nach oben

Erschienen in:

20.12.2016 | Oncology

Can lymphovascular invasion be predicted by preoperative multiphasic dynamic CT in patients with advanced gastric cancer?

verfasst von: Zelan Ma, Changhong Liang, Yanqi Huang, Lan He, Cuishan Liang, Xin Chen, Xiaomei Huang, Yabing Xiong, Zaiyi Liu

Erschienen in: European Radiology | Ausgabe 8/2017

Einloggen, um Zugang zu erhalten

Abstract

Objectives

To determine whether multiphasic dynamic CT can preoperatively predict lymphovascular invasion (LVI) in advanced gastric cancer (AGC).

Methods

278 patients with AGC who underwent preoperative multiphasic dynamic CT were retrospectively recruited. Tumour CT attenuation difference between non-contrast and arterial (Δ_AP), portal (Δ_PP) and delayed phase (Δ_DP), tumour-spleen attenuation difference in the portal phase (Δ_T-S), tumour contrast enhancement ratios (CERs), tumour-to-spleen ratio (TSR) and tumour volumes were obtained. All CT-derived parameters and clinicopathological variables associated with LVI were analysed by univariate analysis, followed by multivariate and receiver operator characteristics (ROC) analysis. Associations between CT predictors for LVI and histopathological characteristics were evaluated by the chi-square test.

Results

Δ_PP (OR, 1.056; 95% CI: 1.032–1.080) and Δ_T-S (OR, 1.043; 95% CI: 1.020–1.066) are independent predictors for LVI in AGC. Δ_PP, Δ_T-S and their combination correctly predicted LVI in 74.8% (AUC, 0.775; sensitivity, 88.6%; specificity, 54.1%), 68.7% (AUC, 0.747; sensitivity, 68.3%; specificity, 69.4%) and 71.7% (AUC, 0.800; sensitivity, 67.6%; specificity, 77.8%), respectively. There were significant associations between CT predictors for LVI with tumour histological differentiation and Lauren classification.

Conclusion

Multiphasic dynamic CT provides a non-invasive method to predict LVI in AGC through quantitative enhancement measurement.

Key points

• Lymphovascular invasion rarely can be evaluated preoperatively in advanced gastric cancer (AGC).

• Δ _PP and Δ _T-S were independent predictors for LVI in patients with AGC.

• Δ _PP and Δ _T-S showed acceptable predictive performance for LVI.

• Combination of Δ _PP and Δ _T-S improved predictive performance for LVI.

• Multiphasic dynamic CT may be a useful adjunct for detecting LVI preoperatively.

Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 11:439–449CrossRefPubMed

Komori M, Asayama Y, Fujita N et al (2013) Extent of arterial tumor enhancement measured with preoperative MDCT gastrography is a prognostic factor in advanced gastric cancer after curative resection. AJR Am J Roentgenol 201:W253–W261CrossRefPubMed

Ahmad R, Setia N, Schmidt BH et al (2016) Predictors of Lymph Node Metastasis in Western Early Gastric Cancer. J Gastrointest Surg 20:531–538CrossRefPubMed

Li P, He HQ, Zhu CM et al (2015) The prognostic significance of lymphovascular invasion in patients with resectable gastric cancer: a large retrospective study from Southern China. BMC Cancer 15:370CrossRefPubMedPubMedCentral

Talamonti MS, Kim SP, Yao KA et al (2003) Surgical outcomes of patients with gastric carcinoma: the importance of primary tumor location and microvessel invasion. Surgery 134:720–727CrossRefPubMed

Dicken BJ, Graham K, Hamilton SM et al (2006) Lymphovascular Invasion Is Associated With Poor Survival in Gastric Cancer. Ann Surg 243:64–73CrossRefPubMedPubMedCentral

Maehara Y, Kabashima A, Koga T et al (2000) Vascular invasion and potential for tumor angiogenesis and metastasis in gastric carcinoma. Surgery 128:408–416CrossRefPubMed

Padera TP, Kadambi A, di Tomaso E et al (2002) Lymphatic metastasis in the absence of functional intratumor lymphatics. Science 296:1883–1886CrossRefPubMed

Kikuchi E, Margulis V, Karakiewicz PI et al (2009) Lymphovascular invasion predicts clinical outcomes in patients with node-negative upper tract urothelial carcinoma. J Clin Oncol 27:612–618CrossRefPubMed

10.

Chou CT, Chen RC, Lee CW, Ko CJ, Wu HK, Chen YL (2012) Prediction of microvascular invasion of hepatocellular carcinoma by pre-operative CT imaging. Br J Radiol 85:778–783CrossRefPubMedPubMedCentral

11.

Kim SH, Kim CS, Kim MJ, Cho JY, Cho SH (2016) Differentiation of clear cell renal cell carcinoma from other subtypes and fat-poor angiomyolipoma by use of quantitative enhancement measurement during three-phase MDCT. Am J Roentgenol 206:W21–W28CrossRef

12.

Lee-Felker SA, Felker ER, Tan N et al (2014) Qualitative and Quantitative MDCT Features for Differentiating Clear Cell Renal Cell Carcinoma From Other Solid Renal Cortical Masses. Am J Roentgenol 203:W516–W524CrossRef

13.

