Computed tomography scan efficacy in staging gastric linitis plastica lesion: a retrospective multicentric French study

Stéphanie Morgant,¹ Pascal Artru,² Ammar Oudjit,³ Nelson Lourenco,⁴ Arnaud Pasquer,⁵ Thomas Walter,⁶ Jean-Marc Gornet,⁴ Alexandre Rouquette,⁷ Gérard Lledo,² Catherine Brezault,¹ Romain Coriat<sup>1

1</sup>Gastroenterology and Digestive Oncology Unit, Cochin Teaching Hospital, Paris, France; ²Gastroenterology and Digestive Unit, Jean Mermoz Clinic, Lyon, France; ³Radiology Unit, Cochin Teaching Hospital, Paris, France; ⁴Gastroenterology Unit, Saint-Louis Teaching Hospital, Paris, France; ⁵Digestive Surgery Unit, Edouard Herriot Teaching Hospital, Lyon, France; ⁶Oncology Unit, Edouard Herriot Teaching Hospital, Lyon, France; ⁷Pathology Department, Cochin Teaching Hospital, Paris, France

Background: Computed tomography (CT) scan is a key imaging technique in the staging of gastric adenocarcinoma and therapeutic management of patients. The aim of this study was to evaluate the performance of CT scan in the staging of parietal and metastatic invasion in gastric linitis plastica group.
Methods: A retrospective multicentric French study was conducted from January 2006 to December 2015 on patients with no metastatic gastric linitis plastica and operated by gastrectomy. A 2/1 matching based on pTNM stage and center was performed.
Results: Fifty patients were included in the linitis plastica group and 100 in the control group. Patients from the linitis group were significantly different from those from the control group with a lower age at diagnosis, a more advanced histological lesion, a more frequent ­undiagnosed peritoneal carcinomatosis, and a higher risk of R1 resection. Sensitivity and specificity of CT scan for the diagnosis of lymph node involvement were 44% and 75%, respectively, in the linitis plastica group and 55% and 60%, respectively, in the control group. The sensitivity and specificity of CT scan for the T3–T4 parietal invasion were 26% and 100%, respectively, in the linitis group and 40% and 72%, respectively, in the control group.
Conclusion: CT scan has an equal sensitivity and specificity for the evaluation of lymph node and parietal involvement in gastric adenocarcinoma, including linitis plastica. CT scan remains the cornerstone of preoperative evaluation in gastric adenocarcinoma, including linitis plastica. However, CT presents a lack of sensitivity to diagnose low-volume peritoneal carcinomatosis.

Keywords: computed tomography, CT scan, linitis, gastric adenocarcinoma