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Abstract：
Background Gastric adenocarcinoma (GCA) poses a significant global health burden due to its prevalence and high morbidity and mortality rates. GCA is classified into three main histological types: well-differentiated (intestinal type), poorly differentiated (diffuse type), and mixed or indeterminate forms. These types vary in causes, epidemiology, and genetics, with the diffuse type often associated with the worst prognosis. Endoscopic biopsy is the primary method for characterization, but it has its limitations. There is potential in using contrast-enhanced computed tomography (CT) to differentiate between histological subtypes of gastric adenocarcinoma, which could aid subtype differentiation. Building on this, our study aims to assess CT\'s effectiveness in distinguishing between broad histological groups of gastric adenocarcinoma based on enhancement patterns, contributing to improved diagnostic accuracy Objective Our research focuses on evaluating the effectiveness of multiphasic contrast-enhanced computed tomography (CECT) in distinguishing between the three broad histopathological subtypes of gastrointestinal cancers. Methods This study was a prospective, analytical observational study that was approved and carried out in our institutional tertiary care hospital. Consecutive individuals who had undergone endoscopic-guided biopsy and demonstrated histological evidence of GCA were taken into consideration for participation in the study. In order to complete the clinical staging process, further multiphasic CT scans were carried out on each of the fifty patients and were categorised accordingly based on the findings of histopathology. Results In the differentiated type, segmental distribution was: 5.5% upper segment, 16.7% middle segment, 66.7% lower segment, and 11.1% diffuse type. Esophageal involvement was 5.6%, duodenal involvement was similar, and lymph node involvement was approximately 38.8%. TNM staging: 38.8% IIIB, 22.2% III, 27.8% IVA, and 11.1% IVB. In the undifferentiated type, segmental distribution: 6.2% upper segment, 31.2% middle segment, 50.0% lower segment, and 12.5% diffuse type. Esophageal involvement was around 6.25%, duodenal involvement was 18.75%, and lymph node involvement was about 71.8%. TNM staging: 34.4% IIIB, 21.8% III, 28.1% IVA, and 15.6% IVB. Conclusion Multiphasic CT evaluations provide valuable insights into the prognostic aspects of gastric carcinomas by assessing peak enhancement. Differentiated tumors typically exhibit arterial phase enhancement, while undifferentiated tumors show venous phase enhancement, reflecting their microvascular architecture. Recent studies emphasize the importance of understanding gastric carcinoma characteristics for diagnosis and prognosis. Our research aligns with this, revealing distinct contrast enhancement patterns between differentiated and undifferentiated types. However, discrepancies in histological classifications and contrast enhancement patterns across studies warrant further investigation. Integrating histopathological and radiological insights is essential for accurate diagnosis and treatment planning.
摘要：
背景胃腺癌（GCA）由于其患病率和高发病率和死亡率而造成了巨大的全球健康负担。GCA分为三种主要的组织学类型：高分化（肠型），分化差（弥漫型），和混合或不确定的形式。这些类型的原因各不相同，流行病学,和遗传学，弥漫型通常与最差预后相关。内窥镜活检是表征的主要方法，但它有其局限性。有可能使用对比增强计算机断层扫描（CT）来区分胃腺癌的组织学亚型，这可以帮助亚型分化。在这个基础上，我们的研究旨在评估CT在基于增强模式区分胃腺癌的广泛组织学组中的有效性，有助于提高诊断准确性目的我们的研究重点是评估多相对比增强计算机断层扫描（CECT）在区分胃肠道肿瘤的三种广泛的组织病理学亚型中的有效性。方法本研究是一项前瞻性研究,在我们的机构三级护理医院批准并进行的分析观察性研究。连续接受内窥镜引导活检并显示GCA组织学证据的个体被考虑参与研究。为了完成临床分期过程,对50例患者中的每一例进行了进一步的多相CT扫描,并根据组织病理学结果进行了相应分类.结果在分化型中,节段分布为：上节段5.5%，16.7%中段，细分市场较低66.7%，和11.1%扩散型。食管受累为5.6%，十二指肠受累相似,淋巴结受累约为38.8%。TNM分期：38.8%IIIB，22.2%III,27.8%IVA,和11.1%IVB。在未分化类型中，节段分布：6.2%上段，31.2%中段，下段50.0%，和12.5％扩散型。食管受累约为6.25%，十二指肠受累为18.75%,淋巴结受累约为71.8%。TNM分期：34.4%IIIB，21.8%III,28.1%IVA,和15.6%IVB。结论多相CT评估通过评估峰值增强为胃癌的预后方面提供了有价值的见解。分化肿瘤通常表现出动脉期增强，而未分化肿瘤显示静脉期增强，反映了它们的微血管结构。最近的研究强调了解胃癌特征对诊断和预后的重要性。我们的研究与此相符，揭示了分化和未分化类型之间不同的对比增强模式。然而,不同研究中组织学分类和对比增强模式的差异值得进一步研究.整合组织病理学和放射学见解对于准确的诊断和治疗计划至关重要。
