Objective To investigate the diagnostic value of vascular‑entry sign on enhanced computed tomography (CT) for lymphovascular invasion of gastric cancer.

Methods The retrospec-tive case‑control study was conducted. The clinicopathological data of 135 patients with gastric cancer who were admitted to Changzhi People′s Hospital Affiliated to Changzhi Medical College from August 2021 to November 2022 were collected. There were 112 males and 23 females, aged (64±8)years. Of the 135 patients, 92 cases had lymphovascular invasion and 43 cases had no lymphovascular invasion. All the patients underwent preoperative enhanced CT examination. Observation indicators: (1) con-sistency assessment of vascular‑entry sign between the 2 radiologists; (2) comparison of clinical characteristics of patients with different lymphovascular invasion; (3) analysis of influencing factors for lymphovascular invasion in gastric cancer patients; (4) evaluation of diagnostic value of vascular-entry sign. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed by the nonparametric test. Count data were represented as absolute numbers or percen-tages, and comparison between groups was performed using the chi‑square test or Fisher exact probability. Nonparametric test was used for ordinal data. Consistency test (Cohen′s κ) was used to assess observer consistency between the two radiologists, and κ >0.8 indicated a good consistency. Logistic regression model was used for univariate and multivariate analyses. The receiver operating characteristic (ROC) curve was drawn, and the area under curve (AUC) was used to evaluate the diagnostic efficacy.

Results (1) Consistency assessment of vascular‑entry sign between the 2 radio-logists. The consistency of vascular‑entry sign evaluated by the two radiologists was good, with the κ value as 0.823. The detection rates of vascular‑entry sign for lymphovascular invasion by the two radiologists were 76.1%(70/92) and 73.9%(68/92), respectively. (2) Comparison of clinical charac-teristics of patients with different lymphovascular invasion. There were significant differences in tumor differentiation, clinical T staging, clinical N staging, CA19‑9 and vascular‑entry sign between them (P<0.05). (3) Analysis of influencing factors for lymphovascular invasion in gastric cancer patients. Results of multivariate analysis showed that stage T3 and T4 of Clinical T staging, stage N3 of clinical N staging and vascular‑entry sign were independent risk factors influencing lymphovascular invasion in gastric cancer patients (odds ratio=3.255, 11.242, 7.203, 3.426, 95% confidence interval as 1.079-10.453, 3.125-46.744, 2.267-28.902, 1.317-9.271, P<0.05). (4) Evaluation of diagnostic value of vascular‑entry sign. The AUC of ROC for vascular‑entry sign was 0.660 (95% confidence interval as 0.573-0.747). The sensitivity, specificity, accuracy, negative predictive value and positive predictive value were 0.739, 0.581, 0.689, 0.638, 0.922, respectively.

Conclusion Vascular‑entry sign on enhanced CT is an independent risk factor for lymphovascular invasion of gastric cancer patients, which has good diagnostic value.