Endoscopic ultrasonography in the preoperative staging of gastric cancer

Abstract

Generally accepted standards for the therapy of advanced gastric carcinomas do not exist. In cases where the therapeutic strategy is surgical exploration, no preoperative staging is necessary. In cases with differentiated treatment strategies, the accuracy of EUS is not sufficient for the selection of patients for endoscopic resection. Its accuracy for submucosal cancer invasion and for the detection of lymph node metastases needs to be further enhanced. If only multimodal therapy is considered, EUS staging seems to be absolutely mandatory. Patients classified preoperatively as T1 to T3 can be operated on primarily with sufficient security. In patients where radical resection of the tumor seems doubtful, we recommend that a diagnostic laparoscopy be performed to confirm the diagnosis.

Usefulness of endoscopic ultrasonography in preoperative gastric cancer staging: diagnostic yield and therapeutic impact

“…Thus the diagnostic precision for stage T varies between 70 and 90% depending on the series and on what type of endoscopic ultrasound is used, ultrasound frequencies and the location of the tumor (cardia or rest of the stomach) (8)(9)(10)(11)(12) deep staging are observed in stage T2 (8-12) tumors diagnosed by endoscopic ultrasound. On most occasions, in our series, it was caused by overstaging (tumors in stage T1 that were wrongly interpreted as being in stage T2).…”

“…Factors which have been described in cases of overstaging in other series include: inflammation, peritumorous necrosis and fibrosis -which usually exists in ulcerated tumor lesions-or obtaining ultrasound images tangential to the gastric wall, above all in tumors located in gastric antrum, incisura and fundus. Errors due to understaging may be due to deep microscopic invasion undetectable by the technique, ultrasound artefacts in relation to air content, mucous or food remains retained in the stomach or anatomical characteristics such as the absence of serosa at the lesser curvature and anterior wall which is why tumors in this location may be incorrectly interpreted as T2 despite transwall infiltration (8)(9)(10)(11)(12). Diagnostic precision in gastric cancer endoscopic ultrasound ganglion staging is lower than in T staging and varies from 55 to 87% in published series (3).…”

“…Diagnostic errors described in ganglion staging has been related to the lack of diagnostic precision of ultrasound characteristics that should allow a distinction between metastatic and reactive-inflammatory adenopathies, the frequency and penetration depth of the transducers used in endoscopic ultrasound, the existence of ganglion level micrometastasis or the extension of surgical lymphadenectomy. Thus, the more ganglions are removed the more metastatic adenopathies are identified and consequently more cases of understaging with imaging techniques occur (8)(9)(10)(11)(12).…”

Expression of Standard CD44 in Advanced Gastric Cancer: Relationship with Metastasis to Lymph Nodes

“…staging tumors by determining the T value has been much improved with EUS having an accuracy of between 78 -92 [5][6][7][8][9][10][11] , and CT between 69 -89 9, 12-18 .…”

“…However, the accuracy of establishing the N category is still poor ; 63 -78 using EUS [5][6][7][8][9][10][11] and 51 -78 using CT 9,[12][13][14][15][16][17][18] . The N category estimates 5-year survival rate in patients with N0 gastric cancer as 89.4 , but 68.3 in those with N1 disease 19 .…”