CT에 의한 신우암의 병기 결정

윤수웅 대한영상의학회 1999 대한영상의학회지 Vol.40 No.1

Purpose : To assess the value of computed tomography (CT) in the preoperative staging of transitional cellcarcinoma (TCC) of the renal pelvis. Materials and Methods : We retrospectively evaluated the CT TNM staging of 38patients with TCC of the renal pelvis who had undergone preoperative abdominal CT examination between January 1990and January 1998. In CT staging for differentiation between early-stage (TO-2) and advanced-stage disease (T3-T4),three criteria were used, namely the presence or obliteration of the renal sinus fat layer, the smoothness orirregularity of margin between the tumor and renal parenchyma, and the presence or absence of hydronephrosisproximal to the tumor. CT staging was performed by two genitourinary radiologists blinded to the pathologicresults, and was compared with pathologic staging. Results : Pathologic results revealed 19 cases of early stagedisease (TO=8, T1=9, T2=2) and 19 of advanced stage (T3=12, T4=7). Overall CT staging accuracy was 82%(31/38);fourcases were overstaged and three were understaged. In early-stage disease, sensitivity and specificity were 79%,and 84%, and in advanced stage disease were 83% and 80%. Three of four overstaged cases showed hydronephrosisproximal to the tumor. In the second CT staging, using proximal hydronephrosis of the tumor as a criterion forearly-stage disease, the sensitivity and specificity of early-stage disease were 95% and 75%, respectively, andthe specificity of advanced-stage disease was 95%. Conclusion : When hydronephrosis proximal to a tumor wasconsidered to be a sign of early stage disease, the CT staging of renal pelvic TCC was highly accurate.

Prognostic Value of the Anatomic Region of Metastatic Lymph Nodes in the Current TNM Staging of Gastric Cancer

Jeong, Oh,Jung, Mi Ran,Kang, Ji Hoon The Korean Gastric Cancer Association 2021 Journal of gastric cancer Vol.21 No.3

Purpose: The numeric N stage has replaced the topographic N stage in the current tumor node metastasis (TNM) staging in gastric carcinoma. However, the usefulness of the topographic N stage in the current TNM staging system is uncertain. We aimed to investigate the prognostic value of the topographic N stage in the current TNM staging system. Materials and Methods: We reviewed the data of 3350 patients with gastric cancer who underwent curative gastrectomy. The anatomic regions of the metastatic lymph nodes (MLNs) were classified into 2 groups: perigastric and extra-perigastric. The prognostic value of the anatomic region was analyzed using a multivariate prognostic model with adjustments for the TNM stage. Results: In patients with lymph node metastasis, extra-perigastric metastasis demonstrated significantly worse survival than perigastric metastasis alone (5-year survival rate, 39.6% vs. 73.1%, respectively, P<0.001). Extra-perigastric metastasis demonstrated significantly worse survival within the same pN stage; the multivariate analysis indicated that extra-perigastric metastasis was an independent poor prognostic factor (hazard ratio=1.33; 95% confidence interval=1.01-1.75). The anatomic region of the MLNs improved the goodness-of-fit (likelihood ratio statistics, 4.57; P=0.033) of the prognostic model using the TNM stage. Conclusions: The anatomic region of MLNs has an independent prognostic value in the numeric N stage in the current TNM staging of gastric carcinoma.

Prognostic Validation of the American Joint Committee on Cancer 8th Staging System in 24,014 Korean Patients with Breast Cancer

김이삭,최희준,류재민,이세경,유종한,김석원,남석진,이정언 한국유방암학회 2018 Journal of breast cancer Vol.21 No.2

Purpose: The American Joint Committee on Cancer (AJCC) recently released the breast cancer staging system, 8th edition, which included additional four biologic factors. However, there has been no external validation of the prognostic value of the new stages with different population-based databases. Methods: To validate the prognostic value of the new staging system in the Asian population, with a focus on Korean patients with breast cancer, we performed a retrospective study with data from the Korean Breast Cancer Society that included 24,014 patients with invasive ductal or lobular carcinoma who underwent surgery between January 2009 and January 2012 in Korea. The proportional differences were evaluated between the anatomic staging system (AJCC 7th edition) and the prognostic staging system (AJCC 8th edition, December 2017 published version). Comparisons of overall survival (OS) and disease-free survival (DFS) with Kaplan-Meier graphs and hazard ratios were also performed. Results: Our analysis included 24,014 patients (median age, 50 years; range, 20–91 years). Stage I, II, and III disease accounted for 47.6%, 43.5%, and 8.9%, respectively, of anatomic stages and 61.8%, 27.6%, and 10.8%, respectively, of clinical prognostic stages. A total of 6,272 cases (26.1%) were upstaged, 4,656 (19.4%) were downstaged, and 13,086 (54.5%) remained unchanged. OS and DFS decreased in the order from prognostic stages IA to IIIC but did not change among the anatomic stage groups. Conclusion: Our data suggests that the prognostic staging system provides superior prognostic value to the anatomic staging system in Korean patients with breast cancer.

