• Radiology · Nov 2016

    Early Gastric Cancers: Is CT Surveillance Necessary after Curative Endoscopic Submucosal Resection for Cancers That Meet the Expanded Criteria?

    • Kyu Sung Choi, Se Hyung Kim, Sang Gyun Kim, and Joon Koo Han.
    • From the Departments of Radiology (K.S.C., S.H.K., J.K.H.) and Internal Medicine (S.G.K.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (S.H.K., J.K.H.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.K.H.).
    • Radiology. 2016 Nov 1; 281 (2): 444-453.

    AbstractPurpose To determine the yield of follow-up abdominopelvic computed tomography (CT) in detecting extragastric recurrence after curative endoscopic submucosal dissection (ESD) for early gastric cancers (EGCs) that meet the expanded criteria. Materials and Methods Institutional review board approval was obtained for this retrospective study, and the requirement to obtain informed consent was waived. Patients who underwent curative ESD for EGCs that met the expanded criteria between November 2005 and December 2009 and who underwent post-ESD CT and endoscopy were included. The final cohort comprised 415 EGCs in 404 patients (261 EGCs in 251 patients met the conventional criteria, and 154 EGCs in 153 patients met the expanded criteria). The primary outcome was post-ESD CT discovery of extragastric recurrence (ie, lymph node or distant metastasis) not detected with endoscopy. The mean radiation dose from each CT examination was calculated. The incidence of gastric recurrence detected with endoscopy and/or CT was also analyzed. The cumulative incidence of gastric recurrence during the post-ESD follow-up period was analyzed with the Kaplan-Meier method. Results From a total of 2182 post-ESD CT examinations, extragastric recurrence (lymph node metastasis) was detected in only two patients (one with EGC that met conventional criteria and one with EGC that met expanded criteria). The mean (±standard deviation) volume CT dose index, dose-length product, and size-specific dose estimate per CT examination was 28.95 mGy ± 8.44, 876.80 mGy · cm ± 161.86, and 43.78 mGy ± 11.54, respectively. From a total of 3262 post-ESD endoscopic examinations, 41 gastric recurrences were detected (11 local recurrences and five synchronous and 25 metachronous gastric cancers). Among them, eight gastric recurrences were also detected with CT. The cumulative incidences of gastric recurrence 1, 3, and 5 years after ESD were 1.7% (two of 404 patients), 3.2% (13 of 404 patients), and 7.4% (30 of 404 patients), respectively. Conclusion When EGC meets the expanded criteria, surveillance CT after curative ESD rarely depicts extragastric recurrence during 5-year post-ESD follow-up. © RSNA, 2016 Online supplemental material is available for this article.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…

What will the 'Medical Journal of You' look like?

Start your free 21 day trial now.

We guarantee your privacy. Your email address will not be shared.