PURPOSE: To prospectively evaluate the accuracy of multi–detector row computed tomography (CT) gastrography for preoperative staging of gastric cancer, with pathologic and surgical results as the reference standard. MATERIALS AND METHODS: This study was approved by the institutional review board, and patients gave written informed consent. One hundred six patients (72 male, 34 female; mean age, 56 years) with endoscopically proved gastric cancer underwent unenhanced and contrast material–enhanced multi–detector row CT gastrography, with effervescent granules used as oral contrast material. Two experienced radiologists independently evaluated the depth of tumor invasion into the gastric wall (tumor staging), the involvement of regional lymph nodes (nodal staging), and the presence or absence of metastasis (metastatic staging) on transverse and volumetric CT images, which included images produced with multiplanar reformation and a virtual endoscopic technique. TNM staging of each tumor was compared with the...

Gastric cancer staging at multi-detector row CT gastrography: comparison of transverse and volumetric CT scanning.

From 1986 to 1990 a prospective comparative study was undertaken to compare the relative accuracy of computed tomography, endogastric ultrasonography, and intraoperative surgical assessment in evaluating the depth of invasion (T category) and involvement of lymph nodes (N category) of patients with gastric carcinoma. One hundred and eight consecutive patients, who were treated by total gastrectomy and previously evaluated with computed tomography, endogastric ultrasonography, and intraoperative surgical assessment, entered the study. Results (T and N category) were compared with those of histopathological staging (pT and pN category). T categories were correctly staged in 43% of cases with computed tomography, 86% with endogastric ultrasonography, and 56% with intraoperative surgical assessment. Computed tomography scanning correctly staged 51% of all N1 and N2 lymph nodes compared with 74% for endogastric ultrasonography and 54% for intraoperative surgical assessment. In general, computed tomography was more accurate for advanced stages of cancer and showed a tendency to overstage the T category and understage N category of gastric tumours. By contrast, endogastric ultrasonography was equally accurate for all T categories and showed an understaging for N categories. Intraoperative surgical assessment overstaged early T stages, understaged T4 tumours, and was equally accurate for all grades of N categories. Computed tomography scanning and intraoperative surgical assessment of T and N categories were of little value in staging of gastric carcinoma. Endogastric ultrasonography is more accurate than computed tomography scanning and intraoperative surgical assessment. Therefore endogastric ultrasonography should be introduced in the preoperative assessment of patients with gastric carcinoma.

https://gut.bmj.com/content/gutjnl/34/5/604.full.pdf

Comparison of computed tomography, endosonography, and intraoperative assessment in TN staging of gastric carcinoma.

A lesion localization and marking wire and needle assembly for marking non-palpable lesions within the body. A marking device having a helically wound coil of wire attached to an end of the shaft which is insertable into the body through a needle or cannula for rotatingly anchoring the marking device into a lesion or tumor is provided. The needle or cannula is inserted into the body with the marking device positioned therein so that when the cannula is positioned proximate to a lesion the shaft of the marker is rotated to advance the marker into the lesion to mark it for subsequent surgical procedures. A second helical wire may be provided on the shaft which cooperates with a wire guide device attached to the needle to enable the physician to determine the depth of the marking device as it anchors into the lesion. In particular, the device is provided for marking for biopsy lesions of the breast.

Helical-tipped lesion localization needle device and method of using the same

Stomach cancer is one of the leading causes of cancer mortality worldwide. Complete resection of a gastric tumor and adjacent lymph nodes represents the only potentially curative intervention. Computed tomography (CT) has remained the modality of choice for the preoperative staging of gastric cancer and for follow-up. A recently developed advanced CT technique that makes use of thin sections, optimal contrast material enhancement, and multiplanar reformation allows more accurate staging. However, CT may be limited in the identification of nonenlarged lymph node metastasis, peritoneal dissemination, and small hematogenous metastasis. Positron emission tomography (PET) with 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) has been recognized as a useful diagnostic technique in clinical oncology. FDG PET allows scanning of a larger volume than is possible with CT. Although FDG PET is not an appropriate first-line diagnostic procedure in the detection of stomach cancer and is not helpful in tumor staging, it may play a valuable role in the detection of distant metastases, such as those of the liver, lungs, adrenal glands, ovaries, and skeleton. FDG PET may also be helpful in the follow-up of patients undergoing chemotherapy, as it allows the identification of early response to treatment. Further studies are needed to determine the efficacy of FDG PET in the detection of local nodal metastases and peritoneal dissemination. Nevertheless, the combined use of CT and PET can be helpful in the preoperative staging of stomach cancer and in the therapeutic monitoring of affected patients.