Comparison of CT or MRI and ¹⁸F-FDG PET/CT for the Preoperative Staging Accuracy of Ovarian Cancer

정국원,이영준,오순남,나성은,변재영,유이령,김성훈,정수교 대한영상의학회 2009 대한영상의학회지 Vol.60 No.3

Purpose: To compare the diagnostic accuracy of CT or MRI with 18F-FDG PET/CT for the preoperative staging of ovarian cancer. Materials and Methods: Twenty-eight patients (15-67 years; mean 46 years) with 38 surgically confirmed ovarian cancer lesions (4-30 cm, mean 11.2 cm) underwent CT or MR (CT on 20; MR on 10) and ¹⁸F-FDG PET/CT to compare each imaging modality in accordance to the FIGO stage. Results: The FIGO staging results revealed stage I disease in 11 patients, stage III disease in 14 patients, and stage IV disease in three patients. In total, six of the 38 tumors (16%) showed no evidence of abnormal uptake on the 18F-FDG PET/CT, while one of the 38 tumors (3%) showed no evidence of enhancing on the solid portion for either CT or MRI. The lack of typical advanced stage characteristics of the aforementioned tumors resulted in their stage I disease classification. The CT or MRI staging was correlated with FIGO staging in 21 of the 28 patients (75%), whereas the 18F-FDG PET/CT staging was similarly correlated in 23 of the 28 patients (82%). We found no significant difference in the diagnostic accuracy of CT or MRI versus the ¹⁸F-FDG PET/CT in the preoperative staging of ovarian cancer. Conclusion: Besides CT or MRI, additional 18F-FDG PET/CT imaging is not mandatory for the preoperative staging of ovarian cancer.

Usefulness of hydrogel-CT for detecting and staging of rectosigmoid colon cancer

Jeong, S.,Kim, S.H.,Joo, I.,Ahn, S.J.,Han, J.K. G. Thieme ; Elsevier Science Pub. Co 2016 European journal of radiology Vol.85 No.5

<P>Purpose: To demonstrate the usefulness of hydrogel-CT for detecting and staging of rectosigmoid colon cancer. Materials and methods: Fifty-four patients with rectosigmoid colon cancers underwent routine CT without (n = 27) and with (n = 27) rectum distension using a sonographic gel. Rectum distensibility and tumor visualization were evaluated. T and N stages on CT independently recorded by two radiologists were correlated with pathologic staging. Staging accuracies were compared using Fisher's exact test. Diagnostic performances in differentiating <T3 from >= T3 and NO from >= N1 were evaluated using areas under the receiver operating characteristic curves (Az). Results: Rectum distensibility (3.52) and tumor visualization (3.70) were significantly more scored in the distended group than in the control group (1.44 and 2.04) (P < 0.0001). Pathologic and CT staging were more correlated in the distended group in both reviewers. Accuracy for staging was higher in the distended group (T: 50-85.2%/N: 59.3-92.6%) than in the control group (T: 45.5-62.5%/N: 33.3-59.3%) without statistical significance except N staging for reviewer 2 (P = 0.0091). Az values for T and N staging in the distended group (T: 0.827-0.989/N: 0.858-0.980) were also higher than in the control group (T: 0.817-0.907/N: 0.544-0.654). Conclusion: Hydrogel-CT can provide better diagnostic performance for T and N staging of rectosigmoid colon cancer. (C) 2016 Elsevier Ireland Ltd. All rights reserved.</P>

식도암의 병기 결정에 있어 흉부 CT의 유용성

오봉석,홍성범,장원채,김윤현,김병표,최용선 대한흉부외과학회 2004 Journal of Chest Surgery (J Chest Surg) Vol.37 No.12

