative group, the number negative LNs was 1301 based on CT and 174 based on pathology. Receiver operating characteristic (ROC) analysis indicated the critical LN measurement was 7.5 mm for the long axis and 5.5 mm for the short axis. The critical values of average HU values (AHUVs) from CT increased with cancer stage. The sensitivity, specificity, and the area under the curve (AUC) had moderate values based on a single index. The combination of LN short axis and arterial phase AHUVs after logistic regression led to a sensitivity of 77%, specificity of 84%, and AUC of 0.89. Conclusions: Use of the LN short axis length and arterial phase AHUVs had high reliability for diagnosis of LNM in AGC patients, and may be useful for clinical decision-making.