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Abstract
Introduction. Peritoneal carcinomatosis (PC) is one of the most common and prognostically unfavorable patterns of metastasis in gastric cancer (GC), often representing the sole manifestation of disseminated disease. Stratification of patients based on the extent of peritoneal involvement is crucial for determining the treatment strategy, which depends on preoperative imaging findings.
Aim. To evaluate the diagnostic performance of contrast-enhanced computed tomography (CT) for the preoperative assessment of PC extent, measured by the Peritoneal Carcinomatosis Index (PCI), in patients with GC, in comparison with diagnostic laparoscopy (DL) and surgical/histopathological findings.
Materials and Methods. The study included 42 patients with verified GC and PC (mean age 61.1 ± 9.9 years) treated at the Kaluga Regional Clinical Oncology Dispensary between 2019 and 2023. To assess the extent of the disease, including involvement of peritoneal structures, all patients underwent DL, contrast-enhanced CT with PCI calculation. The results of DL and CT were compared against surgical and histological data. Statistical analysis employed Pearson's χ², Mann-Whitney U, and post-hoc tests.
Results. DL demonstrated superior diagnostic accuracy in assessing peritoneal carcinomatosis in GC compared to CT. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for DL were 97.81, 66.9, 92.23 %, and 87.96 %, respectively, versus 80.05, 63.38, 54.87, and 82.23 % for CT. The area under the ROC curve (AUC) was 0.8431 for DL and 0.733 for CT. Post-hoc analysis revealed that CT agreement with histology was highest (93–98 %) in PCI regions 4, 5, and 8, and lowest (52–64 %) in regions 1, 9, 10, 11, and 12. DL showed consistently high agreement (71–100 %) across all regions, reaching 100 % in regions 6 and 8. A key limitation of CT was its low sensitivity in detecting metastatic lesions ≤ 0.5 cm.
Conclusion. CT is unreliable for definitively excluding PC in GC due to its high false-negative rate for small (< 0.5 cm) metastases, particularly in the small intestine region. Therefore, the primary role of CT should shift from attempting to "screen out" PC to confirming the presence of extra-abdominal metastases, guiding treatment strategy and preventing unnecessary laparotomies.
References
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