배경 및 목적: 식도암의 병기 결정은 병변의 절제 가능성 여부를 결정하고 환자의 예후를 예측하는 데 지대한 영향을 미친다. 흉부 전산화 단층 촬영(Computerized Tomography, CT)은 식도암의 병기 결정을 위해 현재까지 가장 널리 사용되고 있는 진단 방법 중의 하나이지만, 다양한 위양성 및 위음성 소견에 의해 제한점들이 보고되고 있다. 이에 본 저자는 수술 전 식도암의 병기 결정에 있어서 흉부 CT의 유용성에 대해 연구하고자 하였다. 대상 및 방법: 1999년 1월부터 2003년 6월까지 식도 편평 상피 세포 암으로 진단받고 수술을 시행한 환자 114예를 대상으로 수술 전 CT에 의한 병기와 수술 후 조직 소견에 의한 병기를 후향적으로 비교 분석하였다. CT 진단에 의한 주변 조직 침습, 림프절 침범, 그리고 원위부 전이 여부 등을 관찰하고 , 이를 수술 후 조직 병리 소견과 비교함으로써, 이들의 진단에 대한 CT의 민감도(Sensitivity), 특이도(Specificity), 정확도(Accuracy) 및 일치도(Reproducibility)를 구하였다. 일치도는 Z-test를 시행하여 통계적 유의성을 평가하였다. 결과: 식도암의 CT에 의한 병기와 조직 병리 소견에 의한 병기의 일치도는 원발성 종양의 국소 침윤의 경우 0.32 (p<0.01), 림프절 전이에 대하여는 0.36 (p<0.01)이었으며, 원위부 장기에 대한 전이 여부에 대하여는 0.62 (p<0.01)이었다. 림프절 전이나 원거리 전이에 대한 CT와 조직 병리 소견의 일치도는 종양의 국소 침윤에 대한 일치도보다 우수하였다. 원발성 종양의 주변 장기 침습에 대한 CT의 정확도는 T1군(78.9%)과 T2군(62.3%)에 비해 T3군(65.8%)과 T4군(98.2%)에서 우수하였다. 또한 식도암의 국소 종양 침윤에 대한 CT진단은 각 병기별로 민감도에 비해 특이도가 높았다. 결론: 식도암의 병기 결정에 있어 CT 진단은 종양에 의한 식도 벽의 침습 정도를 파악하는 것보다 주위 조직이나 장기, 그리고 림프절의 전이를 파악하는데 더 유용함을 알 수 있었다. Background: The decision of staging of esophageal cancer have great effect on the resectability of the lesion and estimation of the patient's prognosis. Today, CT is one of the most popular modality for staging of esophageal cancer. However, it has some limitations because of false-positive or false-negative findings on cancer staging. The purpose of this study was to analyze the efficacy of CT in preoperative staging of esophageal cancer. Material and Method: We retrospectively analysed the difference of staging of esophageal cancer between CT and histopathological findings for the 114 patients with histologically proven esophageal cancer who underwent operation at the department of thoracic and cardiovascular surgery, Chonnam national university hospital, between January 1999 and June 2003. We evaluated the efficacy of chest CT in the staging of esophageal cancer compared to postoperative histopathologic findings by calculating sensitivity, specificity, accuracy, and reproducibility of chest CT to detect abnormality. Result: The reproducibilities between chest CT and histopathologic findings were 0.32 (p<0.01) for primary tumor (T), 0.36 (p<0.01) for lymph node invasion (N), and 0.62 (p<0.01) for distant metastasis (M). The reproducibilities between chest CT and histopathologic findings for lymph node invasion (N) and distant metastasis (M) were superior to that of primary tumor (T). The accuracy of primary tumor (T) was 65.8% and 98.2% in group III and IV, which was significantly higher than that of group I and II (78.9% and 62.3%). In general, specificity of chest CT for TNM staging was superior to sensitivity. Conclusion: In conclusion, preoperative CT scanning can provide important information on lymph node invasion and metastasis of lesion than primary tumor invasion.

폐암의 병기 결정

김혜영 대한의사협회 2008 대한의사협회지 Vol.51 No.12

Accurate staging of lung cancers is important to determine the treatment options and the prognosis of patients with a lung cancer. TNM system revised in 1997 by American Joint Committee on Cancer and the Union Internationale Contre le Cancer is widely used in staging of the lung cancer. The TNM system is an expression of the anatomic extent of diseases and is based on the assessment of three components; extent of the primary tumor (T), regional lymph node metastasis (N), and distant metastasis (M). Non-invasive staging of lung cancers is based primarily on chest computed tomography (CT), and if available, on positron emission tomography (PET). Chest CT scanning is useful in providing anatomic details, but the accuracy of the chest CT scanning in differentiating benign from malignant lymph nodes in the mediastinum is poor. PET scanning has a much better sensitivity and specificity than chest CT scanning for mediastinal lymph node staging, and distant metastatic diseases can be detected by PET scanning. With either test, abnormal findings must be confirmed by a tissue biopsy to ensure accurate staging. Invasive techniques for biopsy of mediastinal lymph nodes or pathologic tissue include transbronchial needle aspiration, transesophageal fine needle aspiration, and surgery.

