고신의료원에서의 위암의 술전 병기 결정 = The Preoperative Staging of Gastric Cancer in Kosin Medical Center

다국어 초록 (Multilingual Abstract)

-Abstract- Determination of the extent of gastric cancer may assist in making decisions regarding therapeutic intervention. Several diagnostic tools were used for preoperative staging in Kosin medical center. Authors retrospectively analyzed the preoperative checked tumor markers, endoscopic findings and abdominal CT findings in 449 cases of pathologically stage-made gastric adenocarcinoma after surgery for 12 months from January to December 1993 at department of surgery, Kosin medical center. The purpose of this report is assessment of commonly used preoperative studies for staging of gastric cancer.
The results were as follows : 1. The preoperative serum CEA, CA 19-9 levels were not correlated with stage except stage Ⅳ. In case of aFP, there were no positive correlation with staging.
2. 74 (63.2%) of 117 cases diagnosed endoscopically were T1 cancer histologically, whereas among 332 cases, which diagnosed advanced gastric cancer endoscopically, 28 cases (8.4%) were T1 cancer.
3. 188 of 275 cases showed wall thickness greater than 1츠 on abdominal CT scan. 167 of 188 cases were advanced gastric cancer (89%) and 21 cases were T1 gastric cancer (11%).
4. In a comparison of enlargement of regional lymph node by CT scan to tumor infiltration of regional lymph node by histology, sensitivity was 52.7%, specificity was 73.3% and accuracy was 63.6%.
5. CT images of distant metastasis had a sensitivity of 22.2%, specificity of 98%, accuracy of 93.1%, false-negative of 77.8% and false-positive of 1.9%.
6. 125 patients (45%) were correctly staged with CT scan, 77 patients (29%) overstaged and 72 patients (26%) understaged comparing to pathologic staging.
These results showed that conventional diagnostic tools alone does not accurately displayed the true extent of disease in patients with gastric carcinoma. The results of multiple studies each other must be combined and it can provide valuable information in management of gastric cancer.