EUS for the staging of gastric cancer: a meta-analysis

Mocellin, Simone; Marchet, Alberto; Nitti, Donato

doi:10.1016/j.gie.2011.01.030

Cited by 114 publications

(76 citation statements)

References 84 publications

(56 reference statements)

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“…In particular, Borrmann 4 gastric cancer exhibits a thickened wall, referred to as 'sandwich sign' (23). Our findings suggested that DWIBS/T2 may add diagnostic information to the process of T-staging (20)(21)(22)24).…”

Section: Discussionmentioning

confidence: 66%

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Diffusion-weighted whole-body imaging with background body signal suppression/T2-weighted image fusion of gastrointestinal cancers

Tomizawa

Shinozaki

Fugo

et al. 2016

Molecular and Clinical Oncology

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Abstract. Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) yields positive results for cancer against the surrounding tissues. The combination of DWIBS and T2-weighted images (DWIBS/T2) in the diagnosis of gastrointestinal tract cancers was retrospectively analyzed in the present study. Patients were subjected to magnetic resonance imaging after cancer was diagnosed through specimens obtained via biopsy or endoscopic mucosal resection. Sixteen patients were assessed between July, 2012 and June, 2013 and the correlation between detection with DWIBS/T2 and T staging was analyzed. Regarding patients who underwent surgery, the correlation between detection with DWIBS/T2 and the diameter or depth of invasion was analyzed. All cancers that had advanced to >T2 stage were detectable by DWIBS/T2, whereas all cancers staged as T2) or invading beyond the muscularis propria. IntroductionEndoscopy is the gold standard for diagnosing cancers of the gastrointestinal tract, including the esophagus, stomach, colon and rectum (1,2). However, endoscopy is not suitable for evaluating the depth of invasion and extent of cancer, as it only allows observation of the lumen. Endoscopic ultrasonography (EUS) and contrast-enhanced computed tomography (CE-CT) are performed to assess the structure of the primary lesion, the depth of invasion into the surrounding tissues and distant metastasis (3,4). Assessing the depth of invasion may occasionally be difficult due to the weak contrast of the cancer against the surrounding tissues. Therefore, an imaging modality with a strong signal and contrast would facilitate the assessment of the depth of tumor invasion.Magnetic resonance imaging (MRI) is not as popular as CT due to blurring and low spatial resolution (5). However, MRI may be a promising method if a strong soft tissue contrast in the abdomen can be achieved. Diffusion-weighted wholebody imaging with background body signal suppression (DWIBS) images are acquired using multiple-signal averaging, pre-pulse fat suppression and heavy diffusion weighting during free breathing (6). DWIBS is based on diffusion-weighted imaging (DWI) that visualizes and assesses the random movement of water at the molecular level (Brownian motion) (7,8). An advantage of DWIBS is that it provides a strong contrast of cancerous against surrounding non-cancerous tissues, which is useful for the detection, staging and monitoring of the response to therapy (9). A major limitation of DWIBS is that anatomical analysis may be difficult at times (10,11).

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Section: Discussionmentioning

confidence: 66%

“…and depth of invasion of gastric cancer (20)(21)(22). By contrast, all gastric and duodenal cancers exhibiting invasion of <T1 were not detected by DWIBS/T2, indicating that T stage affected tumor detectability by DWIBS/T2.…”

Section: Discussionmentioning

confidence: 93%

Diffusion-weighted whole-body imaging with background body signal suppression/T2-weighted image fusion of gastrointestinal cancers

Tomizawa

Shinozaki

Fugo

et al. 2016

Molecular and Clinical Oncology

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“…The positive likelihood ratio was 9.8 (95% CI 7.5-12.8) and the negative likelihood ratio 0.15 (95% CI 0.11-0.21). Assessment of Nstage by endoscopic ultrasound was less reliable with a sensitivity of 69%, a specificity of 84%, and a positive likelihood ratio of 4.4 (95% CI 3.6-5.4) and a negative likelihood ratio of 0.37 (0.32-0.44) [5]. Overall, the diagnostic accuracy of endoscopic ultrasound in the primary staging of GC was lower than expected.…”

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confidence: 73%

“…A meta-analysis of Mocellin et al assessed the efficacy of endoscopic ultrasound in the primary staging of GC disease in 54 trials (n = 5601) [5]. There was a high accuracy to differentiate T stages 1 and 2 from the more advanced stages (T3 and T4) with a pooled sensitivity of 86% and as specificity of 91%.…”

