Contribuição da tomografia helicoidal no estadiamento pré-operatório do carcinoma gástrico

Conteúdo do artigo principal

Flávio Mendes de Oliveira
Nadia Pavarini
Juliana Ortiz
Aline Biral Zanon
Lourdes Conceição Martins
Wilson Roberto Catapani
Ana Maria Amaral Antonio Mader
Jaques Waisberg

Resumo

Objetivo: Analisar a sensibilidade da tomografia helicoidal abdominal na detecção do comprometimento linfonodal e de metástases hepáticas e peritoneais no estadiamento pré-operatório do carcinoma gástrico. Método: Foram estudados retrospectivamente 52 doentes operados por carcinoma gástrico e estadiados por tomografia helicoidal abdominal com contraste oral e intravenoso. Os resultados baseados nos laudos correspondentes foram correlacionados com os achados intraoperatórios e exame anatomopatológico dos espécimes cirúrgicos. Resultados: A neoplasia gástrica localizou-se na região do antropilórica em 38 (73,1%) doentes, na cárdia em 8 (15,4%) e no corpo e fundo em 6 (11,5%). A tomografia helicoidal abdominal detectou lesão gástrica em 25 (48,1%) doentes, metástases hepáticas em 6 (11,5%), acometimento de linfonodos em 5 (9,6%), ascite em 4 (7,7%) e comprometimento no fígado, baço e pâncreas em 1 (1,9%). Na laparotomia, constataram-se metástases hepáticas em 6 (11,5%) doentes e ascite em 12 (23,1%). Nos doentes submetidos à ressecção com intenção curativa da neoplasia, foram identificados pela tomografia helicoidal abdominal pré-operatória 27 (67,5%) linfonodos sugestivos de comprometimento. O exame anatomopatológico mostrou 16 (40,0%) doentes com linfonodos infiltrados pelo carcinoma gástrico. A sensibilidade do exame de tomografia helicoidal abdominal na identificação pré-operatória da lesão gástrica foi 48,1%, para linfonodos acometidos foi de 18,5% e para metástases hepáticas a sensibilidade foi 100,0%. Treze (25%) doentes apresentaram metástases peritoneais não reveladas pela tomografia helicoidal. Conclusões: O exame de tomografia computadorizada helicoidal abdominal no pré-operatório do carcinoma gástrico apresentou sensibilidade elevada na detecção de metástases hepáticas, sensibilidade baixa na detecção do comprometimento linfonodal pela neoplasia e não foi capaz de identificar metástases peritoneais.

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Referências

Prado FC, Ramos JA, Valle JR. Atualização Terapêutica: Manual Prático de Diagnostico e Tratamento. In: Borges DR, Rothschild HA, editores. Câncer de Estômago. 22ª ed. São Paulo: Artes Médicas; 2005. p. 566-9.

Paramo JC, Gomez G. Dynamic CT in the preoperative evaluation of patients with gastric cancer: correlation with surgical findings and pathology. Ann Surg Oncol. 1999;6(4):379-84.

http://dx.doi.org/10.1007/s10434-999-0379-7

Brancato S, Winner TJ. Surgical management of gastric cancer: review and consideration for total care of the gastric cancer patient. Curr Treat Options Gastroenterol. 2008;11(2):109-18.

http://dx.doi.org/10.1007/s11938-008-0023-9

Habermann CR, Weiss F, Riecken R, Honarpisheh H, Bohnacker S, Staedtler C, et al. Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US. Radiology. 2004;230(2): 465-71. http://dx.doi.org/10.1148/radiol.2302020828

Incidência de Câncer no Brasil: estimativa 2008: síntese de resultados e comentários. [citado 5 mai 2008]. Disponível em: www.inca.gov.br/estimativa/2008/index.asp?link=conteudo_view.asp&ID=5.

Tschmelitsch J, Weiser MR, Karpeh MS. Modern staging in gastric cancer. Surg Oncol. 2000;9(1):23-30. http://dx.doi.org/10.1016/S0960-7404(00)00020-7

Wakelin SJ, Deans C, Crofts TJ, Allan PL, Plevris JN, Paterson-Brown S. A Comparison of computerized tomography, laparoscopic ultrasound and endoscopic ultrasound in the preoperative staging of esophago-gastric carcinoma. Eur J Radiol. 2002;41(2):161-7. http://dx.doi.org/10.1016/S0720-048X(01)00418-1

Ziegler K, Sanft C, Zimmer T, Zeitz M, Felsenber D, Stein H, et al. Comparison of computerized tomography, endosonography and intraoperative assessment in TN staging of gastric carcinoma. Gut. 1993;34(5):604-10. http://dx.doi.org/10.1136/gut.34.5.604

Fukuya T, Honda H, Hayashi T, Kaneko K, Tateshi Y, Ro T, et al. Lymph-node metastases : efficacy for detection with helical CT in patients with gastric cancer. Radiology. 1995;197(3):705-11.

