6
Journal of the Korean Radiol ogica l Society, 1994; 31(2) ; 301 -305 Staging of Advanced Gastric Cancer: Comparison of Conventional CT and Intraoperative Assessment 1 Hyun Chul Rhim , M.D. , Yoon Young Choi , M.D. , 0 Keun Bae , M.D. , Jong Sung Kim , M.D ., Byung Hee Koh , M.D. , On Koo Cho , M.D. , Chang- Kok Hahm , M.D. Purpose: We performed a retrospective study to compare the accuracy be - tween conventional CT staging and intraoperative staging for advanced gastric cance r. Materials and Methods: Sixty patients with advanced gastric cancer were in- cluded in this study during the recent 2 year-period. AII were pre- and posto- peratively diagnosed as advanced gastric cancer. CTwas performed with G E 9800 and Somatom DR3 under conventional technique in 50 and with others in 10 re- ferred patients. The CT staging for T and N category with emphasis on incurable factor , if not resected , were performed . And we compared the accuracy between conventional CT and intraoperative staging. The final histo-pathologic staging was used as a gold standard. Results: Accuracy of CT and operation for T4(n=17) factor is 76.9 % and 86.2 % respectively . Overestimation rate for T4 was 9.3 % by CT and 6 .1 % by operation , and underestimation rate for was 13.8 % and 7.7 % respectively. Accuracy of CT and operation for N(n=60) factorwas 50% and 60% respectively. Overestimation rate for N factor was 18.3 % by CT and 18.3 % by operation , and underestimation rate for N factor was 31.7 % and 21.7 % respectively. Correct Tand N staging was possible only in 33% by CTand 38% by intraoperative assessment. Conclusion: Conventional CT and intraoperative staging for incurable T/N fac- tor in advanced gastric cancer have a potential limitations , especially for N fac - tor . Therefore , more reliable modality or technique such as dynamic scanning by spiral CT, transabdominal or endoscopic ultrasonography should be preopera- tively performed to complement infrequent errors in intraoperativestaging. Fur- thermore , a histology-oriented surgical approach seems essential in selecting the most appropriate surg ical procedure. IndexWords: Stomach, neoplasms Stomach , CT Neoplasms, staging INTRODUCTION Accurate preoperative staging of gastric cancer is essential to plan appropriate treament whether it is surgical or non - surgical( 1). However , accuracies of radiologic methods including computed tomography (CT) are still conflicting (2 , 6 - 16). Therefore , unnec- is still unavoidable. ' Department o fD iagnostic R ad iology , Coll ege 01 Medicine, Hanyang University Received December8 , 1993 ; Accepted June 20 , 1994 Address reprint re quests to:H yun Chul Rhim , M .D., Department 01 Di a gnostic Radiology , College 01 Medicine , Han yang University. 17, H aengdang-dong , Sungdong-ku , Seoul , 133.792 Korea Te l. 82 -2-293-21 11 , 3111 F ax. 82-2-291-9866 On the other hand , recent studies revealed frequent errors even in intraoperative assessment which has been considered as the most reliable and final staging method (16 - 19). And Japanese Stomach Cancer Study Group is recently emphasing the importance of cura- tive resection and proposing the criteria of incurable factor , if not resected , in gastric resection(20). In this study , we compared the accuracy of conven- tional CT and intraoperative staging for advanced gas- tric cancer with final patholog ic staging as a gold stan- dard. MATERIALS and METHODS In a 26 - month period , we retrospectively studied 60 - 301 โ€ข

Staging of Advanced Gastric Cancer: Comparison of ......errors even in intraoperative assessment which has been considered as the most reliable and final staging method (16-19). And

  • Upload
    others

  • View
    1

  • Download
    0

Embed Size (px)

Citation preview

Page 1: Staging of Advanced Gastric Cancer: Comparison of ......errors even in intraoperative assessment which has been considered as the most reliable and final staging method (16-19). And

Journal of the Korean Radiologica l Society, 1994; 31(2) ; 301 -305

Staging of Advanced Gastric Cancer: Comparison of Conventional CT and Intraoperative Assessment1

Hyun Chul Rhim, M.D. , Yoon Young Choi , M.D., 0 Keun Bae, M.D.,

Jong Sung Kim, M.D., Byung Hee Koh , M.D.,

On Koo Cho, M.D. , Chang- Kok Hahm, M.D.

