• artificial intelligence (AI)
• deep learning
• gastric cancer
• gastrointestinal endoscopy

• Humans
• Stomach Neoplasms/pathology
• Stomach Neoplasms/diagnostic imaging
• Stomach Neoplasms/diagnosis
• Artificial Intelligence
• Male
• Female
• Middle Aged
• Aged
• Retrospective Studies
• Adult
• Sensitivity and Specificity
• Aged, 80 and over
• Gastroscopy/methods
• Video Recording

• NRF-2022R1A2B5B01001430 National Research Foundation of Korea
• 2022 Ainex Corporation

• Gastric cancer
• Iodine concentration
• Peritoneal metastasis
• Spectral CT

• Humans
• Stomach Neoplasms/diagnostic imaging
• Stomach Neoplasms/pathology
• Peritoneal Neoplasms/diagnostic imaging
• Peritoneal Neoplasms/secondary
• Male
• Female
• Retrospective Studies
• Middle Aged
• Tomography, X-Ray Computed/methods
• Radiography, Dual-Energy Scanned Projection/methods
• Aged
• Sensitivity and Specificity
• Adult
• Contrast Media
• Predictive Value of Tests
• Aged, 80 and over

• BE2017772 Key Social Development Program for the Ministry of Science and Technology of Jiangsu Province

• Humans
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Stomach Neoplasms/mortality
• Nomograms
• Male
• Female
• Middle Aged
• Lymphatic Metastasis/pathology
• Retrospective Studies
• Aged
• Lymph Node Excision
• Lymph Nodes/pathology
• Lymph Nodes/diagnostic imaging
• Lymph Nodes/surgery
• Spleen/pathology
• Gastrectomy/methods
• Prognosis
• Neoplasm Invasiveness/pathology
• Neoplasm Staging
• Preoperative Period
• Adult
• Preoperative Care/methods
• Tomography, X-Ray Computed

Gastric cancer (GC) is the most common malignant tumor and ranks third for cancer-related deaths among the worldwide. The disease poses a serious public health problem in China, ranking fifth for incidence and third for mortality. Knowledge of the invasive depth of the tumor is vital to treatment decisions.

To evaluate the diagnostic performance of double contrast-enhanced ultrasonography (DCEUS) for preoperative T staging in patients with GC by comparing with multi-detector computed tomography (MDCT).

This single prospective study enrolled patients with GC confirmed by preoperative gastroscopy from July 2021 to March 2023. Patients underwent DCEUS, including ultrasonography (US) and intravenous contrast-enhanced ultrasonography (CEUS), and MDCT examinations for the assessment of preoperative T staging. Features of GC were identified on DCEUS and criteria developed to evaluate T staging according to the 8^th edition of AJCC cancer staging manual. The diagnostic performance of DCEUS was evaluated by comparing it with that of MDCT and surgical-pathological findings were considered as the gold standard.

A total of 229 patients with GC (80 T1, 33 T2, 59 T3 and 57 T4) were included. Overall accuracies were 86.9% for DCEUS and 61.1% for MDCT (P < 0.001). DCEUS was superior to MDCT for T1 (92.5% vs 70.0%, P < 0.001), T2 (72.7% vs 51.5%, P = 0.041), T3 (86.4% vs 45.8%, P < 0.001) and T4 (87.7% vs 70.2%, P = 0.022) staging of GC.

DCEUS improved the diagnostic accuracy of preoperative T staging in patients with GC compared with MDCT, and constitutes a promising imaging modality for preoperative evaluation of GC to aid individualized treatment decision-making.

• Double contrast-enhanced ultrasonography
• Multi-detector computed tomography
• Gastric cancer
• T staging

• Humans
• Stomach Neoplasms/diagnostic imaging
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Middle Aged
• Male
• Female
• Neoplasm Staging
• Contrast Media/administration & dosage
• Prospective Studies
• Aged
• Ultrasonography/methods
• Ultrasonography/statistics & numerical data
• Multidetector Computed Tomography/methods
• Adult
• China/epidemiology
• Gastroscopy/methods
• Stomach/diagnostic imaging
• Stomach/pathology
• Stomach/surgery
• Aged, 80 and over

• GI tract
• diagnostic indications
• endoscopic ultrasound

• endoscopic ultrasound‐guided fine‐needle aspiration
• gastroscopy
• linitis plastica
• scirrhous

• breast neoplasms
• carcinoma
• immunohistochemistry
• neoplasm metastasis
• stomach neoplasms

Gastric linitis plastica (GLP) is a subset of gastric cancer with a poor prognosis. It is difficult to obtain a definitive diagnosis by endoscopic mucosal biopsies, and the usefulness of an endoscopic ultrasonography-guided fine-needle biopsy (EUS-FNB) for GLP has been recently reported. Meanwhile, autoimmune diseases are occasionally known to coexist with malignant tumors as paraneoplastic syndrome. We herein report the usefulness of an EUS-FNB for detecting GLP and the possibility of paraneoplastic syndrome coexisting with GLP.

