Aims and objectives
With gastric cancer,
the lymph node (LN) staging system was changed from an anatomically based system to a numerically based system.
This change offers more appropriate prediction of prognosis,
but has some problems: it offers no information on the anatomical extent of disease,
is not useful in preoperative N staging,
and cannot represent the extent of LN dissection.
An alternative N staging system is necessary for resolving these problems.
Recently a multicenter study ofKorea and Japan proposed a new N staging system for gastric cancer...
Methods and materials
Patients
This study was approved by the Institutional Review Board of Soonchunhyang University Bucheon Hospital.
The data from 358 patients who underwent gastrectomy for primary gastric cancer at our hospital between January 2010 and September 2012 were reviewed.
Classification of LN groups based on anatomical locations
LN groups can be divided roughly into perigastric LN and extra-perigastric (EP) LN groups.
However,
because the stomach has lesser curvature (LC) and greater curvature (GC) sides,we divided perigastric LNs into two groups: LC (#1,
3,
and 5 according...
Results
The mean interval between CT scan and operation was 16.97 days ±13.59.
Using pathologic findings as the golden standard,
overall accuracy using the current N staging system was 63.7% (reader 1,
62.0%; reader 2,
67.6%).
With the new N staging system,
overall accuracy was increased to 70.1% (reader 1,
65.4%; reader 2,
72.6%).
The inter-observer agreement between the two radiologists was substantial for the current N staging and the new N staging system (0.71 and 0.69,
respectively).
There was no significant difference between two κ-values...
Conclusion
This new N classification system for gastric cancer based on modified anatomical location is simple,
intuitive,
and easy to apply to daily practice.
It may resolve problems caused by the current numeric N staging system with better diagnostic performance and acceptable inter-observer agreement.
Personal information
Min Hee Lee,
MD
Departments of Radiology,
Soonchunhyang University Bucheon Hospital,
170 Jomaru-ro,
Wonmi-Gu,
Bucheon-Si,
Gyeonggi-Do
420-767,
SouthKorea
[email protected]
Hae-Kyung Lee,
MD,
PhD
Departments of Radiology,
Soonchunhyang University Bucheon Hospital,
170 Jomaru-ro,
Wonmi-Gu,
Bucheon-Si,
Gyeonggi-Do
420-767,
SouthKorea
[email protected]
Beom Ha Yi,
MD,
PhD
Departments of Radiology,
Soonchunhyang University Bucheon Hospital,
170 Jomaru-ro,
Wonmi-Gu,
Bucheon-Si,
Gyeonggi-Do
420-767,
SouthKorea
[email protected]
References
Sobin L,
Wittekind C.
TNM Classification of Malignant Tumours.
5th ed.
New York: John Wiley. 1997.
Japanese Gastric Cancer A.
Japanese gastric cancer treatment guidelines 2010 (ver.
3).
Gastric Cancer 2011;14:113-23
Japanese Gastric Cancer A.
Japanese Classification of Gastric Carcinoma - 2nd English Edition.
Gastric Cancer 1998;1:10-24.
Japanese Gastric Cancer A.
Japanese classification of gastric carcinoma: 3rd English edition.
Gastric Cancer 2011;14:101-12.
Landis JR,
Koch GG.
The measurement of observer agreement for categorical data.
Biometrics.
1977;33(1):159–74