분화갑상선암의 수술 전 병기결정: 영상의학적 검사의 의의

정기욱 대한갑상선학회 2011 International Journal of Thyroidology Vol.4 No.2

Staging is the process of determining how much cancer there is in the body and where it is located. Correct staging helps the oncologist to plan a treatment and determine a prognosis. For the surgeon’s perspective,planning of surgical treatment is the main concern in preoperative staging. Preoperative staging would be synonym of “preoperative planning” or “preoperative localization” in this context. Extent of primary tumor and lymph node status is the main factor to decide initial surgical treatment of well-differentiated thyroid carcinomas (WDTC). Precise description of lymph node status is also important in the planning of surgery for WDTC. Surgeon performed preoperative ultrasound is highly recommended in the planning of surgery,especially in recurrent cases. There have been debates for what the best imaging modality is in the preoperative staging of WDTC. Surgeon should understand pros and cons of each modality and should communicate with radiologist to decide surgical plan. In this article, we will discuss importance of radiological imaging in preoperative staging of WDTC.

Validation of the 8th AJCC Cancer Staging System for Pancreas Neuroendocrine Tumors Using Korean Nationwide Surgery Database

유영훈,장진영,김송철,윤유석,박준성,조철균,박상재,양재도,이우정,홍태호,안근수,정치영,이현국,이승은,노영훈,김희준,김홍범,한인웅 대한암학회 2019 Cancer Research and Treatment Vol.51 No.4

Purpose The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic neuroendocrine tumor (PNET) included several significant changes. We aim to evaluate this staging system compared to the 7th edition AJCC staging system and European Neuroendocrine Tumors Society (ENETS) system. Materials and Methods We used Korean nationwide surgery database (2000-2014). Of 972 patients who had undergone surgery for PNET, excluding patients diagnosed with ENETS/World Health Organization 2010 grade 3 (G3), only 472 patients with accurate stage were included. Results Poor discrimination in overall survival rate (OSR) was noted between AJCC 8th stage III and IV (p=0.180). The disease-free survival (DFS) curves of 8th AJCC classification were well separated between all stages. Compared with stage I, the hazard ratio of II, III, and IV was 3.808, 13.928, and 30.618, respectively (p=0.007, p < 0.001, and p < 0.001). The curves of OSR and DFS of certain prognostic group in AJCC 7th and ENETS overlapped. In ENETS staging system, no significant difference in DFS between stage IIB versus IIIA (p=0.909) and IIIA versus IIIB (p=0.291). In multivariable analysis, lymphovascular invasion (p=0.002), perineural invasion (p=0.003), and grade (p < 0.001) were identified as independent prognostic factors for DFS. Conclusion This is the first large-scale validation of the AJCC 8th edition staging system for PNET. The revised 8th system provides better discrimination compared to that of the 7th edition and ENETS TNM system. This supports the clinical use of the system.

Diagnostic Value of Clinical T Staging Assessed by Endoscopy and Stomach Protocol Computed Tomography in Gastric Cancer: The Experience of a Low-Volume Institute

김태현,정인호,김정재,김승형,김봉수,송현주,나수영,부선진,김흥업,맹영희,현창림,김광식 대한위암학회 2012 Journal of gastric cancer Vol.12 No.4

Purpose: Clinical staging of gastric cancer appears to be important more and more for tailored therapy. This study aimed to verify the accuracy of clinical T staging in a low-volume institute. Materials and Methods: We retrospectively reviewed prospectively collected data of gastric cancer patients who underwent resection. A total of 268 patients of gastric cancer were enrolled from March 2004 to June 2012. These demographics, tumor characteristics, and clinical stages were analyzed for identification of diagnostic value of clinical T staging. Results: The predictive values for pT1 of endoscopy and computed tomography were 90.0% and 89.4%, respectively. In detail, the predictive values of endoscopy for pT1a, pT1b, and pT2 or more were 87%, 58.5%, and 90.6%, respectively. The predictive values of computed tomography for pT1a, pT1b, and pT2 or more were 68.8%, 73.9%, and 84.4%, respectively. The factors leading to underestimation of pT2 or more lesions by gastroscopy were the middle third location, the size greater than 2 cm, and younger age. Those for overestimation of pT1 lesion by computed tomography were male, age more than 70 years, elevated type, and size greater than 3 cm. Conclusions: Diagnostic accuracy of early gastric cancer was 90%, which is comparable to those of high volume center. In patients with early gastric cancer, limited gastrectomy or minimal invasive surgery can be safely introduced at a low volume center also. However, the surgeon of low-volume institute should consider the accuracy of clinical staging before extending the indication of limited treatment.