Purpose: We performed a retrospective study to compare the accuracy be ยญtween conventional CT staging and intraoperative staging for advanced gastric cancer.

Materials and Methods: Sixty patients with advanced gastric cancer were inยญcluded in this study during the recent 2 year-period. AII were pre- and postoยญperatively diagnosed as advanced gastric cancer. CTwas performed with G E 9800 and Somatom DR3 under conventional technique in 50 and with others in 10 reยญferred patients. The CT staging for T and N category with emphasis on incurable factor , if not resected , were performed . And we compared the accuracy between conventional CT and intraoperative staging. The final histo-pathologic staging was used as a gold standard.

Results: Accuracy of CT and operation for T4(n=17) factor is 76.9 % and 86.2 % respectively. Overestimation rate for T4 was 9.3 % by CT and 6 .1 % by operation ,

and underestimation rate for was 13.8 % and 7.7 % respectively. Accuracy of CT and operation for N(n=60) factorwas 50% and 60% respectively. Overestimation rate for N factor was 18.3 % by CT and 18.3 % by operation , and underestimation rate for N factor was 31.7 % and 21.7 % respectively. Correct Tand N staging was possible only in 33% by CTand 38% by intraoperative assessment.

Conclusion: Conventional CT and intraoperative staging for incurable T/N facยญtor in advanced gastric cancer have a potential limitations, especially for N fac ยญtor . Therefore, more reliable modality or technique such as dynamic scanning by spiral CT, transabdominal or endoscopic ultrasonography should be preoperaยญtively performed to complement infrequent errors in intraoperativestaging. Furยญthermore, a histology-oriented surgical approach seems essential in selecting the most appropriate surg ical procedure.

IndexWords: Stomach , neoplasms Stomach , CT Neoplasms, staging

INTRODUCTION

Accurate preoperative staging of gastric cancer is essential to plan appropriate treament whether it is surgical or non - surgical(1). However, accuracies of radiologic methods including computed tomography (CT) are still conflicting (2 , 6-16). Therefore , unnecยญcessoryexpl์ด aparotomy is still unavoidable.

'Department ofD iagnostic Radiology, Coll ege 01 Medicine, Hanyang University Received December8, 1993 ; Accepted June 20,1994 Address reprint requests to: Hyun Chul Rhim , M.D., Department 01 Diagnostic Radiology , College 01 Medicine, Hanyang University. 17, Haengdang-dong ,

Sungdong-ku ,Seoul , 133.792 Korea Tel. 82-2-293-2111 ,3111 Fax.82-2-291-9866

On the other hand , recent studies revealed frequent errors even in intraoperative assessment which has been considered as the most reliable and final staging method (16 -19). And Japanese Stomach Cancer Study Group is recently emphasing the importance of curaยญtive resection and proposing the criteria of incurable factor , if not resected , in gastric resection(20).

In this study , we compared the accuracy of convenยญtional CT and intraoperative staging for advanced gasยญtric cancer with final patholog ic staging as a gold stanยญdard.

MATERIALS and METHODS

In a 26 - month period , we retrospectively studied 60

- 301 โ€ข

Page 2: Staging of Advanced Gastric Cancer: Comparison of ......errors even in intraoperative assessment which has been considered as the most reliable and final staging method (16-19). And

Journal 01 the Korean Radiologica l Society, 1994; 31(2) : 301 - 305

patients who had pathologically proved adenocar cinยญoma of stomach. They consisted of 37 men and 23 womยญen (mean age ; 54 yeras , range ; 27 - 81 years). CT scans were performed with either GE 9800 (General Electric , Milwaukee, U. S. A.) in 38 patients or Somatom DR3 (Siemens, Erlangen , Germany) in 12 patients , and with other third generation CT scanners in 10 referred patiยญents. Scanning variables were 120 kVp , 240 mA, scannยญing time 2 sec for GE 9800 system and 125 kVp , 350 mA, scanning time 4 secfor Somatom DR3. Ten - millimeter thick contiguous sections with 3 mm interval were acqยญuired from the diaphragm to the iliac crest. AII of 50 inยญpatients received contrast medium [a bolus 50 ml and a drip infusion 100 ml of Ultravist 300 (Schering , Germaยญny)] intravenously. AII of 50 inpa- tients received contยญrast medium (500 ml water in 38 patients , 500 ml Gasยญtrografin in 12 patients) orally before the CT procedure.