https://pubs.rsna.org/doi/pdf/10.1148/rg.261055078

CT and PET in Stomach Cancer: Preoperative Staging and Monitoring of Response to Therapy

With the development of more effective combination chemotherapy and radiation, the role of surgical resection in the management of gastric lymphoma is reappraised. A retrospective review of 32 patients with gastric lymphoma, diagnosed and treated during the period between 1966-1979, is presented in an attempt to evaluate the relative effectiveness of the various modalities of diagnosis and treatment. Preoperative gastric barium x-ray studies were abnormal in 28 patients but were infrequently diagnostic of lymphoma. Endoscopy was employed in 15 patients with washings and biopsy. The biopsies were reported: four nondiagnostic; three suspicious of tumor; three carcinomas; and in only five patients was a clear diagnosis of lymphoma established. Fifteen patients were treated on the basis of biopsy via gastroscopy, or were explored and not resected and were treated with chemotherapy and/or radiation therapy. Fourteen of the nonresected patients have died with disease; one patient is surviving with disease at 20 months. Surgical resection was accomplished in 17 of the 32 cases, with seven patients (41%) surviving from 2-12 years. Aggressive primary chemotherapy with four-drug combination (CAOP) without surgical resection has resulted in massive upper gastrointestinal hemorrhage in four of five patients thus treated. This required emergency surgery for patients with depressed leukocyte and platelet counts. No perforation of the stomach was seen with primary chemotherapy as reported by other authors. In this series surgical exploration was necessary to establish a definite histologic diagnosis in 27 of the 32 patients. Exploration was an essential step in establishing the extent of disease to plan therapy. The only long-term survivors free of tumor were those which had been surgically resected. Resection of the gastric lymphoma prevented the complication of hemorrhage and perforation associated with chemotherapy and radiation therapy.

The role of surgery in the management of gastric lymphoma

Eight patients with proved gastric carcinoma and 3 with gastric lymphoma were studied preoperatively with computed tomography. CT accurately identified abnormal stomach wall thickening and intra-abdominal tumor extension. Mural thickening was seen on the CT scan when a moderately distended stomach had a wall more than 10 mm thick. CT was useful for assessing surgical resectability, evaluating tumor response to chemotherapy or radiotherapy, and detecting postoperative recurrence. Fourteen patients with an abnormal barium study suggesting gastric malignancy were also studied with CT, which correctly demonstrated a normal stomach or identified the reason for the abnormal barium study, such as an unusually placed spleen or a pancreatic carcinoma invading the stomach.

Computed tomographic staging of malignant gastric neoplasms.

Percutaneous needle localisation of breast lesions prior to biopsy: analysis of failures.

The medullary rays are well-defined anatomic structures consisting of bundles of renal tubules which form in the renal cortex and continue through the renal medulla as the medullary striations. These structures are occasionally visualized during excretory urography in abnormal physiologic states characterized by tubular stasis and hyperconcentration of contrast material. Under these conditions, fine striations are visualized which correspond in position and orientation to these structures. The work of others has shown that in tubular stasis, contrast material is hyperconcentrated in the tubules. On microradiography in normal and obstructed kidneys, the highest concentrations of contrast material are seen in the lumen of collecting ducts. Lastly, retrograde injection of contrast material into the medullary rays produces a roentgen image similar to our illustrated cases.

Medullary rays. Visualization during excretory urography.

Incidental thin-walled renal mass in an older man.

The authors describe an inexpensive device which displaces the dependent breast from the chest wall for optimum and uniform compression of breast tissue during mammography. Exposure is reduced, detail is enhanced, and superimposed structures are spread out. The filming time is about five minutes, and repeat or additional views are rarely necessary. The authors feel that by using this device, they have not missed any posterior lesions in more than 10 years of use. Even dense breasts are adequately visualized with this technique.

Lawrence R. Bigongiari

Papers

Computed tomographic staging of malignant gastric neoplasms.

Percutaneous needle localisation of breast lesions prior to biopsy: analysis of failures.

Medullary rays. Visualization during excretory urography.

Incidental thin-walled renal mass in an older man.

A simple device for dependent compression mammography.