Feasibility of differentiating T3 from T4a gastric cancer in different Lauren classification by determining serosa invasion: Diagnostic performance of high enhanced serosa sign

Objective: To study the value of high enhanced serosa sign on contrast-enhanced computed tomography (CT) in differentiating T3 from T4a gastric cancer in different Lauren classification. Methods: This study included 276 consecutive patients with surgically confirmed pT3 or pT4a gastric cancers. The pre-operative CT images were reviewed by two radiologists blinded. The demonstration of the high enhanced serosa on CT between T3 and T4a was compared with chi-square test. The diagnostic performance of this sign on CT in the differentiation of T4a from T3 in different Lauren classification was calculated. Results: The accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the judgement of serosa invasion using the high enhanced serosa sign on CT was 74.6%, 63.7%, 83.6%, 76.0% and 73.8% by one radiologist and 76.4%, 66.1%, 84.9%, 78.1% and 75.4% by the other radiologist. Compared to the intestinal-type, the sensitivity of the judgement of serosa invasion using the high enhanced serosa sign on CT in diffuse-type was significant higher (80% in both readers), while the specificity trended to be lower (65.9% and 80.5%, respectively). There is no significant difference in the accuracy of diagnosis between intestinaltype and diffuse-type of gastric cancers (the P-values of two radiologists were 0.968, 0.591, respectively). The combination of the high enhanced serosa sign with conventional CT signs is significant different in diagnosis of T3 and T4a (P < 0.001). The diagnostic accuracy was increased in both radiologists after the combination. The two readers achieved substantial agreement, with Kappa coefficient of 0.63, P < 0.001. Conclusions: The high enhanced serosa sign on CT is associated with serosa involvement. The sensitivity of the judgement of serosa invasion using this sign on CT in diffuse-type was significant higher than that in intestinal-type.