AII CT scans were reviewed in respect to depth of inยญvasion of primary lesion and Iymph node metastasis by two radiologists (H. C. R. , Y. Y. C.). Especially we foยญcused on the incurable T/N factor (T4 or any N) , if not resected , according to criteria of curative resection by Japanese Research Society for Gastric Cancer (20). T4 criteria on CT was defined as obliteration of fat plane between primary lesion and adjacent organ. T2 and T3 were considered as a single category because differยญentiation of two was very difficult by conventional techยญnique. Total number of T lesions was 65 in 60 patients , including double T41esions in 5 patients.

Lymph node metastasis were evaluated as following criteria ; NO (No metastasis) , N1 (perigastric Iymph nodes), N2(left gastric , common hepatic, splenic , celiac artery Iymph node) , and > N2(the other intraabยญdominal Iymph nodes). Lymph nodes were considered positive if they exceed 10 mm in greatest diameter. The results of CT and intraoperative surgical staging for

Fig .1 . Hepatic invasion Contrast-enhanced CT scan shows obliteration 01 lat plan e (white arrow) between 01 gastric mass and lateral segment 01 liver with adjacent locallow-attenuation lesion (b lack arrow); true positive on CT and operation

T/N factor were compared with final histo -pathologic staging.

RESULTS

Accurate estimate for T4 factor was possible in 76.9 % by CT and 86.2 % by intraoperative staging(Fig. 1) Overestimation rate for T4 was 9.3 % by CT and 6.1 % by operation , and underestimation rate was 13.8 % and 7.7 % respectively (Table 1 )(Fig. 2, 3) . Pathologically proven T4 factors were invasion to pancreas(n= 10) , transverse colon(n= 5) , and liver(n = 2)(Fig. 2, 3) . Estiยญmation of N status was accurate in 50 % by CT and 60 % by intraoperative staging. Overestimation rate for N was 18.3 % and 18.3 %, and underestimation rate was 31 .7 % and 21.7 % respectively (Table 2)(Fig. 4). Corยญrect T and N staging was possible in 33 % by CT and 38% by intraoperative assessment (Table 3).

DISCUSSION

An accurate preoperative staging of the most importยญant prognostic factor of gastric cancer , such as depth of

invasion(T) and Iymph node metastasis(~ฮนfor pl anning of appropriate treatment(1) , because overยญ

estimation may result in an unduly conservative operยญation and reduce the likel ihood of cure, whereas underยญestimation may lead to inappropriate radical surgery with risk(13)

The previous reports on the accuracy of convenยญtional CT staging is somewhat conflicting(6 -16). Five out of twelve papers revealed pessimistic conclusions for CTโ€™s role(2 , 13 -16) , while seven found CTto be useยญful(6 -12). Major limitations of these optimistic data lie in retrospective evaluation with small sized materials and comparison with intraoperative surgical assessยญment as a gold standard. But recent prospective stuยญdies using pathologic staging as a gold standard has shown the low accuracy of conventional CT and intraยญopertive staging(19). Our data has shown the agreeยญment with recent pessimistic views for the role of pre ยญoperative conventional CT staging(2 , 13 -16). Their accuracies for T and/or N categories ranged from 45 % to 56 %, which were comparable with ours.