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confidence: 99%

Gastric Cancer: Clinical Aspects, Epidemiology and Molecular Background

et al. 2011

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In 2010, the WHO introduced the seventh edition of the tumor node metastasis (TNM) classification that provides a more detailed classification for both local tumor invasion (T) and lymph node involvement (N) compared with the previous version. The T and N categories of tumors located in the stomach have been further modified with the intention to ensure a better correlation to the prognostic outcome. For the classification of a pN0, the number of lymph nodes has been adjusted to 16.The description of tumors with origin in the esophagus has been simplified and includes tumors of the esophagogastric junction as well as gastric tumors extending to the proximal 5 cm of the stomach. Major changes are further the subclassification of the categories T1 and T4 and the new N categorization now considering the number of lymph nodes involved within tree categories. Furthermore, positive lymph nodes in the region of the celiac trunc are considered as regional in case of esophageal cancers.The validity of the new classification system in its prognostic efficacy was compared to the previous edition. A study conducted in China proved a better prognostic stratification for the new actualized version [1]. Another study from Korea showed similar results for the new TNM system, proving a more detailed prognostic assessment, especially between T2 and T3 and N1 and N2 tumors [2]. The advantage of the new (7th) edition was mainly confirmed for the prognostic value of accurate lymph node assessment [3].Concerning the classification of early gastric cancer (GC) in the new system, a study from Italy confirmed the usefulness of the new classification for metastatic lymph nodes as a prognostic tool in case of early GC. AbstractThe validity and usefulness of the 7th edition of the UICC tumor node metastasis classification in the context of clinical management of gastric cancer are discussed. The most relevant new agent in gastric cancer therapy is trastuzumab for HER2-positive gastric carcinomas. This marks the success of continuous effort of translational research. Trastuzumab, initially applied in palliative settings, is currently being evaluated also in neoadjuvant treatment regimens. Several new meta-analyses support the carcinogenic effect of high salt intake and smoking in the context of Helicobacter pylori infection. Further data have become available on the efficacy of protective agents, acetyl salicylic acid ⁄ nonsteroidal anti-inflammatory drugs, and antioxidants. In search for a successful prevention strategy, the focus is on the identification of individuals at high risk who demand screening (testing) and surveillance. Serological assessment of gastric mucosal abnormalities with increased risk for gastric cancer development is extensively studied, and new data are presented from Asia as well as from Europe. New high-throughput techniques combined with bioinformatic vector analysis open the gate to the identification of new potential diagnostic and therapeutic targets. Furthermore, these approaches allow us to elucidate the int...

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“…Contrast fluorography and fibrogastroscopy (FGS) are the most efficient methods of GC screening. FGS is three times less expensive for early diagnosis, although it does require greater skills from the endoscopist (3,4).…”

Section: Diagnosismentioning

confidence: 99%

Current practice for gastric cancer treatment in Ukraine

Sydiuk

2017

Transl. Gastroenterol. Hepatol.

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IntroductionGastric cancer (GC) is a significant and unsolved problem, despite a slight decrease in its morbidity. Globally, 952,000 new GC cases were registered in 2012. In South Korea and Japan, because of screening for GC, the 5-year survival rate is more than 60%. In most other countries, this value is 2-3 times lower (1,2). In Ukraine, GC is a serious problem. Annually, the country registers more than 8,000 new GC cases. The disease is usually diagnosed at stage III-IV (65% of cases) and 62.2% of patients die within 1 year. About 70% of patients with GC need chemotherapy, and for most of them, this is the only way to increase their life expectancy. Morbidity and death rateAccording to the national cancer register of Ukraine, there were 8,350 new cases of GC in 2014 (5,104 in men and 3,246 in women). Thus, the morbidity rate is 23.0 cases per 100,000 people (30.3 for men and 16.7 for women), which puts the disease in fourth place for men and eighth place for women for morbidity as a result of malignant tumors in Ukraine. During the period under investigation, 6,414 patients diagnosed with GC died. The death rate was 17.7 cases per 100,000 people (23.8 for men and 12.3 for women), which means that, for men and women respectively, GC has the second and third highest death rates from malignant tumors in Ukraine.People diagnosed with GC for the first time are diagnosed at the following stages according to the TNM classification: stage I-II, 37.6%; stage III, 22.5%; stage IV, 33.9%; and indistinct stage, 5%. Thus, advanced GC is diagnosed for the first time in as many as 60% of all patients, which leads to a high death rate of more than 50% during the first year.The above information allows us to conclude that the early diagnosis of GC, as well as combined methods of treating it with neo-adjuvant and adjuvant therapy, is of paramount importance in Ukraine.Despite the gradual decline in GC morbidity, there are still some serious associated problems. Namely, in the last 10 years, the following was noted ( Table 1): (I) very few changes in the morbidity rate for women; (II) decrease in the diagnosis of stage I-II disease in spite of the necessary endoscopic equipment; (III) high death rate within 1 year.Given this information, we should define the most of patients with GC need chemotherapy, and for most of them, this is the only way to increase their lifeexpectancy. An unsolved problem of nationwide importance is achieving the early diagnosis of GC, which predetermines the treatment outcome. The 5-year survival rate for GC patients in Ukraine is only 13%, while early diagnosed GC is almost totally curable using surgery. Another important task is the development of national diagnosis and treatment standards, which will be based on national breakthroughs and will meet modern international requirements.

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EUS for the staging of gastric cancer: a meta-analysis

Cited by 114 publications

References 84 publications

Diffusion-weighted whole-body imaging with background body signal suppression/T2-weighted image fusion of gastrointestinal cancers

Diffusion-weighted whole-body imaging with background body signal suppression/T2-weighted image fusion of gastrointestinal cancers

Gastric Cancer: Clinical Aspects, Epidemiology and Molecular Background

Current practice for gastric cancer treatment in Ukraine

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