CT diagnosis and TNM staging of gastric cancer, everything you want to know is here

Spiral CT staging of gastric cancer is the main technology for preoperative staging diagnosis of gastric cancer.

Lesion sites: 30% in the antrum, 30% in the body, 30% in the fundus, cardia, and 10% diffuse infiltrates

AJCC gastric cancer TNM staging (8th edition)

T - primary tumor Tx: primary tumor cannot be evaluated; T0: no evidence of primary tumor; Tis: high-grade dysplasia, confined to the epithelium, not invading the lamina propria; T1: tumor invading the lamina propria or submucosa T1a tumor invades the lamina propria; T1b tumor invades the submucosa; T2: tumor invades the muscularis propria; T3: tumor invades the subserosa; T4: T4a tumor invades the serosa; T4b tumor invades adjacent organs

N——Regional lymph node Nx: regional lymph node cannot be evaluated; N0: no regional lymph node metastasis; N1: 1~2 lymph node metastasis; N2: 3~6 lymph node metastasis; N3: N3a 7~15 lymph node metastasis; N3b ≥16 lymph node metastasis

M - distant metastasis M0: no distant metastasis; M1: distant metastasis

T1: The mucosal layer of low density remains intact

T2: The gastric wall is thickened, the low-density zone is interrupted, the outer contour is smooth, and the surrounding fat layer is clear and the shadow is less than 1/3

Next, the editor will take you through a typical case to consolidate the TNM staging of gastric cancer

【Basic situation】 The patient, female, 66 years old, has anemia

Figure 1 Plain scan + enhancement phases

Figure 2 Tumor

The following are the regional lymph nodes involved, for a total of 15 regions:

【Image findings】 The gastric antrum was narrowed, the gastric wall was thickened annularly, a huge ulcer was seen on the lesser curvature side, surrounded by a "ring embankment sign", the serous surface was incomplete, and the perigastric fat showed grid-like streak shadows.

【Diagnostic opinion】 Gastric cancer in the gastric antrum (T4N3 stage) The tumor in this case broke through the serosal layer, the boundary with the left lobe of the liver and the uncinate process of the pancreas was unclear, and the fat interface disappeared.