Endosonography Versus Helical Computed Tomography for Locoregional Staging of Gastric Cancer

Abstract

EUS is more accurate than HCT in the T-staging of gastric carcinoma. Both methods are comparable for N-staging, when this is done according to the older, fourth edition of the TNM classification. If the fifth edition is used, EUS is less accurate than HCT.

Imaging in assessing lymph node status in gastric cancer

“…• The sensitivity and specifi city of AUS for the detection of LN metastasis varied between 12.2% and [33] 2004 − − − − − + − + + + − − − 2 2 31 Lee et al [42] 2001 − − − + + + − + + + + + + 4 5 69 Düx et al [53] 1997 + − + + − + − + + − + + + 5 4 69 Kim et al [54] 1997 − − + − + + − − + + − + + 3 4 54 Stell et al [57] 1996 − − − − + − − + + + + + + 2 5 54 EUS Lok et al [17] 2008 − − − − + − − − + + + − + 1 4 38 Bentrem et al [19] 2007 + − − + + + − + + − + + + 5 4 69 Tan et al [20] 2007 − − + + + + − + + + − − − 5 2 54 Arocena et al [24] 2006 + − − − + + − − + + − + + 3 4 54 Ganpathi et al [25] 2006 − − − − + + − + + + + − + 3 4 54 Tsendsuren et al [26] 2006 − − − + + + − + + + − − − 4 2 46 Ang et al [27] 2006 + − − − + + − − + − − + − 3 2 38 Potrc et al [29] 2006 + + − + + + − + + − − + + 6 3 69 Polkowski et al [34] 2004 + − − − + + − + + + + + + 4 5 69 Bhandari et al [35] 2004 + − − − + + − + + + − − + 4 3 54 Javaid et al [36] 2004 − − − + + + − + + + − + − 4 3 54 Habermann et al [37] 2004 + − − + + + − + + + + − + 5 4 69 Xi et al [40] 2003 − − − + + + − + + + − + − 4 3 54 Chen et al [41] 2002 − − + + + + − + + + + + + 5 5 77 Willis et al [43] 2000 + − − + + + − + + + + + − 5 4 69 Tseng et al [44] 2000 − − − + + + − + + + − + + 4 4 62 Mancino et al [46] 2000 − − − + + + − + + + − − − 4 2 46 Akahoshi et al [48] 1998 + − − − + + − + + + + + − 4 4 62 Hunerbein et al [49] 1998 + − − − + + − + + − − − + 4 2 46 Wang et al [50] 1998 + − − + + + − + + + − + − 5 3 62 Hamada et al [52] 1997 − − − + + + − + + + − − − 4 2 46 Hunerbein et al [55] 1996 + − − − − + − + + − + + − 3 3 46 François et al [56] 1996 + − − − + + − + + + − + − 4 3 54 Perng et al [58] 1996 + − − + + − − − + + − + − 3 3 46 Smith et al [60] 1993 − − − + + + − + + − − − + 4 2 46 Ziegler et al [61] 1993...…”

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).…”

“…While waiting for these results another possible procedural model, closer to what we have been using in our medium is to reserve neoadjuvant treatment for patients in stage T4 without distant metastasis or with extensively affected ganglions, which would mean carrying out an extended lymphadenectomy and consider later surgical treatment when a significant response to chemotherapy treatment existed (19). Endoscopic ultrasound plays an important role in this decision as the diagnostic precision is still superior to other imaging techniques in the study of invasion depth (11).…”