Accuracy for T in our study seems to be higher than

Table 1 . Staging lor T Factor : CT versus Operation

CT

T2 /3 T4

42 6

9 8

76.9 9.3

13.8

4 10

86.2

6.1

7.7

OPERATION

T2 /3 T4

PATHOLOGY (n) T2 / 3(48)

T4 (17)

Accurate( %)

Overstage( %)

Understage( %)

46 5

U ใ€Œj

Page 3: Staging of Advanced Gastric Cancer: Comparison of ......errors even in intraoperative assessment which has been considered as the most reliable and final staging method (16-19). And

Hyun Chul Rhim, et al : Stagin g of Advanced Gastric Cancer

a b Fig. 2 . Pancreatic invasion

a. Contrast-enhanced CT scan shows obliteration 01 lat plane (arrows) between gastric wall and pancreatic head ; lalse positive on CT and true negative on operation

b. Contrast-enhanced CT scan shows ob literation 01 lat plane (arrows) between gastric wall and pancreatic head ; true positive on CT

and lalse negative on operation

a b Fig. 3 . Transverse colon invasion

a. Contrast-enhanced CT scan shows suspicious colonic wall thickening (arrowheads) without signilicant adjacemt omental inliltration

probably due to collapsed bowel ; lalse negative on CT and true positive on operation

b. Contrast-enhanced CT scan shows suspicious colonic wall thickening (arrows) with prominent adjacemt omental inli ltration prob-

ably du e to colonic invasion ; lalse positive on CT and true negative on operation

those of previous studies , because we excluded early Table 2 . Staging for N Factor: CT versus Operation

gastric cancer and considered T2 and T3 as single CT OPERATION category due to difficulty of differentiation between T2

NO N1 N2 ) N2 NO N1 N2 ) N2 and T3 by conventional C T. The criteria for T4 factor by

CT is not reliable because the source of errors is un- PATHOLOGY (n)

avoidable ifthe patients is emaciated or the perigastric NO( 6) 5 0 0 2 2 o 2

inflammation around tumor is present. Endoscopic N1 (24) 7 8 7 2 3 16 4

ultrasonography for T4 factor by Ziegler et al(19) N2(17) 0 5 11 4 10 2

revealed high sensitity(89%) , compared with conven- N3(13) 0 6 6 0 3 2 8

tional CT(44%) and intraoperative surgical assess- Accu rate( %) 50.0 60.0 ment(22 % ). Overstage( %) 18.3 18.3

Accuracy of conventional CT for overall N staging ac-Understage( %) 31.7 21 .7

cording to NO, N1 , N2, and ) N2 was 50 % , which was

m

ฯ‰

X ใ€

Page 4: Staging of Advanced Gastric Cancer: Comparison of ......errors even in intraoperative assessment which has been considered as the most reliable and final staging method (16-19). And

Journal of the Korean Radiological Society, 1994 : 31(2) : 301 - 305

a b Fig. 4. Lymph node metastasis a. Contrast-enhanced CT scan shows equivocallow - attenuation lesion(arrow) , considered as partial volume effect of pancreas ; false negative celiac nodes on CT and true positive on operation b. Contrast-enhanced CT scan shows 1.5 cm sized , ovoid low - attenuation lesion adjacent to portal vein(arrow) ,suggested as hepatoduodenallymph node ; true positive hepatoduodenal node on CT and false negative on operation

similar to other results. But our results revealed high underestimation rate in contrast to other reports(12 , 19). It is suggested that the criteria of Iymph node inยญvolvement could have influenced on the difference. It deems neccessary to define more sophisticated criยญteria other than size category , including shape, multiยญplicity , inter- nal texture , or relation to the tumor mass.

Another purpose of this study is to assess the re-liability of intraoperative surgical assessment. Intraยญoperative estimation of tumor infiltration and Iymph node metastases usually serve as major guidelines for decision about which operation should be performed in patients with gastric carcinoma. Type and magnitude of errors of intraoperative surgical staging in gastric canยญcer might be negligible if preoperatively conventional diagnostic procedures such as UGI , endoscopy, ultrasonography, CT were able to give a reliable inforยญmation on extent of tumors(17). Recent studies by Rhode , Madden , or Ziegler pointed outthe possibility of errors in intraoperative staging by comparing with histo - pathologic staging as a gold standard (16 -19). Rhode described that su rgical errors in staging depended on innumerable factors ; 1) . surgeon โ€™s attiยญtude towards staging 2) type of standardization or methods 3) difficulty to differentiate not advanced from more advanced at laparotomy and to ascertain the deยญgree of invasiveness of advanced tumors 4) difficulty or, rather impossibility of differention between invaded and non - invaded structures , especially ifthere is a lot of inflammatory tissue surrounding the primary tumor (1?). Our data, which showed low accuracy with conยญsiderable over - or underestimation rates of intraopeยญrative staging , support their opinion . Therefore , intraoยญperative staging alone could be insufficient in selecting the best surgical procedure for i ndividual patient(19)

