MDCT in the preoperative staging of gastric adenocarcinoma

Radiol Bras. 2015 Mar/Abr;48(2):VII–VIII Gastric cancer is the second cause of cancer-related mortality. The selection of the best therapeutic approach in cases of gastric adenocarcinoma is a complex task. Much has been discussed at international level in order to reach a consensus about the management of gastric adenocarcinomas in the clinical practice. Multiple studies have also been developed to evaluate the accuracy of gastric adenocarcinoma staging by means of the different imaging modalities. The role of pelvic and abdominal multidetector-row CT in the investigation of the digestive system has been discussed in several studies recently published in the Brazilian literature and this has been the method of choice for preoperative staging of the disease. Pelvic and abdominal MDCT is a widely available imaging method capable of identifying local invasion and distant metastases. The staging with MDCT allows for less invasive treatments, such as endoscopic resection, in cases of early-detected tumors. On the other hand, patients with distant metastases might be spared extensive surgeries with curative intention. It is important to emphasize that the obtention of better results is closely connect with the application of the correct technique. Thus, the stomach should be appropriately distended at the moment of the scanning. Studies describe gas distention and water distention techniques – either effervescent granules taken orally, or ingestion of 750 to 1,000 mL of tap water immediately before the scan. The seventh issue if the TNM classification, published in 2010, incorporated some significant modifications. Because of their biological behavior, tumors located 5 cm proximal to the stomach should be staged as esophageal tumors. The T staging of tumors in the rest of the gastrointestinal tract is subdivided as follows: T2, defined as a tumor compromising the muscularis propria; T3, a tumor extending toward the subserous layer; and T4, a tumor invading the subserous layer or adjacent structures. Additionally, because of the abundant lymphatic chain in the gastric mucosa, leading to lymph node metastasis even with a tumor restricted to the lamina propria, the T1 category was subdivided into T1a (tumor restricted to the lamina propria or muscular layer of the mucosa); and T1b (submucosal invasion). In the present issue of Radiologia Brasileira, Barros et al. evaluate the MDCT accuracy in the preoperative staging of patients