Davies J, Chalmers AG, Sue-Ling HM, May J, Miller GV, Martin IG, et al. Spiral computed tomography and operative staging of gastric carcinoma: a comparison with histopathological staging. Gut. 1997;41(3):314-9. http://dx.doi.org/10.1136/gut.41.3.314

Kumano S, Murakami T, Kim T, Hori M, Iannaccone R, Nakata S, et al. T staging of gastric cancer: role of multi-detector row CT. RSNA. 2005;237(3):961-6.

Barry JD, Edwards P, Lewis WG, Dhariwal D, Thomas GV. Special interest radiology improves the perceived preoperative stage of gastric cancer. Clin Radiol. 2002;57(11):982-3.

http://dx.doi.org/10.1053/crad.2002.1073

Sarela AI, Lefkowitz R, Brennan MF, Karpeh MS. Selection of patients with gastric adenocarcinoma for laparoscopic staging. Am J Surg. 2006;191(1):134-8. http://dx.doi.org/10.1016/j.amjsurg.2005.10.015

Triantafillidis JK, Cheracakis P. Diagnostic evaluation of patients with early gastric cancer – a literature review. Hepato-gastroenterol. 2004;51:618-24.

Chamadol N, Wongwiwatchai J, Bhudhisawasd V, Pairojkul C. Accuracy of spiral CT in preoperative staging of gastric carcinoma: correlation with surgical and pathological findings. J Med Assoc Thai. 2008;91(3):356-63.

Lee DH, Seo TS, Ko YT. Spiral CT of the gastric carcinoma: staging and enhancement pattern. J Clin Imag. 2001;25(1):32-7. http://dx.doi.org/10.1016/S0899-7071(01)00245-5

Wei WZ, Yu JP, Li J, Liu CS, Zheng XH. Evaluation of contrast-enhanced helical hydro-CT in staging gastric cancer. World J Gastroenterol. 2005;11(29):4592-5.

Botet JF, Lightdale CJ, Zauber AG, Gerder H, Winawer SJ, Urmacher C, et al. Preoperative staging of gastric cancer: comparison of endoscopic US and dynamic CT. Radiology. 1991;181(2):426-32.

Blackshaw GR, Stephens MR, Lewis WG, Boyce J, Barry JD, Edwards P, et al. Progressive CT system technology and experience improve the perceived preoperative stage of gastric cancer. Gastric Cancer. 2005;8(1):29-34. http://dx.doi.org/10.1007/s10120-004-0311-6

Wei WZ, Yu JP, Li J, Liu CS, Zheng XH. Evaluation of contrast-enhanced helical hydro-CT in staging gastric cancer. World J Gastroenterol. 2005;11(29):4592-5.

Ianora AA, Pedote P, Scardapane A, Memeo M, Rotondo A, Angelelli G. Preoperative staging of gastric carcinoma with multidetector spiral CT. Radiol Med (Torino). 2003;106(5-6):467-80.

Madden MV, Price SK, Learmonth GM, Dent DM. Surgical staging of gastric carcinoma: sources and consequences of errors. Br J Surg. 1987;74(2): 19-21. http://dx.doi.org/10.1002/bjs.1800740217

Kleinhaus U, Militianu D. Computed tomography in the preoperative evaluation of gastric carcinoma. Gastrointest Radiol. 1988;13(2):97-101. http://dx.doi.org/10.1007/BF01889034

Dehn TC, Reznek RH, Nockler IB, White FE. The preoperative assesment of advanced gastric cancer by computed tomography. Br J Surg. 1984;71(6):413-7. http://dx.doi.org/10.1002/bjs.1800710603

Moss AA, Schnyder P, Marks W, Margulis AR. Gastric adenocarcinoma: a comparison of the accuracy and economics of staging by computed tomography and surgery. Gastroenterology. 1981;80(1):45-50.

