Application Value Of 64 Row Enhanced CT In Preoperative N Staging Of Gastric Cancer

Objective:The purpose of this study was to evaluate the diagnostic value of enhanced CT in preoperative N staging of gastric cancer by using 64 row enhanced CT in the preoperative N staging of gastric cancer and comparing it with postoperative pathological results.Method:A retrospective comparative study of preoperative enhanced CT and postoperative pathological findings in 53 patients undergoing radical gastrectomy for gastric cancer from December 2014 to October 2016 was carried out.The patients aged from 28 to 76 years old,with an average age of 63 years old.There were 43 male patients(81.1%),aged from 28 to 81 years old,with an average age of 62.9 years old;There were 10 female patients(18.9%),aged from 43 to 75 years old,with an average age of 63.2 years old.Inclusion Criteria of this study: Patients with gastric cancer diagnosed by gastroscope and pathology before operation;patients with complete data of preoperative enhanced CT examination and the postoperative pathology has been returned;Patients without preoperative neoadjuvant chemoradiotherapy;Exclusion criteria: Patients with preoperative neoadjuvant chemoradiotherapy;Patients with largetumor that cannot be resected;Patients with remnant gastric cancer;Patients who have had abdominal surgeries;Patients with incomplete imaging data.Preoperative enhanced CT examination was performed.Radical resection of gastric cancer was performed shortly after the examination(one week).There was a complete resection with negative margins(>4cm).The range of lymph node dissection is mainly D2 cleaning.Intraoperative specimens were fixed by formalin within half an hour.After Paraffin embedded sections and HE staining,they were observed and diagnosed by the pathologist under the microscope.All CT images were evaluated independently for lymph node metastasis by two radiologists with many years of experience using D ' Elia gastric cancer lymph node assessment.All pathological sections were independently read by two experienced pathologist to make their own TNM staging results.The accuracy of enhanced CT in preoperative N staging was evaluated by using the pathological staging as the gold standard.Taking the postoperative pathological diagnosis of paraffin as the gold standard,the results of preoperative N staging diagnosed by enhanced CT examination were compared with the results of postoperative pathological N staging.The SPSS 17.0 was used for consistency checking(kappa test).If the Kappa value is greater than 0.7,it means a good consistency.If the kappa value is between 0.4 and 0.7,it means a relatively good consistency.If the Kappa value is less than 0.7,it means a poorconsistency.The accuracy of enhanced CT in preoperative N staging was determined by comparison and statistical analysis.Results:The total accuracy rate of enhanced CT in preoperative N staging was 69.8%(37/53).The sensitivity of N0,N1,N2,N3 phase were 69.2%,72.7%,64.3%,73.3%,respectively;The specificity of N0~N3 was 90.9%,80%,92.3%,97.4%.There were 10 cases of understaging(62.5%)and 6cases of over stage(37.5%)in the 16 patients whose preoperative N staging had been misdiagnosed by enhanced CT.The accuracy of enhanced CT in the diagnosis of NO staging was 69.2%(9/13).There were 4 cases of over stage(30.8%).The accuracy of N1 staging was72.7%(8/11).There were 2 cases of understaging(18.1%).There were 1case of over stage(9.2%).The accuracy of N2 staging was 64.2%(9/14).There were 4 cases of understaging(28.6%).There were 1 case of over stage(7.2%).The accuracy of N3 staging was 73.3%(11/15%).There were 4 cases of understaging(26.7%).The kappa examination was performed by using the postoperative pathological diagnosis as the gold standard.The Kappa value was 0.601 kappa.The results of enhanced CT examination were well consistent with the postoperative pathological findings.Conclusion:The overall accuracy rate of enhanced CT examination for preoperative N staging was 69.8%.The result of kappa test was 0.601.The diagnostic results were in good agreement with the results of postoperative pathological diagnosis,which can evaluate the value of preoperative N staging of gastric cancer,and can be used to guide clinical treatment.