Table 3. Staging for T and N Factor

T + N

CT Operation

Accurate (%) 32.0 % 38.5 %

Overstage (%) 26.0 % 20.0 %

Understage (%) 42.0 % 41 .5 %

This study showed two points; 1) the significant limitations were found in accurate T/N staging for gasยญtric cancer by conventional CT, similar to recent pessiยญmistic results , 2) the considerable errors are possible by intraoperative assessment without standardized frozen section

In conclusion , conventional CT staging in advanced gastric cancer has potential limitations as well as intraoperative surgical assessment. Therefore , more reliable modalities or techniques such as dynamic scanning by spiral CT, high - resolution transabยญdominal , or endoscopic ultrasonography are required to complement a possible errors in intraoperative macrospcopic staging. Furthermore , histology - orienยญted surgical approach with standardized frozen sections ofT/N factor during operation seems essential for selecting the most appropriate surgical procedure , whether the aim of operation is curative or pall iative

REFERENCES

1. BoddieAJr โ€˜ McBride CM , Balch CM. Gastric cancer. Am J Surg

1989 : 1 57 : 595-606 2. Andaker L, Morales 0 , Hojer H, Backstrand 8, 80rch K,Larsson

J. Evaulation of preoperative computed tomography in gastric mal ignancy. Surgery 1991 : 1 09: 132-135

304 -

Page 5: Staging of Advanced Gastric Cancer: Comparison of ......errors even in intraoperative assessment which has been considered as the most reliable and final staging method (16-19). And

Hyun Chu l Rhim, et al : Staging of Advanced Gastric Cancer

3. Meyers WG, Daniano RJ, Postlethwant RW. Adenocarcinoma 01 12 ์†๊ฒฝ๋ช…๏ผŒ ํ•˜ํ˜„๊ถŒ๏ผŒ ์ฐจ์€์ถ•๏ผŒ ๋ฐ•์กฐ๋ จ ๏ผŒ ๊น€์ธ์ฒ  ๏ผŒ ์‹ฌ๊ฒฝ์„ญ๏ผŒ ๋ฐ•์šฉํ›„| ์œ„์•”์˜ ๋ฆผํ”„

the stomach: changing patterns over the last lour decades. Ann ์ ˆ ๋ณ‘๊ธฐ ํ‰๊ฐ€์— ์žˆ์–ด์„œ CT์˜ ์œ ์šฉ์„ฑ ๋Œ€ํ•œ๋ฐฉ์‚ฌ์„ ์˜ํ•™ํšŒ์ง€ 1992 ;28

Surg 1987 ; 205: 1-8 728-732

4. Bozetti F, Bonlanti G, Audisio Ra, etal. Prognosis 01 patients after 13. Cook AOโ€˜ Levine BA, Si rinek KR , Gaskill HV. Evaluation 01 gastric

palliative surgical procedures lor carcinoma 01 stomach. Surg adenocarcinoma. Arch Surg 1986 ; 121 : 603-606

Gynecol Obstet 1987 ; 164 : 151-154 14. Sussaman SK , Halvorsen RA, IIlescas FF, et al. Gastric adeno-

5. Nalen B, Viste A, Haugstvedt T, Eide GE, Soereide O. Treatment carcinoma: CT versus surgical staging. Radiology 1988 ; 167