An 81-year-old man was admitted to our hospital for a 1-mo history of epigastric pain that increased after eating. His laboratory data revealed high levels of serum carbohydrate antigen 19-9 and immunoglobulin-G4. Endoscopic examinations showed giant gastric folds and reddish mucosa; however, no epithelial changes were observed. The gastric lumen was not distensible by air inflation, suggesting GLP. Computed tomography showed the thickened gastric wall, the diffuse enlargement of the pancreas, and the peripancreatic rim, which suggested autoimmune pancreatitis (AIP) coexisting with GLP. Because the pathological findings of the endoscopic biopsy showed no malignancy, he underwent an EUS-FNB and was diagnosed with GLP. He received chemotherapy for unresectable gastric cancer due to peritoneal metastasis, after which both the gastric wall thickening and diffuse enlargement of the pancreas were improved.

An EUS-FNB for GLP with a negative endoscopic biopsy is useful, and AIP may develop as a paraneoplastic syndrome.

• Endoscopic ultrasound-guided fine needle aspiration
• Linitis plastica
• Autoimmune pancreatitis
• Paraneoplastic syndromes
• Case report

• Endoscopic ultrasound
• Fine needle biopsy
• Gastric adenocarcinoma
• Gastric linitis plastica
• Poorly cohesive cells

• Franseen‐tip needle
• breast cancer
• endoscopic ultrasound‐guided fine‐needle biopsy
• gastric metastases
• linitis plastica

• Franseen‐tip needle
• biopsy
• endoscopic ultrasound‐guided fine‐needle biopsy
• linitis plastica
• ultrasonography

• Borrmann classification
• advanced gastric cancer
• ensemble learning
• multilayer perceptron networks
• radiomics

• Computed tomography
• Epithelial-mesenchymal transition
• Nomogram
• Stomach neoplasms

• Humans
• Nomograms
• Prognosis
• Retrospective Studies
• Stomach Neoplasms/diagnostic imaging
• Tomography, X-Ray Computed

• China/epidemiology
• Clinical Decision Rules
• Humans
• Magnetic Resonance Imaging/methods
• Magnetic Resonance Imaging/statistics & numerical data
• Molecular Imaging/methods
• Neoplasm Staging/methods
• Practice Guidelines as Topic
• Preoperative Period
• Prognosis
• Radiotherapy/methods
• Stomach Neoplasms/diagnostic imaging
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Stomach Neoplasms/therapy
• Treatment Outcome

To establish new diagnostic criteria for improvement of the accuracy of multi-slice spiral computed tomography (MSCT) in diagnosing the N-stage and lymph node (LN) metastasis of gastric cancer (GC).

MSCT was performed with plain and triphasic dynamic contrast enhancement. Different regions of LN metastasis and N-staging were determined according to the herein-proposed combined diagnostic criteria and were then correlated with the pathological analysis. The Kappa consistency test was used to study the accuracy of MSCT.

The accuracy of MSCT in diagnosing the N-stage as a whole was 86.3%, and that in diagnosing LN metastasis was 79.1% to 98.9%. The Kappa values for stages N0, N1, and N3 ranged from 0.449 to 0.662, indicating good consistency in diagnosing these three stages between MSCT and the postsurgical pathological results. The K_total value was 0.567 between MSCT and the postsurgical pathological results in diagnosing LN metastasis. The risk of LN metastasis increased with the progression of lesion infiltrates.

Application of the combined diagnostic criteria increased the diagnostic performance of MSCT in not only judging the N-stage but also diagnosing LN metastasis. This study will provide valuable reference data for surgical planning for patients with GC in the clinical setting.

• Multi-slice spiral computed tomography
• N-stage
• diagnostic criteria
• gastric cancer
• lesion infiltrates
• metastatic lymph node

Ultrasonically activated shears (UAS) have been applied in open gastric surgeries with no or little evidence. It was previously reported about the surgical outcome and effectiveness of UAS based on a randomized controlled trial of 256 patients with gastric cancer. We aimed to clarify the long-term oncological safety of the use of UAS in the aspect of overall survival and recurrence.

Gastric cancer patients who underwent gastrectomy with D2 lymph node dissection were enrolled and randomly assigned to either the conventional surgery group (n=125) or the UAS group (n=128). Survival, recurrence and long-term postoperative complications were compared between the two groups. The median follow-up period was 56 months.

