• Computed tomography
• contrast enhancement
• gastric cancer
• lymph node metastasis
• tumor volume

• Humans
• Stomach Neoplasms/diagnostic imaging
• Stomach Neoplasms/pathology
• Lymphatic Metastasis/diagnostic imaging
• Lymphatic Metastasis/pathology
• Tomography, X-Ray Computed/methods
• Lymph Nodes/diagnostic imaging
• Lymph Nodes/pathology
• ROC Curve
• Retrospective Studies

• Adenocarcinoma
• Gastric cancer
• Lymph node metastasis

• early gastric cancer
• lymph node metastasis
• nomogram
• risk
• systemic inflammation response index

The discrepancy between preoperative and final pathological staging has been a long-standing challenge for the application of clinical trials or appropriate treatment options. This study aimed to demonstrate the accuracy of preoperative staging of locally advanced gastric cancer using data from a large-scale randomized clinical trial.

Of the 1050 patients enrolled in the clinical trial, 26 were excluded due to withdrawal of consent (n = 20) or non-surgery (n = 6). The clinical and pathological staging was compared. Risk factor analysis for underestimation was performed using univariate and multivariate analyses.

Regarding T staging by computed tomography, accuracy rates were 74.48, 61.62, 58.56, and 85.16% for T1, T2, T3 and T4a, respectively. Multivariate analysis for underestimation of T staging revealed that younger age, ulcerative gross type, circular location, larger tumor size, and undifferentiated histology were independent risk factors. Regarding nodal status estimation, 54.9% of patients with clinical N0 disease were pathologic N0, and 36.4% of patients were revealed to have pathologic N0 among clinical node-positive patients. The percentage of metastasis involvement at the D1, D1+, and D2 lymph node stations significantly increased with the advanced clinical N stage. Among all patients, 29 (2.8%), including 26 with peritoneal seeding, exhibited distant metastases.

Estimating the exact pathologic staging remains challenging. A thorough evaluation is mandatory before treatment selection or trial enrollment. Moreover, we need to set a sufficient case number when we design the clinical trial considering the stage migration.

• National Research Foundation of Korea Grant funded by Korean Government
• National R / D Program for Cancer Control, the Ministry of Health and Welfare, Republic of Korea

• Anatomy
• Grossing
• Margins
• Staging
• Tissue sections

Gastric cancer (GC) is the fourth most common malignant disease in the world, following breast cancer, colorectal cancer, and lung cancer. This study aimed to evaluate the usefulness of multidetector-row computed tomography (MDCT) in identifying the metastatic lymph node of GC.

A cross-sectional study was performed after receiving approval by the institutional review board. A total of 88 patients with GC, who underwent radical gastrectomy, were examined by MDCT. Categorical variables were compared using Fisher’s exact test. The discriminating ability of lymph node size was determined according to an area under the receiver operating curve(AUROC) analysis, and the optimal cut-off point was determined.

The proportion of metastatic lymph node patients in the proximal group (32.3%) was significantly higher than that in the distal group (18.4%). T categorisation and lymph node sizes were significantly different between the non-metastatic lymph node and metastatic lymph node groups. The AUROC for lymph node size was 0.738, with an optimal cut-off point of 7.5 mm,producing a sensitivity of 71.5% and a specificity of 70.5%.

MDCT displayed medium accuracy for the determination of metastatic lymph nodes and N categorisation. Based on our findings, although MDCT is generally the first choice for preoperative assessments in GC patients, other diagnostic modalities should supplement MDCT in order to achieve more precise N staging.

• MDCT
• N staging
• gastric cancer
• lymph node

• Advanced gastric cancer
• Lymph node metastasis
• Multi-detector spiral computed tomography
• Pathological diagnosis

The low accuracy of preoperative diagnosis of lymph node metastasis in gastric cancer (GC) complicates decisions on patient indication for neoadjuvant chemotherapy.

We investigated the use of preoperative clinical diagnosis of lymph node involvement (cN) in GC patients compared with postoperative pathological diagnosis.