01 stomach cancerโ€˜ national experience. Br J Surg 1988 ; 75: 335-340

708-712 15. Komaki S, Toyshima S. CTโ€™5 capability in detecting advanced

6. Moss AA , Schnyder P, Marks W, Marg๋น„ is AR. Gastric adeno- gastriccancer. Gastrointest radio/1983 ; 8: 307-313

carcinoma: a comparison 01 the accuracy and economics 01 16. Fraser 1, Nasch R, James DC. Computed tomography in gastric

staging by computed tomography and surgery. Gastroentero- cancer. Br J Surg 1985 ;72 โ€™ 248-250

logy 1981 ; 80: 45-50 17. Rohde H, Kรถster R, Gebbensleben B, Stรผtzer H, Rau E Errors 01

7. Balle DM , Koehler RE, Karlstaedt N, Stanley RJ , Sagel SS. surgical staging in patients with cancer 01 the stomach. Scand J

Computed tomography 01 gastric neoplasm. Radiology 1981 Gastroentero/1987 ; 22: 27-30

140:431-436 18. Madden MV, Price SK, Learmonth GM , Dent DM. Surgical

8. Dehn TCB โ€˜ Rezek IB , White FE. The pre-operative assessment 01 staging 01 gastric carcinoma: sources and consequence 01

advanced gastric cancer by computed tomography. Br J Surg errors. Br J Surg 1987 ; 74 : 119-121

1984 ;71 :413-417 19. Ziegler K, Snaft C, Zimmer T, et al. Comparison 01 computed-

9 ์„œํ˜•์‹ฌ ๏ผŒ ์ด์žฌ์„ญ ๏ผŒ ์ด์ข…์ง„ ๋“ฑ ์œ„์•”ํ™˜์ž์— ์žˆ์–ด์„œ ์ „์‚ฐํ™” ๋‹จ์ธต์ดฌ์˜์ˆ ์˜ tomography, endosonography, and intraoperative assessment

์ง„๋‹จ์  ์œผ|์˜ ๋Œ€ํ•œ๋ฐฉ์‚ฌ์„ ์˜ํ•™ํšŒ์ง€ 1985 ; 21 : 105-113 in TN staging olgastric carcinoma. Gut1993 ; 34: 604-61 0

10 ์‹ ์ง€์—ด๏ผŒ ์‹ฌ์ „์„ญ ๏ผŒ ๊น€๋ณ‘์˜ ๋“ฑ ์ „์‚ฐํ™”๋‹จ์ธต์ดฌ์˜์ˆ ์— ์˜ํ•œยท์šฐ|์•”์˜ ์ˆ˜์ˆ ์ „ 20. Japanese Research Society lor Gastric Cancer. The general

๋ณ‘๊ธฐ๊ฒฐ์ •์˜ ์˜์˜ ๋Œ€ํ•œ๋ฐฉ์‚ฌ์„ ์˜ํ•™ํšŒ์ง€ 1989 ;25:741-747 rules 01 gastric cancer study 12th ed ้‡‘ๅŽŸๅ‡บ็‰ˆๆขฐํ•ฉๆœƒ็คพ 1993 ;

11 ๋…ธ๋ณ‘์„ ๏ผŒ ์ž„ ๋• ๏ผŒ ๊น€๊ธฐํ™˜๋“ฑ CT๋ฅผ์ด์šฉํ•œ์œ„์•”์˜ํ›ผ์žฅ์นจ์Šต์—๋Œ€ํ•œํŒ์ • 32-33

๋Œ€ํ•œ๋ฐฉ์‚ฌ์„ ์˜ํ•™ํšŒ์ง€ 1990 ; 26 : 1 02-1 06

๋Œ€ํ•œ๋ฐฉ์‚ฌ์„ ์˜ํ•™ํšŒ์ง€ 1994; 31(2): 301-305

์ง„ํ–‰์„ฑ ์œ„์•”์— ๋Œ€ํ•œ ๋ณ‘๊ธฐ๊ฒฐ์ • :๊ณ ์‹์  CT์™€ ์ˆ˜์ˆ ์ƒ ๋ณ‘๊ธฐ๊ฒฐ์ •์˜ ๋ฒผ๊ต