Gastric cancer-related death was higher in patients of the UAS group compared with the conventional group (P=0.019). Overall survival rates stratified by stage were not significantly different between the two groups (P=0.170). Disease-free survival rates stratified by stage and recurrence-free survival rates of gastric cancer were similar between the conventional group and the UAS group (P=0.313 and 0.199, respectively). The postoperative complication rate was not significantly different between the groups (P=1.000).

It is suggested that the use of UAS in gastrectomy for gastric cancer showed oncologically acceptable safety compared with conventional electric instruments even in long-term period.

• Stomach cancer
• gastrectomy
• oncological safety
• ultrasonically activated shears (UAS)

The value of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy in the gastric linitis plastica (GLP) with negative malignant endoscopy biopsies was investigated. Forty-six patients with linitis plastica who had undergone EUS-FNA were retrospectively studied, and their clinicopathological data were examined. Among the 46 eligible patients, 38 cases were diagnosed clearly by EUS-FNA. There were 24 cases with lymph node metastasis in the 38 patients. Both the lymph nodes and gastric lesions were punctured by EUS-FNA in the 24 cases. We compared the diagnostic accuracy in different sites, and the results showed that the diagnostic accuracy in lymph nodes was significantly higher than that in gastric lesions (P<0.05). Among them, 16 patients underwent surgical resection, and the accuracy of the pathological diagnosis by EUS-FNA was 87.5% (14/16). The preoperative diagnostic accuracy of T and N staging by endoscopic ultrasound (EUS) were both 75%. Neither severe hemorrhage nor perforation occurred in any patient. In conclusion, EUS-FNA is a safe and effective procedure for the diagnosis of indefinite linitis plastica, and puncturing metastatic lymph nodes can improve the diagnostic accuracy.

• diagnosis
• endoscopic biopsy
• endoscopic ultrasonography
• fine needle aspiration
• gastric linitis plastica

To evaluate the frequency and adequacy of statistical analyses in a general radiology journal when reporting a reliability analysis for a diagnostic test.

Sixty-three studies of diagnostic test accuracy (DTA) and 36 studies reporting reliability analyses published in the Korean Journal of Radiology between 2012 and 2016 were analyzed. Studies were judged using the methodological guidelines of the Radiological Society of North America-Quantitative Imaging Biomarkers Alliance (RSNA-QIBA), and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) initiative. DTA studies were evaluated by nine editorial board members of the journal. Reliability studies were evaluated by study reviewers experienced with reliability analysis.

Thirty-one (49.2%) of the 63 DTA studies did not include a reliability analysis when deemed necessary. Among the 36 reliability studies, proper statistical methods were used in all (5/5) studies dealing with dichotomous/nominal data, 46.7% (7/15) of studies dealing with ordinal data, and 95.2% (20/21) of studies dealing with continuous data. Statistical methods were described in sufficient detail regarding weighted kappa in 28.6% (2/7) of studies and regarding the model and assumptions of intraclass correlation coefficient in 35.3% (6/17) and 29.4% (5/17) of studies, respectively. Reliability parameters were used as if they were agreement parameters in 23.1% (3/13) of studies. Reproducibility and repeatability were used incorrectly in 20% (3/15) of studies.

Greater attention to the importance of reporting reliability, thorough description of the related statistical methods, efforts not to neglect agreement parameters, and better use of relevant terminology is necessary.

• Agreement
• Reliability
• Repeatability
• Repeatability coefficient
• Reproducibility
• Software program
• Statistical analysis
• Statistical method

To report on a more accurate diagnostic possibility offered by endoscopic ultrasound-guided cutting of holes and deep biopsy (EUS-CHDB) for pathologic diagnosis of gastric infiltrative tumors and gastrointestinal submucosal tumors.

Ten consecutive patients who were suspected of having gastric invasive tumors or gastrointestinal submucosal tumors underwent EUS-CHDB with a novel vertical diathermic loop. We reviewed their medical data and analysed the effectiveness and safety of this new method. The final diagnosis was based on the surgical pathology or clinical/imaging follow-up.

EUS-CHDB was performed successfully in all the ten patients. Neither severe haemorrhage nor perforation occurred in any patient. Among the ten patients, there were three cases of gastric linitis plastica, one case of gastric lymphoma, five cases of gastrointestinal stromal tumors (GISTs), and only one case of chronic non-atrophic gastritis. That is, nine (90%) of the cases treated by EUS-CHDB showed positive findings.