Chen F, Ni Y, Zheng K, Ju S, Sun J, Ou X, et al. Spiral CT in gastric carcinoma: comparison with barium study, fiberoptic gastroscopy and histopathology. World J Gastroenterol. 2003;9(7):1404-8.

Polkowski M, Palucki J, Wronska E, Szawlowski A, Nasierowska-Guttmejer A, Butruk E. Endosonography versus helical computed tomography for locoregional staging of gastric cancer. Endoscopy. 2004;36(7): 617-23. http://dx.doi.org/10.1055/s-2004-814522

Kadowaki K, Murakami T, Yoshioka H, Kim T, Takahashi S, Tomoda K, et al. Helical CT imaging of gastric cancer: normal wall appearance and the potential for staging. Radiation Med. 2000;18(1):47-54.

Lee DH. Two-dimensional and three-dimensional imaging of gastric tumors using spiral CT. Abdom Imaging. 2000;25(1):1-6. http://dx.doi.org/10.1007/s002619910001

Horton KM, Fishman EK. Current role of CT in imaging of the stomach. Radiographics. 2003;23(1):75-87. http://dx.doi.org/10.1148/rg.231025071

Mani NBS, Suri S, Gupta S, Wig JD. Two-phase dynamic contrast-enhanced computed tomography with water-filling method for staging of gastric carcinoma. J Clin Imaging. 2001;25(1):38-43. http://dx.doi.org/10.1016/S0899-7071(99)00134-5

Komaki S, Toyoshima S. CT's capability in detecting advanced gastric cancer. Gastrointest Radiol. 1983;8:307-13. http://dx.doi.org/10.1007/BF01948140

Sussman SK, Halvorsen RA, Illescas FF, Cohan RH, Saeed M, Silverman PM, et al. Gastric adenocarcinoma: CT versus surgical staging. Radiology. 1988;167(2):335-40.

Giner RG, Sos JE, Sanchís JL, del Castillo JR, Vila JH, Valdivieso EM. Helical CT evaluation in the preoperative staging of gastric adenocarcinoma. Rev Esp Enferm Dig. 2002;94(10):593-600.

Balfe DM, Koehgler RE, Karstaedt M, Stanley RJ, Sagel SS. Computed tomography of gastric neoplasms. Radiology. 1981;140:431-6.

Fusaroli P, Caletti G. Endoscopic ultrasonography: current clinical role. Eur J Gastroenterol Hepatol. 2005;17(3):293-301. http://dx.doi.org/10.1097/00042737-200503000-00006

Xi WD, Zhao C, Ren GS. Endoscopic ultrasonography in preoperative staging of gastric cancer: determination of tumor invasion depth, nodal involvement and surgical resectability. World J Gastroenterol. 2003;9(2):254-7.

Feussner H, Omote K, Fink U, Walker SJ, Siewert JR. Pretherapeutic laparoscopic staging in advanced gastric carcinoma. Endoscopy. 1999;31(5):342-7. http://dx.doi.org/10.1055/s-1999-28

Meining A, Rosch T, Wolf A, Lorenz R, Allescher HD, Kauer W, et al. High interobserver variability in endosonography staging of upper gastrointestinal cancers. Z Gastroenterol. 2003;41(5):391-4. http://dx.doi.org/10.1055/s-2003-39422

Ba-Ssalamah, Prokop M, Uffmann M, Pokieser P, Teleky B, Lechner G. Dedicated multidetector CT of the stomach: spectrum of diseases. Radiographics. 2003;23(3):625-44. http://dx.doi.org/10.1148/rg.233025127

Sohn KM, Lee JM, Lee SY, Ahn BY, Park SM, Kim KM. Comparing MR imaging and CT in the staging of gastric carcinoma. AJR. 2000;174(6): 1551-7. http://dx.doi.org/10.2214/ajr.174.6.1741551

Giner GR, Sos JE, Sanchis JLS, Castillo JR, Vila JHG, Valdivieso EM. Helical CT evaluation in the preoperative staging of gastric adenocarcinoma. Rev Esp Enferm Dig. 2002;94(10):593-600.

Cook AO, Levine BA, Sirinek KR, Gaskill HV. Evaluation of gastric adenocarcinoma. Abdominal computed tomography does not replace celiotomy. Arch Surg. 1986;121(5):603-6. http://dx.doi.org/10.1001/archsurg.1986.01400050121016