Preoperative Staging of Gastric Cancer by Endoscopic Ultrasound
- 1 October 2002
- journal article
- alimentary tract
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Clinical Gastroenterology
- Vol. 35 (4), 321-327
- https://doi.org/10.1097/00004836-200210000-00008
Abstract
Background Endoscopic ultrasound (EUS) is the standard modality in local preoperative staging of gastric cancers and is reputedly able to detect ascites. However, the association between ascites detected by EUS and local tumor staging, peritoneal carcinomatosis, or survival after surgery is not well documented. Goals To assess the accuracy, sensitivity, and specificity of EUS in the preoperative staging and detection of ascites in gastric cancers. We also try to correlate ascites with histologic staging, tumor differentiation, and survival rate of gastric carcinoma after surgery. Study The retrospective analysis was made in 57 consecutive patients with histologically confirmed gastric adenocarcinomas that underwent EUS before surgery. The accuracy of EUS was compared with the final surgical-pathologic findings. We estimated the prognostic usefulness by analyzing the clinicopathologic features of gastric adenocarcinomas and following up their survival rates. Results The overall T staging was 88% accurate by EUS. The accuracy for T staging was as follows: T1, 100%; T2, 33%; T3, 93%; and T4, 100%. About 50% of T2 cases were overstaged. The overall accuracy, sensitivity, and specificity of detecting lymph node metastasis by EUS were 79%, 79%, and 80%, respectively. One of the seven T1 cancers had regional lymph node metastasis, and it was missed by EUS, although the T classification was precisely staged based on finding submucosal invasion. A total of 22 patients (39%) had ascites detected by EUS; both the sensitivity and specificity of EUS in demonstrating ascites were 100% in our study. Ascites was significantly correlated with the depth of tumor invasion (p = 0.036), lymph node metastasis (p = 0.008), and poor cellular differentiation (p = 0.007), but it was not significantly correlated with macroscopic peritoneal carcinomatosis. The survival rate after surgical treatment was poor in those with gastric cancers with lymph node metastasis, ascites, or poorly differentiated tumors (p < 0.05). However, multivariate analysis showed that lymph node metastasis was the only significant prognostic predictor (p = 0.004). Conclusions Endoscopic ultrasound is a valuable diagnostic tool in the local staging of gastric cancers and demonstration of ascites. Although the surgical treatment of gastric cancers with lymph node metastasis, ascites, or poor differentiation had poorer survival rate, only lymph node metastasis was proved to be a significant prognostic predictor in multivariate analysis.Keywords
This publication has 20 references indexed in Scilit:
- EUS in the detection of ascites and EUS-guided paracentesisGastrointestinal Endoscopy, 2001
- Clinical Importance of Preoperative Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 Levels in Gastric CancerJournal of Clinical Gastroenterology, 2001
- Endoscopic ultrasonography for diagnosis of submucosal invasion in early gastric cancerThe Esophagus, 2000
- Neoadjuvant chemotherapy with P-ELF (cisplatin, etoposide, leucovorin, 5-fluorouracil) followed by radical resection in patients with initially unresectable gastric adenocarcinoma: a phase II study.Annals of Surgical Oncology, 2000
- Effectiveness of immunochemotherapy for gastric cancer: A review of the current statusSeminars in Surgical Oncology, 1999
- Endoscopic Ultrasonography: A Promising Method for Assessing the Prospects of Endoscopic Mucosal Resection in Early Gastric CancerEndoscopy, 1997
- Relationship between histological type and endosonographic detection of regional lymph node metastases in gastric cancer.The British Journal of Radiology, 1997
- Prognostic factors in gastric carcinoma. Results of the German gastric carcinoma study 1992Cancer, 1993
- Regional lymph node metastasis in gastric cancer: evaluation with endoscopic US.Radiology, 1992
- Histologic Correlates of Gastrointestinal Ultrasound ImagesGastroenterology, 1989