EUS-CHDB may be a technically feasible and safe option for patients with gastric infiltrative tumors or gastrointestinal submucosal tumors. EUS-CHDB may be used as a remedial or even preferred biopsy method for submucosal lesions.

• Endoscopic ultrasound
• Cutting holes
• Deep biopsy
• Vertical diathermic loop
• Gastric linitis plastica
• Gastrointestinal submucosal tumors

• Adult
• Aged
• Biopsy/instrumentation
• Biopsy/methods
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Stomach/pathology
• Stomach Neoplasms/diagnosis
• Ultrasonography, Interventional/instrumentation
• Ultrasonography, Interventional/methods

• Enhancement pattern
• Gastric cancer
• Multiphasic contrast-enhanced computed tomography

Diagnostic performance of Diffusion-Weighted magnetic resonance Imaging (DWI) and Multi-Detector Computed Tomography (MDCT) for TNM (Tumor, Lymph node, Metastasis) staging of gastric cancer was compared.

We used axial T2-weighted images and DWI (b-0,400 and b-800 s/mm2) protocol on 51 pre-operative patients who had been diagnosed with gastric cancer. We also conducted MDCT examinations on them. We looked for a signal increase in the series of DWI images. The depth of tumor invasion in the stomach wall (tumor (T) staging), the involvement of lymph nodes (nodal (N) staging), and the presence or absence of metastases (metastatic staging) in DWI and CT images according to the TNM staging system were evaluated. In each diagnosis of the tumors, sensitivity, specificity, positive and negative accuracy rates of DWI and MDCT examinations were found through a comparison with the results of the surgical pathology, which is the gold standard method. In addition to the compatibilities of each examination with surgical pathology, kappa statistics were used.

Sensitivity and specificity of DWI and MDCT in lymph node staging were as follows: N1: DWI: 75.0%, 84.6%; MDCT: 66.7%, 82%;N2: DWI: 79.3%, 77.3%; MDCT: 69.0%, 68.2%; N3: DWI: 60.0%, 97.6%; MDCT: 50.0%, 90.2%. The diagnostic tool DWI seemed more compatible with the gold standard method (surgical pathology), especially in the staging of lymph node, when compared to MDCT. On the other hand, in T staging, the results of DWI and MDCT were better than the gold standard when the T stage increased. However, DWI did not demonstrate superiority to MDCT. The sensitivity and specificity of both imaging techniques for detecting distant metastasis were 100%.

The diagnostic accuracy of DWI for TNM staging in gastric cancer before surgery is at a comparable level with MDCT and adding DWI to routine protocol of evaluating lymph nodes metastasis might increase diagnostic accuracy.

• MDCT
• diffusion weighted imaging
• gastric cancer
• staging

• endoscopy
• esophagogastroduodenoscopy
• gastric cancer
• interval
• screening
• survival

• Adenocarcinoma/epidemiology
• Adenocarcinoma/etiology
• Adenocarcinoma/prevention & control
• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Cross-Sectional Studies
• Databases, Factual
• Early Diagnosis
• Endoscopy, Digestive System/statistics & numerical data
• Female
• Humans
• Male
• Middle Aged
• Republic of Korea/epidemiology
• Retrospective Studies
• Stomach Neoplasms/epidemiology
• Stomach Neoplasms/etiology
• Stomach Neoplasms/prevention & control
• Time Factors
• Young Adult

To determine the rate with which diagnostic test accuracy studies that are published in a general radiology journal adhere to the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015, and to explore the relationship between adherence rate and citation rate while avoiding confounding by journal factors.

All eligible diagnostic test accuracy studies that were published in the Korean Journal of Radiology in 2011–2015 were identified. Five reviewers assessed each article for yes/no compliance with 27 of the 30 STARD 2015 checklist items (items 28, 29, and 30 were excluded). The total STARD score (number of fulfilled STARD items) was calculated. The score of the 15 STARD items that related directly to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 was also calculated. The number of times each article was cited (as indicated by the Web of Science) after publication until March 2016 and the article exposure time (time in months between publication and March 2016) were extracted.

Sixty-three articles were analyzed. The mean (range) total and QUADAS-2-related STARD scores were 20.0 (14.5–25) and 11.4 (7–15), respectively. The mean citation number was 4 (0–21). Citation number did not associate significantly with either STARD score after accounting for exposure time (total score: correlation coefficient = 0.154, p = 0.232; QUADAS-2-related score: correlation coefficient = 0.143, p = 0.266).

The degree of adherence to STARD 2015 was moderate for this journal, indicating that there is room for improvement. When adjusted for exposure time, the degree of adherence did not affect the citation rate.

