Abstract
OBJECTIVE: The consistency between clinical and pathological staging of lymph nodes (LNs) in gastric cancer (GC) remains suboptimal, and there is currently no standardized imaging criterion for diagnosing lymph node metastasis (LNM). This study aimed to elucidate the differences in LNs among various groups, regions, and stages, utilizing imaging and histopathology as the foundational basis. METHODS: We retrospectively analyzed the clinical data of 100 GC patients who underwent surgical treatment at Zhongnan Hospital of Wuhan University between January 2022 and May 2023. Patient characteristics, along with pathological and radiological data of LNs, were collected and compared across different groups, regions, and stages. RESULTS: Pathologically, 3566 LNs were collected, with a median of 35 (range: 17-72). Radiologically, 2233 LNs were collected, with a median of 22 (range: 3-47). Significant differences were observed in the long-axis diameter (LAD), short-axis diameter (SAD), ratios of long to short axis (RLSA), and product of long and short axis (PLSA) between negative and positive LNs. However, only within group 3 did the RLSA show statistical significance upon grouping analysis. The areas under the curve (AUC) for LAD, SAD, PLSA, and their combination index (CI) in diagnosing LNM were 0.817, 0.817, 0.828, and 0.827, respectively. Diverse groups, regions, and stages exerted a more pronounced influence on LN groups 1-6, while having a comparatively lesser impact on LN groups 7-16. CONCLUSION: LAD, SAD, and PLSA exhibited significant diagnostic value for LNM and could serve as diagnostic criteria; however, RLSA demonstrated limited diagnostic utility. The formulation of diagnostic criteria should consider the impact of groups, regions, and stages to enhance sensitivity and specificity.