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A COMPARATIVE STUDY OF MDCT, MRI, FDG PET AND DIAGNOSTIC LAPAROSCOPY IN ASSESSING GASTRO ESOPHAGEAL JUNCTION ADENOCARCINOMA.- A PROSPECTIVE STUDY
Rajendran Vellaisamy*1,2, Rajamani Emmanuvel Gunaseelan3, Sudharshini Subramaniam4, Kannan Devy Gounder1, Chandramohan Servarayan Murugesan1,5
1Institute of Surgical Gastroenterology, Rajiv Gandhi Govt General Hospital, Madras Medical College, Chennai, Tamilnadu, India; 2Department of Surgical Gastroenterology, Chengalpattu Medical College, Chennai, Tamilnadu, India; 3Department of Radiology, Bharat scans, Chennai, Tamilnadu, India; 4Institute of Social and Preventive Medicine, Madras Medical College, Chennai, Tamilnadu, India; 5Center for Gastroesophageal Disorders, ESOINDIA, Chennai, Tamilnadu, India
AIM
The aim of this study is to assess the efficacy of MDCT, MRI and FDGPET in Potentially Resectable GEJ Adenocarcinoma.
METHODS
The study is between December 2014 to August 2016. It includes 30 patients (M 16: F 14) (mean age 57.03 years) with potentially resectable GEJ adenocarcinoma having good performance status. Evidence of metastasis was excluded by clinical examination, x-ray chest and ultrasound abdomen. All patients were subjected to MDCT, MRI of neck, chest, abdomen and Whole body FDGPET scan. After the above imaging, all patients underwent diagnostic laparoscopy followed by surgery if resectable.The findings were correlated with postop HPE report. Biopsy of the metastatic sites except pulmonary nodules were taken for confirmation.
.RESULTS
There was no statistically significant difference between CT and MRI both in terms of length (p -0.648) and thickness (p -0.572). Even though there is a good agreement (0.556) between CT and MRI in tumor staging (Kappa statistics) (p <0.001), in 8 cases where the MRI has upstaged. With regards to metastasis, PET has 100% specificity and 75 % sensitivity. Combined MRI and PET have sensitivity and specificity of 97.11% and 90.91% whereas combined MDCT and PET have sensitivity and specificity of 93.50% and 88.24% respectively.
CONCLUSION
MRI is better than MDCT in assessment of adjacent organ involvement. Though PET is more specific than MDCT and MRI in assessing malignant nodes, further studies are required to assess the optimum SUV for malignant nodes. Diagnostic laparoscopy continues to play a role in diagnosing small peritoneal metastasis (< 6 mm) which are missed even by PET. In this study PETMRI appears to be superior to PETCT but requires large volume studies to confirm.
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