Chen HZ, Zhang P, Ma J. Computed tomography with carcinoembryonic antigen and carbohydrate antigen 19-9 in diagnosing lymph node metastasis of early gastric cancer. World J Gastrointest Oncol 2026; 18(2): 114066 [DOI: 10.4251/wjgo.v18.i2.114066]
Corresponding Author of This Article
Ping Zhang, Deputy Director, Department of Radiology, Huai’an Hospital of Huai’an City, Huai’an Clinical Medical College of Jiangsu University, No. 19 Shanyang Avenue, Huai’an 223200, Jiangsu Province, China. 3461905@163.com
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Imaging Science & Photographic Technology
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Feb 15, 2026 (publication date) through Feb 3, 2026
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World Journal of Gastrointestinal Oncology
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Chen HZ, Zhang P, Ma J. Computed tomography with carcinoembryonic antigen and carbohydrate antigen 19-9 in diagnosing lymph node metastasis of early gastric cancer. World J Gastrointest Oncol 2026; 18(2): 114066 [DOI: 10.4251/wjgo.v18.i2.114066]
World J Gastrointest Oncol. Feb 15, 2026; 18(2): 114066 Published online Feb 15, 2026. doi: 10.4251/wjgo.v18.i2.114066
Computed tomography with carcinoembryonic antigen and carbohydrate antigen 19-9 in diagnosing lymph node metastasis of early gastric cancer
Hong-Zhi Chen, Ping Zhang, Jun Ma
Hong-Zhi Chen, Department of Radiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, Anhui Province, China
Ping Zhang, Department of Radiology, Huai’an Hospital of Huai’an City, Huai’an Clinical Medical College of Jiangsu University, Huai’an 223200, Jiangsu Province, China
Jun Ma, Department of Ultrasound, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu Province, China
Co-first authors: Hong-Zhi Chen and Jun Ma.
Author contributions: Chen HZ and Ma J contribute equally to this study as co-first authors; Chen HZ and Ma J contributed to research design, data collection, data analysis, and paper writing; Zhang P was responsible for research design, funding application, data analysis, reviewing and editing, communication coordination, ethical review, copyright and licensing, and follow-up.
Institutional review board statement: The research was reviewed and approved by the Medical Ethics Committee of the First Affiliated Hospital of Bengbu Medical University, Approval No.[2024]KY033.
Informed consent statement: All research participants or their legal guardians provided written informed consent prior to study registration.
Conflict-of-interest statement: No conflict of interest is associated with this work.
Data sharing statement: No other data were available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ping Zhang, Deputy Director, Department of Radiology, Huai’an Hospital of Huai’an City, Huai’an Clinical Medical College of Jiangsu University, No. 19 Shanyang Avenue, Huai’an 223200, Jiangsu Province, China. 3461905@163.com
Received: September 28, 2025 Revised: November 4, 2025 Accepted: December 1, 2025 Published online: February 15, 2026 Processing time: 127 Days and 17.8 Hours
Abstract
BACKGROUND
Gastric cancer (GC) is the fifth most prevalent and fourth most lethal malignancy globally. China bears a disproportionately high burden, accounting for 44.0% of new cases and 48.6% of deaths worldwide. In early GC (EGC), the presence of lymph node metastasis (LNM) is a critical prognostic determinant that directly guides therapeutic strategy. While multi-detector computed tomography (CT) and serum biomarkers carcinoembryonic antigen (CEA)/carbohydrate antigen 19-9 (CA19-9) are established diagnostic tools, each demonstrates limited efficacy when used independently. This study therefore aims to verify whether a combined diagnostic approach integrating multi-detector CT (MDCT) with serum CEA/CA19-9 can significantly improve the accuracy of LNM detection in EGC patients.
AIM
To investigate the diagnostic value of CT combined with CEA or CA19-9 for detecting LNM in EGC.
METHODS
This retrospective study included 120 patients with EGC confirmed by gastroscopic biopsy at our institution (Huai’an Hospital of Huai’an City) between February 2024 and August 2024. Based on postoperative pathological findings, participants were categorized into a LNM group (n = 60) and a non-metastasis group (n = 60). All patients underwent MDCT scanning and serum CEA and CA19-9 level measurements. The diagnostic efficacy of CT, CEA, and CA19-9 alone and in combination was evaluated using receiver operating characteristic (ROC) curve and Kappa consistency analysis.
RESULTS
Serum analysis showed significantly elevated CEA and CA19-9 levels and higher positivity rates in the metastasis group (P < 0.0001). ROC analysis yielded area under the curves of 0.9443 (CEA) and 0.9292 (CA19-9), with Kappa values of 0.683 and 0.650, respectively. CT revealed significantly greater short-axis diameter, CT attenuation, blood volume, and permeability in metastatic nodes (P < 0.05), whereas blood flow and mean transit time showed no significant differences. CT alone demonstrated 85.00% sensitivity and 95.00% specificity (Kappa = 0.800). Combined diagnosis improved sensitivity to 91.67% (CT + CEA) and 90.00% (CT + CA19-9), with specificities of 90.00% and 88.33%, respectively.
CONCLUSION
The combination of CT with CEA or CA19-9 improves sensitivity for detecting LNM in EGC, supporting personalized treatment planning and demonstrating clinical value.
Core Tip: This study identified that elevated computed tomography (CT) values and increased short-axis diameter of lymph nodes, along with raised serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels, are key indicators for lymph node metastasis in early gastric cancer. Combining anatomical imaging with tumor biomarker analysis improved diagnostic sensitivity and reduced the missed diagnosis rate by 6.67%-8.33% compared to using CT alone. These findings highlight the value of integrating morphological and biological data for more accurate metastasis detection, filling a gap in current diagnostic approaches and highlights the need for multimodal strategies in optimizing individualized treatment decisions.
