Korean J Gastrointest Endosc > Volume 37(2); 2008 > Article
Korean Journal of Gastrointestinal Endoscopy 2008;37(2): 90-96.
내시경 절제술이 가능한 조기 위암의 림프절 병기결정에 있어 전산화단층촬영의 진단적 정확도
인제대학교 의과대학 상계백병원 내과학교실, *영상의학교실, 진단병리학교실
Diagnostic Accuracy of Computed Tomography for the Lymph Node Staging of Endoscopically Resectable Early Gastric Cancer
Tae-Hoon Oh, M.D., Ban-Suck Lee, M.D., Min-Geun Kim, M.D., Jeong Soo Ahn, M.D., Tae Joo Jeon, M.D., Dong Dae Seo, M.D., Won Choong Choi, M.D., Won Chang Shin, M.D., Myeong-Ja Jeong, M.D.* and Hyun-Jung Kim, M.D.
Departments of Internal Medicine, *Radiology and Pathology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

Accurate staging of the lymph nodes (LNs) before endoscopic mucosal resection (EMR) is important. We evaluated the accuracy of CT for LN staging in patients the endoscopically resectable early gastric cancer (EGC).
The medical records of 155 EGCs patients who had undergone an operation were analyzed. The pre-operatively performed multidetector CT scans and the post-operative histopathologic findings were reviewed for comparing the LN staging with that using the Japanese classification system. Endoscopically resectable EGC was defined as EGC without LN metastasis and also the EGC that satisfied the EMR criteria according to the Japanese guideline.
The diagnostic efficacy of CT for LN staging of all the enrolled EGC patients was as follow: accuracy 65.2%, overstaging rate 29.7%, understaging rate 5.2%. The overall accuracy and the overstaging rate of CT for LN staging of endoscopically resectable EGC were as follows: EGC without LN metastasis [69.8% (97/139), 30.2% (42/139)], EGC satisfying extended criteria [72.5% (58/80), 27.5% (22/80)] and EGC satisfying limited criteria [79.2% (19/24), 20.8% (5/24)]. The accuracy of the EMR criteria for predicting node negative EGC were as follows: the extended criteria 98.8% (79/80), the limited criteria 100% (24/24). Conclusions: Our study showed that prediction of LN metastasis before EMR according to CT staging had limited value due to the tendency of overestimation. Therefore, we should preferentially consider the treatment strategy according to the EMR criteria. (Korean J Gastrointest Endosc 2008;37:90-96)
Key Words: Early gastric cancer, Computed tomography, Endoscopic mucosal resection, Neoplasm staging
주요어: 조기 위암, 전산화단층촬영, 내시경 점막 절제술, 종양 병기결정
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