In a series of 265 patients enrolled at the University of Yamanashi Hospital, the overall sensitivity was 44.4% and specificity was 93.4% of CT for detecting lymph node metastasis. The positive and negative predictive values were 80.0% and 73.8%, respectively. The negative predictive value was lower for undifferentiated adenocarcinoma than that for differentiated adenocarcinoma (64.9% vs. 78.7%, p = 0.034). In cT2 ≤ and cN2 ≤ GC, overdiagnosis of lymph node metastasis was significantly more frequent in patients with differentiated (50.0%) than in undifferentiated (13.3%) adenocarcinoma (p = 0.046).

Diagnostic accuracy of lymph node involvement depended on histological type and cT-stage. Thus, considering preoperative histological type in GC, it may be useful to decide treatment plan.

• Gastric cancer
• Histological type
• Lymph node metastases

• Multidetector CT
• clinical decision support systems
• gastric cancer
• lymphatic metastasis
• machine learning

• Colon cancer
• En-bloc resection
• Gastric cancer
• Morbidity
• Rectal cancer

• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Combined Modality Therapy
• Follow-Up Studies
• Humans
• Hyperthermia, Induced
• Neoplasm Recurrence, Local
• Peritoneal Neoplasms/drug therapy
• Peritoneal Neoplasms/secondary
• Peritoneal Neoplasms/surgery
• Positron Emission Tomography Computed Tomography
• Prognosis
• Survival Rate

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Anthracosilicosis can mimic extensive node metastasis from gastric cancer.

Lymph node metastasis is one of the most important prognostic factors in gastric cancer and precise assessment of nodal status facilitates optimal therapeutic decisions. Many diagnostic modalities including endoscopic ultrasound (EUS), computed tomography (CT), and sometimes, positron emission tomography (PET) have been utilized to improve diagnostic accuracy in detecting metastatic lymph nodes; however, their accuracy remains unsatisfactory.

We report a case of a 73-year old male patient who was erroneously diagnosed with stage IV gastric cancer due to the distant nodal metastasis from early gastric cancer lesion during the initial staging process. However, surgical exploration revealed an anthracosilicosis-associated lymphadenopathy that mimicked extensive distant nodal metastasis in the preoperative CT and PET-CT scans. The patient was finally diagnosed with stage I gastric cancer confined to the mucosa without nodal metastasis.

We report a rare case of gastric cancer concurrent extensive nodal involvement of anthracosilicosis mimicking metastatic nodal disease in the imaging studies. This case implies that PET-CT scan for clinical staging is not specific enough to clearly delineate malignant lesions, causing a diagnostic dilemma.

When the characteristics of the primary tumor is poorly correlated to the findings of imaging studies, surgical exploration can be a viable option for a definitive diagnosis before making a hasty decision based only upon the diagnostic imaging results.

• Anthracosilicosis
• Case report
• Lymphatic metastasis
• Positron-emission tomography
• Stomach neoplasm

To create a nomogram to predict the incidence of lymph node metastasis (LNM) in early gastric cancer (EGC) patients and to externally validate the nomogram.

To construct the nomogram, we retrospectively analyzed a primary cohort of 272 EGC patients. Univariate analysis and a binary logistic regression were performed. A nomogram predicting the incidence of LNM in EGC patients was created. The discrimination ability of the nomogram was measured using the concordance index (c-index), and the nomogram was also calibrated. Then, another prospective cohort of 81 patients was analyzed to validate the nomogram.

In the primary cohort, LNM was pathologically confirmed in 37 (13.6%) patients. In multivariate analysis, the presence of an ulcer, the maximum lesion diameter observed via gastroscopy, the thickness of the lesion observed via endoscopic ultrasonography, and the presence of enlarged lymph nodes on computed tomography (CT) were independent risk factors for LNM. A nomogram was then created based on the regression model with the c-index of 0.905, and the calibration curve of the nomogram fell approximately on the ideal 45-degree line. The cut-off score of the nomogram was 110, and the sensitivity, specificity, positive predictive and negative predictive values of the nomogram in the primary cohort were 81.1%, 86.0%, 47.6% and 96.7%, respectively, and in the prospective validation cohort were 75.0%, 91.0%, 60.0% and 95.5%, respectively. The calibration curve of the external validation cohort was almost on the 45-degree line.

We developed an effective nomogram predicting the incidence of LNM for EGC patients.

• Early gastric cancer
• lymph node metastasis
• nomogram
• validation