Value of Computed Tomography in Diagnosis of Gastric Cancer

Abstract

Author: Jeswin Paul Title: Value of Computed Tomography in diagnosing Gastric cancer Aim: To evaluate the value of CT in diagnosing gastric cancer

Objective: Evaluate the diagnostic accuracy of Computed tomography in Gastric cancer Examine the role of CT in gastric cancer staging Compare computed tomography with other imaging modalities in gastric cancer diagnosis.

Methodology: Search for relevant articles systematically using search engines such as Google Scholar, PubMed, Web of Science, and ScienceDirect. References were manually searched to identify other further valuable studies. The following keywords were used: "MDCT" OR "multi-detector computed tomography" OR "CT" OR "computed tomography" OR "MSCT" OR "multi-slice computed tomography" OR "EUS" OR "endoscopic ultrasound" OR "MRI" OR "magnetic resonance imaging" AND "stomach cancer" OR "gastric cancer" OR "gastric adenocarcinoma" AND "specificity" OR "sensitivity" OR "diagnostic accuracy". The studies were narrowed down using PRISMA using inclusion and exclusion criteria.

Results: CT alone for the detection of GC has an average sensitivity of 75.2%, specificity of 82.9%, and diagnostic accuracy of 85.8%. MDCT, combined with reconstructive techniques, increased sensitivity and diagnostic accuracy to 90.2% and 91.5%, respectively. CT shows variation in its ability to differentiate between benign and malignant GC using antral wall thickness, but the most common agreed thickness used to determine malignancy is 10mm.

MDCT's sensitivity for T staging GC is 41-71% for T1, 48-67% for T2, 63-74% for T3, and 61-66% for T4. MDCT combined with reconstructive methods increases the sensitivity in all T stages. CT showed a sensitivity range between 72-86.5% for N staging. However, the sensitivity decreased as the cancer advanced to 21-61%. Regarding M staging, CT had a total accuracy of 94.7%, with an average sensitivity of 33-90% for peritoneal metastasis and 90-100% for liver metastases.

When comparing EUS and CT, the sensitivity of MDCT ranged between 53.5-96% with an average sensitivity of 72.9%. EUS ranged between 64-82.4% with an average sensitivity of 71.6%. The specificity of T staging GC with MDCT ranged between 89.3-94.4%, with an average specificity of 92.1%. Meanwhile, EUS ranged between 87.3-96%, with an average specificity of 91.7%. In terms of total accuracy, MDCT had an accuracy of 67.1%, while EUS had an average total accuracy of 81.1%.

MRI had a sensitivity of 82.1% for T staging, while MDCT had 79.7%. The specificity of T staging GC was 87.9%, while MDCT was 92.1%. Regarding N staging GC, MRI had an average sensitivity of 82.4% and an average sensitivity of 57.6%. On the other hand, for specificity, MRI had a range between 58.8-100% with an average of 81.7%, and MDCT had a range between 80.1-100% with an average of 92.4%. For M staging, MRI had an average sensitivity, specificity, and total accuracy of 66.5%, 100%, and 97.6%, while for MDCT, it was 49.5%, 100% and 67.1%.

Conclusion: In conclusion, although EUS is the most accurate method for GC for staging both T and N, computed tomography presents a valuable method for gastric cancer diagnosis, especially for detecting distant metastasis. The accuracy of CT is improving significantly with the use of VG, MPR, and VP as these increase their value in T staging and distinguishing between benign and metastatic tumors. According to studies, MRI/DWI may be comparable to MDCT. The progression in advancement suggests that MDCT's value may become more prominent in diagnosing and staging gastric cancer.