Research articleHistopathologic diversity of gastric cancers: Relationship between enhancement pattern on dynamic contrast-enhanced CT and histological type
Introduction
Computed tomography (CT) has been a standard imaging modality for preoperative staging for gastric cancers. Recently, multidetector row CT (MDCT) techniques have advanced the accuracy of determinations of depth of invasion at the primary site of gastric cancer (T stage) as well as nodal involvement (N stage) and distant metastasis (M stage) [1], [2], [3]. There have also been reports on gastric-cancer analysis using a three-dimensional (3D) CT technique known as CT gastrography (CTG) [2], [4], [5], [6]. These studies demonstrated that gastric cancer causes wall thickening of the stomach with moderate to marked enhancement in the early phase [6], [7], [8]. However, unlike colorectal, esophageal and other gastrointestinal cancers, gastric cancers exhibit diversity in various pathological factors, including histological type, differentiation, stroma, and infiltration patterns. Histological type is one of the most important factors because it has a close relationship to the aggressiveness of the disease or prognosis of patients with gastric cancer [9], [10], [11]. It is known that patients with poorly differentiated-type gastric cancers have a worse prognosis than those with well differentiated-type gastric cancers [12]. Endoscopic biopsy is the only way to obtain histological diagnosis of gastric cancer preoperatively. However, the small specimens obtained by endoscopic biopsy allow diagnosis of only a small part of the lesion, and not the whole lesion. Some gastric cancers are of a mixed histological type that includes both differentiated and undifferentiated adenocarcinoma. Several authors reported that CT enhancement pattern of gastric cancers would be influenced by histological components [10], [13]. We hypothesized that histological feature of whole component of gastric cancer can be preoperatively predictable by CT enhancement pattern.
The purpose of this study was to evaluate the diagnostic value of CE-CTG to predict the histological type of gastric cancer and to compare the diagnostic performance of CTG and endoscopic biopsy.
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Patients
This retrospective study was approved by the institutional review board of our institusion, and informed consent was waived. From January 2013 to December 2015, 142 consecutive patients with gastric cancer were evaluated by gastroscopy and CE-CTG at our institution. All gastric cancer patients at our institution preoperatively underwent CE-CTG to determine clinical stage except for contraindication for intravenous contrast agent such as iodine allergy.
We enrolled 56 patients with advanced
Peak enhancement (subjective analysis)
We compared the peak enhancement phase of the three types using Chi-square tests as subjective analyses. The interobserver agreement between the two readers was evaluated using κ statistics. A κ value of 0.00–0.20 indicated poor, 0.21–0.40 fair, 0.41–0.60 moderate, 0.61–0.80 good and 0.81–1.00 excellent agreement.
CT attenuation values (objective analysis)
We compared the CT attenuation values of the three types in each phase using analysis of variance (ANOVA) as objective analyses for the two readers’ results. Interobserver variability
Peak enhancement (subjective analysis)
In the subjective CT analyses, the Chi-square test results showed that the peak enhancement was significantly different between the three types for both readers (reader 1, p = 0.001; reader 2, p = 0.009); most of the undifferentiated types had peak enhancement in the delayed phase (Table 2). The agreement of the two readers was good for the peak enhancement analyses (κ, 0.76).
CT attenuation values (objective analysis)
In the objective CT analyses, the CT attenuation values were significantly different between three types in the delayed
Discussion
There were differences in CT attenuation values among histological types of gastric cancers in this objective study. Undifferentiated-type gastric cancers showed significantly higher CT attenuation values than other types of gastric cancers in the delayed phase. According to the subjective study, the peak enhancement differed depending on the histological type: the differentiated type peaked in the arterial or portal phase while the undifferentiated type peaked in the delayed phase.
It is
Conflict of interest
The authors declare that they have no conflict of interest.
Funding
This work was supported by JSPS KAKENHI Grant Number 16K10284.
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