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Four-Point Computed Tomography Scores for Evaluation of Occult Peritoneal Metastasis in Patients with Gastric Cancer: A Region-to-Region Comparison with Staging Laparoscopy

四点 ct 评分评价胃癌患者隐匿性腹膜转移: 与分期腹腔镜的区域间比较

  • 影响因子:3.60
  • DOI:10.1245/s10434-019-07812-y
  • 作者列表:"Li, Zi-Yu","Tang, Lei","Li, Zhe-Min","Li, Yan-Ling","Fu, Jia","Zhang, Yan","Li, Xiao-Ting","Ying, Xiang-Ji","Ji, Jia-Fu
  • 发表时间:2020-01-21
Abstract

Background Preoperative diagnosis of peritoneal metastasis with gastric cancer remains challenging. This study explored the abnormal computed tomography (CT) signs of occult peritoneal metastasis (OPM) and evaluated it by region-to-region comparison using staging laparoscopy, from which a 4-point CT score system was developed. Methods Patients with advanced gastric cancer (stage cT ≥ 2M0) diagnosed by CT were enrolled in the study. Occult peritoneal metastasis detected during staging laparoscopy was compared with preoperative CT to investigate the presence of abnormal signs by a region-to-region comparison. A 4-point CT score system was developed to define the radiologic characteristics. Subsequently, the diagnostic efficacy of the CT score system was prospectively verified. Results In this study, 57 OPM regions were detected by staging laparoscopy in 33 of the 385 enrolled patients. The greater omentum was the most frequent site of OPM (38.60%, 22/57), which usually exhibited a smudge-like ground-glass opacity (S-GGO) (90.91%, 20/22) with a mean CT score of 2.14. The parietal and perihepatic peritoneum was the second most common site (22.81%, 13/57). A 4-point CT score system was developed based on the results. A cutoff CT score of 2 or higher was associated with a false-negative rate of 2% (2/99). This CT score system had a sensitivity of 87.5% and a specificity of 76.4% for an OPM-positive diagnosis (area under the curve, 0.848). The agreement between two radiologists on the assigned final score was 76.2% (kappa, 0.5). Conclusions Patients with OPM mostly exhibited S-GGO on CT, which should be interpreted cautiously. The 4-point CT score system may improve the pretreatment evaluation of occult peritoneal metastasis, and staging laparoscopy might not be necessary for patients with a score lower than 2.

摘要

背景胃癌腹膜转移的术前诊断仍然具有挑战性。本研究探讨隐匿性腹膜转移 (OPM) 的异常计算机断层扫描 (CT) 征象,并使用分期腹腔镜通过区域间比较进行评价, 从中开发了 4 分 CT 评分系统。方法经 CT 诊断为进展期胃癌 (CT ≥ 2M0 期) 患者纳入研究。将分期腹腔镜术中发现的隐匿性腹膜转移与术前 CT 进行比较,通过区域间比较探讨异常征象的存在。开发了一个 4 分 CT 评分系统来定义放射学特征。随后,前瞻性验证了 CT 评分系统的诊断效能。结果在本研究中,385 例入组患者中 33 例通过分期腹腔镜检测到 57 个 OPM 区域。大网膜是 OPM 最常见的部位 (38.60%,22/57),它通常表现出类似污迹的磨玻璃不透明度 (S-GGO) (90.91%,20/22) 平均 CT 评分为 2.14。壁层和肝周腹膜是第二常见的部位 (22.81%,13/57)。根据结果开发了 4 分 CT 评分系统。截断值为 2 分或更高的 CT 评分与 2% (2/99) 的假阴性率相关。该 CT 评分系统对 OPM 阳性诊断的敏感性为 87.5%,特异性为 76.4% (曲线下面积,0.848)。两名放射科医生对分配的最终评分的一致性为 76.2% (kappa,0.5)。结论 OPM 患者 CT 上多表现为 S-GGO,应谨慎解读。4 分 CT 评分系统可改善隐匿性腹膜转移的预处理评价,评分低于 2 分的患者可能不需要分期腹腔镜。

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