Risk factors and multidetector-row computed tomography evaluation of lymph node metastasis in early gastric carcinoma

AIM: To identify the risk factors predicting lymph node metastasis in early gastric carcinoma (EGC) and to investigate the value of multidetector-row computed tomography (MDCT) in the preoperative assessment of lymph node metastasis. METHODS: Relationship between the clinicopathological parameters and lymph node metastasis in 109 EGC patients (male 64, female 45, mean age 56) who underwent preoperative MDCT examination and curative gastrectomy was retrospectively analyzed. In addition, the results of lymph node status evaluated by MDCT were compared with pathologic findings. RESULTS: The incidence rate of lymph node metastasis was 15.60% in EGC patients. The incidence of lymph node metastasis in submucosal carcinoma was significantly higher than that in mucosal carcinoma (25.00% vs 9.23%, P = 0.026). However, the lymph node metastasis in EGC was not closely related to the gender, age of patients, tumor size, macroscopic type, tumor location, and histological type. Receiver operating characteristic (ROC) analysis further showed that the accuracy of tumor size for determination of lymph node metastasis in EGC was relatively low (area under ROC curve was 0.63). The overall accuracy of MDCT in preoperative N staging of EGC was 82.6% (N0 85.9%, N1 64.3%, N2 66.7%, respectively). The diagnostic sensitivity, specificity and accuracy of MDCT for determining lymph node metastases of EGC were 70.6%, 85.9%, and 83.5%, respectively. The diagnostic sensitivity of MDCT for determining lymph node metastasis was 50.0% in patients with solitary lymph node metastasis, while 88.89% in those with more than one lymph node metastasis. In 5 EGC patients, the lymph node metastasis was not detected by MDCT. However, the tumor size of all these 5 patients was larger than or equal to 2 cm in diameter, and both of the two mucosal carcinomas belonged to depressed EGC. CONCLUSION: Although the clinical value of MDCT in the preoperative assessment of lymph node metastasis in patients with EGC is relatively high, we still must pay great attention to the value of lymph node metastasis-associated clinicopathological parameters in predicting lymph node status when the minimally invasive therapy is to be performed for patients with EGC.