ํ•œ์–‘๋Œ€ํ•™๊ต ์˜๊ณผ๋Œ€ํ•™ ์ง„๋‹จ๋ฐฉ์‚ฌ์„ ๊ณผํ•™๊ต์‹ค

์ž„ํ˜„์ฒ ยท์ตœ์œค์—‰ยท๋ฐฐ์˜ค๊ทผยท๊น€์ข…์„ฑยท๊ณ ๋ณ‘ํฌยท์กฐ์˜จ๊ตฌยทํ•ฉ์ฐฝ๊ณก

๋ชฉ ์ :์ง„ํ–‰์„ฑ ์œ„์•”์˜ ๋ณ‘๊ธฐ๊ฒฐ์ •์— ์žˆ์–ด์„œ ๋น„์ ˆ์ œ์‹œ ์น˜์œ ๋ถˆ๊ฐ€์ธ์ž๋กœ ์•Œ๋ ค์ง„ T4๋ฐ N์„์ค‘์‹ฌ์œผ๋กœ ๊ณ ์‹์  CT ๋ฐ ์ˆ˜์ˆ ์ƒ์˜ ๋ณ‘

๊ธฐ๊ฒฐ์ •์˜ ์„ฑ์ ์„ ํ›„ํ–ฅ์ ์œผ๋กœ ๋น„๊ตํ•˜์—ฌ ์ˆ ์ „ ๋ฐ ์ˆ ์ค‘ ๋ณ‘๊ธฐ๊ฒฐ์ •์˜ ์œ ์šฉ์„ฑ ๋ฐ ๋ฌธ์ œ์ ์„ ์•Œ์•„๋ณด๊ณ ์ž ํ•˜์˜€๋‹ค.

๋ฐฉ ๋ฒ• . ์ตœ๊ทผ 2๋…„๋™์•ˆ ์ง„ํ–‰์„ฑ ์œ„์•”์œผ๋กœ ์ง„๋‹จ๋ฐ›์•„ ์œ„์ ˆ์ œ์ˆ ์„ ๋ฐ›์•˜๋˜ 60๋ช…์˜ ํ™˜์ž๋ฅผ ๋Œ€์ƒ์œผ๋กœ ํ•˜์—ฌ ๊ณ ์‹์  CT๊ฒ€์‚ฌ์ƒ ๋ฐ ์ˆ˜

์ˆ ์ค‘ ์œก์•ˆ์ ์œผ๋กœ ํ‰๊ฐ€ํ•œ ๋ณ‘๋ณ€์˜ ์นจ์œค๋„(T)์™€ ์ž„ํŒŒ์„  ์ „์ด ์ •๋„(N)์— ๋Œ€ํ•˜์—ฌ ํ›„ํ–ฅ์ ์œผ๋กœ ํ‰๊ฐ€ํ•˜์—ฌ ์ด๋ฅผ ์ตœ์ข…๋ณ‘๋ฆฌํ•™์  ๋ณ‘๊ธฐ

๋ฅผ ๊ธฐ์ค€์œผ๋กœ ๊ฐ๊ฐ์˜ ์ •ํ™•๋„๋ฅผ ๋น„๊ต๋ถ„์„ํ•˜์˜€๋‹ค.

๊ฒฐ ๊ณผ : ๋ณ‘๋ณ€์˜ ์นจ์œค๋„์— ๋Œ€ํ•œ ์ฆ‰๏ผŒ ์ธ์ ‘์žฅ๊ธฐ ์นจ๋ฒ” (T4)์— ๋Œ€ํ•œ CT ๋ฐ ์ˆ ์ค‘์ง„๋‹จ์˜ ์ •ํ™•๋„๋Š” ๊ฐ๊ฐ 76.9 % , 86.2 % ์˜€์œผ๋ฉฐ๏ผŒ ๊ณผ

๋Œ€ํ‰๊ฐ€๋Š” 9.3 %. 6.1 % ์˜€๊ณ  ๊ณผ์†Œํ‰๊ฐ€๋Š” 13.8 %. 7.7 % ์˜€๋‹ค. ์ž„ํŒŒ์„  ์ „์ด์ •๋„(N)์— ๋Œ€ํ•˜์—ฌ CT ๋ฐ ์ˆ ์ค‘์ง„๋‹จ์˜ ์ •ํ™•๋„๋Š” ๊ฐ

