Routine chest CT for staging of gastric cancer

• Published in: British journal of surgery Vol. 106; no. 9; pp. 1197 - 1203
• Main Authors: Chen, A.‐H., Chan, W.‐H., Lee, Y.‐H., Tseng, J.‐H., Yeh, T.‐S., Chiu, C.‐T., Chen, J.‐S., Chen, C.‐M.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-08-2019; Oxford University Press
• Subjects: Aged; Female; Gastric cancer; Humans; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - secondary; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - secondary; Male; Metastasis; Middle Aged; Neoplasm Staging - methods; Original; Peritoneal Neoplasms - diagnostic imaging; Peritoneal Neoplasms - secondary; Radiography, Thoracic; Retrospective Studies; Stomach Neoplasms - diagnostic imaging; Stomach Neoplasms - pathology; Surgery; Tomography, X-Ray Computed; Upper GI
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.11186

Background
International guidelines on clinical staging of gastric cancer recommend the use of chest CT for the detection of pulmonary metastases. This study assessed the clinical value of routine chest CT in the staging of gastric cancer.
Methods
This retrospective study included patients identified from the gastric cancer registry of Chang Gung Memorial Hospital, Linkou, Taiwan. All patients who underwent clinical staging between 2008 and 2014 were included. The pattern, site and number of metastases at initial presentation and after surgery with curative intent were evaluated. Pulmonary metastases were defined as multiple small round pulmonary nodules with a random distribution or of variable size.
Results
Some 1669 patients were included, of whom 478 (28·6 per cent) had metastatic disease at clinical presentation. The majority of metastases were to the peritoneum (75·7 per cent of patients) or liver (30·5 per cent), and only 27 patients (5·6 per cent) had pulmonary metastases at presentation, none of which were isolated to the lung. Of these 27 patients, 11 had primary lesions located at the cardia/fundus. In 19 patients the lung metastases were also detected on the staging chest X‐ray. After surgery there were 196 cancer recurrences. Some 15 patients (7·6 per cent) had lung metastasis and this was not the only site of metastases in any patient. The prevalence of lung metastasis at presentation of the disease and after surgery was 1·6 and 1·5 per cent respectively.
Conclusion
This study does not support the routine use of chest CT for staging of gastric cancer as isolated pulmonary metastasis in the absence of other metastatic sites could not be detected.
Routine inclusion of chest CT in gastric cancer staging is not necessary because of the rarity of pulmonary metastasis at initial presentation and at recurrence following surgery with curative intent, and the absence of isolated pulmonary metastasis. The incidence of lung metastasis was 1·6 per cent. LN, lymph nodes.
Not needed