• Accuracy
• Adherence
• Citation
• Impact
• Impact factor
• Reporting quality
• STARD
• STARD 2015

• Borrmann type IV gastric cancer
• diagnosis
• endoscopic biopsy
• positron emission tomography-computed tomography

• Cancer
• Computed tomography
• Gastric linitis plastica
• Linitis plastica

AIM: To evaluate the value of computed tomography (CT) with multi-direction adjusting multi-planar reformation (MPR) in the differential diagnosis between Borrmann types Ⅱ and Ⅲ gastric cancer.

METHODS: Eighty patients with pathologically proven gastric cancer underwent contrast enhanced CT examinations, and all the images were reconstructed by multi-direction adjusting MPR and normal reformation. The diagnostic results by the two construction methods were compared with the pathology as the gold standard, and the consistency and accuracy were analyzed by the Chi-square test.

RESULTS: Of the 80 patients, 33 had Borrmann type Ⅱ disease and 47 had Borrmann type Ⅲ. The value of Kappa and accuracy of multi-direction adjusting MPR in the differential diagnosis between Borrmann types Ⅱ and Ⅲ gastric cancer were 0.77 and 88.8%, respectively, which were higher than those of the normal reformation. Borrmann type Ⅱ gastric cancer was diagnosed more easily than type Ⅲ.

CONCLUSION: The accuracy of multi-direction adjusting MPR in the differential diagnosis between Borrmann types Ⅱ and Ⅲ gastric cancer is higher than the normal reformation and is close to pathology.

• Gastric cancer
• Computed tomography
• Multi-planar reformation

AIM: To assess the diagnostic yield and safety of a deep and large biopsy technique under the guidance of endoscopic ultrasound (EUS) for diagnosis of gastric infiltrating tumors with negative malignant endoscopy biopsies.

METHODS: From January 2009 to March 2014, 36 patients in whom gastric infiltrating tumors had been diagnosed by EUS received negative results for malignancy after endoscopic biopsies. The deep and large biopsy technique combined bite-on-bite technique with or without endoscopic mucosal resection (EMR) to obtain submucosal tissue from lesions. EUS was used to select the appropriate biopsy sites. If the lesion protruded into the cavity, EMR was performed for removal of the overlying mucosa and then bite-on-bite technique was conducted in the resected area to obtain submucosal tissue. If the lesion appeared to be flat or was difficult to lift by injection, the bite-on-bite technique was directly used.

RESULTS: Twenty-eight of the 36 patients were treated by EMR followed by bite-on-bite technique, while 8 patients only underwent bite-on-bite technique. Histological results showed 23 of the 36 lesions were poorly differentiated adenocarcinomas, 2 diffuse large B cell lymphomas, 4 mucosa-associated lymphoid tissue-type lymphomas, and 7 undiagnosed. The deep and large biopsy technique provided a definitive and conclusive diagnosis in 29 (80.6%) of the 36 patients. The 12 gastric linitis plastica and 6 lymphoma patients received chemotherapy and avoided surgery. Minor oozing of blood in 2 mucosal resection wounds was managed by argon plasma coagulation and in 5 cases after deep biopsies by epinephrine (0.001%). Neither severe hemorrhage nor perforation occurred in any patient.

CONCLUSION: The deep and large biopsy technique is superior to ordinary endoscopic biopsy for achieving an accurate diagnosis of gastric infiltrating tumors. This procedure guided by EUS is an effective and safe diagnostic method for gastric infiltrating tumors in which endoscopic biopsy results were negative for malignancy.

• Endoscopic ultrasonography
• Endoscopic biopsy
• Diagnosis
• Gastric linitis plastica
• Gastric lymphoma

• Adenocarcinoma/diagnostic imaging
• Adenocarcinoma/pathology
• Adenocarcinoma/therapy
• Adult
• Aged
• Endosonography
• Female
• Gastric Mucosa/diagnostic imaging
• Gastric Mucosa/pathology
• Gastric Mucosa/surgery
• Gastroscopy
• Humans
• Image-Guided Biopsy/methods
• Lymphoma, B-Cell, Marginal Zone/diagnostic imaging
• Lymphoma, B-Cell, Marginal Zone/pathology
• Lymphoma, B-Cell, Marginal Zone/therapy
• Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
• Lymphoma, Large B-Cell, Diffuse/pathology
• Lymphoma, Large B-Cell, Diffuse/therapy
• Male
• Middle Aged
• Neoplasm Invasiveness
• Patient Selection
• Predictive Value of Tests
• Prognosis
• Retrospective Studies
• Stomach Neoplasms/diagnostic imaging
• Stomach Neoplasms/pathology
• Stomach Neoplasms/therapy

• MDCT
• MRI
• gastric cancer
• staging