Tsurumaru D, Miyasaka M, Nishimuta Y et al (2015) Differentiation of early gastric cancer with ulceration and resectable advanced gastric cancer using multiphasic dynamic multidetector CT. Eur Radiol 26:1330–1337CrossRefPubMed

14.

Yin XD, Huang WB, Lu CY, Zhang L, Wang LW, Xie GH (2011) A preliminary study on correlations of triple-phase multi-slice CT scan with histological differentiation and intratumoral microvascular/lymphatic invasion in gastric cancer. Chin Med J (Engl) 124:347–351

15.

Kim HJ, Kim AY, Oh ST et al (2005) Gastric cancer staging at multi-detector row CT gastrography: comparison of transverse and volumetric CT scanning. Radiology 236:879–885CrossRefPubMed

16.

Rockall AG, Sohaib SA, Evans D et al (2003) Hepatic steatosis in Cushing's syndrome: a radiological assessment using computed tomography. Eur J Endocrinol 149:543–548CrossRefPubMed

17.

Lauren P (1965) The two histological main types of gastric carcinoma: Diffuse and so-called intestinal-type carcinoma. An attempt at a histo-clinical classification. Acta Pathol Microbiol Scand 64:31–49PubMed

18.

Liang YX, Deng JY, Guo HH et al (2013) Characteristics and prognosis of gastric cancer in patients aged >/= 70 years. World J Gastroenterol 19:6568–6578CrossRefPubMedPubMedCentral

19.

Busing KA, Kilian AK, Schaible T, Debus A, Weiss C, Neff KW (2008) Reliability and validity of MR image lung volume measurement in fetuses with congenital diaphragmatic hernia and in vitro lung models. Radiology 246:553–561CrossRefPubMed

20.

Holopainen T, Bry M, Alitalo K, Saaristo A (2011) Perspectives on lymphangiogenesis and angiogenesis in cancer. J Surg Oncol 103:484–488CrossRefPubMed

21.

Tomoda M, Maehara Y, Kakeji Y, Ohno S, Ichiyoshi Y, Sugimachi K (1999) Intratumoral neovascularization and growth pattern in early gastric carcinoma. Cancer 85:2340–2346CrossRefPubMed

22.

Maehara Y, Kakeji Y, Oda S, Baba H, Sugimachi K (2001) Tumor growth patterns and biological characteristics of early gastric carcinoma. Oncology 61:102–112CrossRefPubMed

23.

Kim H, Park MS, Choi JY et al (2009) Can microvessel invasion of hepatocellular carcinoma be predicted by pre-operative MRI? Eur Radiol 19:1744–1751CrossRefPubMed

24.

Yao J, Yang ZG, Chen TW, Li Y, Yang L (2010) Perfusion changes in gastric adenocarcinoma: evaluation with 64-section MDCT. Abdom Imaging 35:195–202CrossRefPubMed

25.

Satoh A, Shuto K, Okazumi S et al (2010) Role of perfusion CT in assessing tumor blood flow and malignancy level of gastric cancer. Dig Surg 27:253–260CrossRefPubMed

26.

Sun ZQ, Cheng XF, Ge YX et al (2015) Role of CT perfusion imaging in patients with variously differentiated gastric adenocarcinoma. J Xray Sci Technol 23:737–744PubMed

27.

Zongqiong S, Xiaohong L, Wei C et al (2016) CT perfusion imaging of the stomach: a quantitative analysis according to different degrees of adenocarcinoma cell differentiation. Clin Imaging 40:558–562CrossRefPubMed

28.

Sieren JC, Ohno Y, Koyama H, Sugimura K, McLennan G (2010) Recent technological and application developments in computed tomography and magnetic resonance imaging for improved pulmonary nodule detection and lung cancer staging. J Magn Reson Imaging 32:1353–1369CrossRefPubMedPubMedCentral

29.

Dong Y, Lei GW, Wang SW, Zheng SW, Ge Y, Wei FC (2014) Diagnostic value of CT perfusion imaging for parotid neoplasms. Dentomaxillofac Radiol 43:20130237CrossRefPubMed

30.

Lee SM, Kim SH, Lee JM et al (2009) Usefulness of CT volumetry for primary gastric lesions in predicting pathologic response to neoadjuvant chemotherapy in advanced gastric cancer. Abdom Imaging 34:430–440CrossRefPubMed

31.

Mori N, Mugikura S, Takasawa C et al (2016) Peritumoral apparent diffusion coefficients for prediction of lymphovascular invasion in clinically node-negative invasive breast cancer. Eur Radiol 26:331–339CrossRefPubMed

Titel: Can lymphovascular invasion be predicted by preoperative multiphasic dynamic CT in patients with advanced gastric cancer?
verfasst von: Zelan Ma
Changhong Liang
Yanqi Huang
Lan He
Cuishan Liang
Xin Chen
Xiaomei Huang
Yabing Xiong
Zaiyi Liu
Publikationsdatum: 20.12.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 8/2017
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4695-6

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Can lymphovascular invasion be predicted by preoperative multiphasic dynamic CT in patients with advanced gastric cancer?