๊ฐ 50 %์™€ 60 %์˜€๊ณ  ๊ณผ๋Œ€ํ‰๊ฐ€๋Š” ๊ณตํžˆ 18.3 % ๊ณผ์†Œํ‰๊ฐ€๋Š” ๊ฐ๊ฐ 3 1.7 % ์™€ 2 1.7 % ์˜€๋‹ค. ํ•œํŽธ ๋ณ‘๋ณ€์˜ ์นจ์œค๋„ ๋ฐ ์ž„ํŒŒ์„ฃ ์ „์ด

์ •๋„๋ฅผ ๋ชจ๋‘ ์ •ํ™•ํžˆ ํ‰๊ฐ€๊ฐ€ ๊ฐ€๋Šฅํ–ˆ๋˜ ๊ฒฝ์šฐ๋Š” CT๋กœ๋Š” 33%์—์„œ ์ˆ ์ค‘์—์„œ๋Š” 38%์—์„œ ๊ฐ€๋Šฅํ•˜์˜€๋‹ค.

๊ฒฐ ๋ก :๊ณ ์‹์  CT์–ด| ์˜ํ•œ ์ง„ํ–‰์„ฑ์œ„์•”์˜ ๋ณ‘๊ธฐ๊ฒฐ์ •์€ ๋น„์ ˆ์ œ์‹œ ์น˜์œ ๋ถˆ๋Šฅ์ธ์ž๋กœ ์—ฌ๊ฒจ์ง€๋Š” ์ฃผ๋ณ€์žฅ๊ธฐ๋กœ์˜ ์นจ๋ฒ”์œ ๋ฌด(T4)์— ๋Œ€

ํ•ด์„œ๋Š” ์–ด๋Š์ •๋„์˜ ์œ ์šฉ์„ฑ์„ ๊ฒฌ์ง€ํ•˜๊ณ  ์žˆ์œผ๋‚˜ ์ž„ํŒŒ์„ฃ ์ „์ด์˜ ํ‰๊ฐ€์— ์žˆ์–ด์„œ๋Š” ๋‚ฎ์€ ์ •ํ™•๋„๋ฅผ ๋ณด์˜€๊ณ ๏ผŒ ์ด๋Ÿฌํ•œ ๋ฌธ์ œ์ ์€ ์ตœ์ข…

๋ณ‘๊ธฐ๊ฒฐ์ • ๋ฐฉ๋ฒ•์ธ ์ˆ ์ค‘ ๋ณ‘๊ธฐ ํ‰๊ฐ€์ƒ์—์„œ๋„ ๋‚ด์žฌ๋˜์–ด ์žˆ์Œ์ด ํ™•์ธ๋˜์—ˆ๋‹ค. ๋”ฐ๋ผ์„œ ํ˜„ํ–‰์˜ ๊ณ ์‹์  CTOI์ƒ์˜ ๋ณด๋‹ค ์‹ ๋ขฐ๋„ ๋†’์€

์ˆ ์ „ ๋ฐฉ์‚ฌ์„ ํ•™์  ์ง„๋‹จ๋ฒ•์œผ๋กœ์˜ ์ „ํ–ฅ์ด ํ•„์š”ํ•˜๋ฉฐ๏ผŒ์ˆ ์ค‘ ๋ณ‘๊ธฐ๊ฒฐ์ •์˜ ์ •ํ™•๋„์˜ ํ–ฅ์ƒ์„์œ„ํ•œ๋‹ค๊ฐ์ ์ธ ๋…ธ๋ ฅ๋„์ด์–ด์ ธ์•ผ ํ• ๊ฒƒ์œผ

๋กœํŒ๋‹จํ•œ๋‹ค.

%

Page 6: Staging of Advanced Gastric Cancer: Comparison of ......errors even in intraoperative assessment which has been considered as the most reliable and final staging method (16-19). And

1994๋…„๋„ ์ถ˜๊ณ„ํ•™์ˆ ๋Œ€ํšŒ ์ฆ๋ก€ํ€ด์ฆˆ( III )

Case 4. F/30 C.C. ; intermittent neck pain since

2 months ago

Answer ; neurenteric cyst of C-spine

- 306