Gastric adenocarcinoma: a comparison of the accuracy and economics of staging by computed tomography and surgery.

We studied a series of 22 patient with proven gastric adenocarcinoma who underwent upper gastrointestinal radiography, computed tomography, upper gastrointestinal endoscopy, and/or surgical exploration and resection. Based on the computed tomographic findings, gastric carcinoma was classified into one of four stages: stage 1, intraluminal masses without gastric wall thickening; stage 2, gastric wall thickening (> 1 cm) and exophytic masses; stage 3, gastric wall thickening and contiguous spread of tumor into adjacent organs such as the pancreas, spleen, liver, transverse mesocolon, or esophagus; and stage 4, gastric wall thickening with distant metastatic disease. The stage of gastric malignancy as determined by computed tomography was correlated with presenting symptoms, location of tumor, upper GI findings, endoscopy, and findings of surgical exploration. The cost and estimated initial saving realized by performing routine preoperative gastric computed tomographic examinations were analyzed. Our results indicated that computed tomographic staging of gastrointestinal malignancy correlated closely with surgical findings and compared with other modalities, local extension, regional adenopathy, and the size of the tumor mass were better evaluated by computed tomography. Computed tomographic staging of gastric tumors cost $7150 and resulted in an estimated initial savings of $35,000-$56,000. The results of this study indicated that computed tomography is an accurate, cost effective method of preoperatively staging gastric carcinoma, capable of providing staging information heretofore only available by surgical exploration.