Value of multi-slice spiral computed tomography in the diagnosis of metastatic lymph nodes and N-stage of gastric cancer

OBJECTIVE: To establish new diagnostic criteria for improvement of the accuracy of multi-slice spiral computed tomography (MSCT) in diagnosing the N-stage and lymph node (LN) metastasis of gastric cancer (GC). METHODS: MSCT was performed with plain and triphasic dynamic contrast enhancement. Different regions of LN metastasis and N-staging were determined according to the herein-proposed combined diagnostic criteria and were then correlated with the pathological analysis. The Kappa consistency test was used to study the accuracy of MSCT. RESULTS: The accuracy of MSCT in diagnosing the N-stage as a whole was 86.3%, and that in diagnosing LN metastasis was 79.1% to 98.9%. The Kappa values for stages N0, N1, and N3 ranged from 0.449 to 0.662, indicating good consistency in diagnosing these three stages between MSCT and the postsurgical pathological results. The K(total) value was 0.567 between MSCT and the postsurgical pathological results in diagnosing LN metastasis. The risk of LN metastasis increased with the progression of lesion infiltrates. CONCLUSIONS: Application of the combined diagnostic criteria increased the diagnostic performance of MSCT in not only judging the N-stage but also diagnosing LN metastasis. This study will provide valuable reference data for surgical planning for patients with GC in the clinical setting.