Preoperative staging of gastric cancer: comparison of endoscopic US and dynamic CT.

Abstract

Fifty consecutive patients with gastric adenocarcinoma proved by means of biopsy underwent preoperative staging with endoscopic ultrasonography (US). Dynamic computed tomography (CT) of the chest and abdomen was performed before surgery in 33 of the patients. In all 50 patients, the TNM classification of the American Joint Committee on Cancer was used to compare the imaging findings with pathologic findings in specimens resected at surgery. When the depth of tumor penetration was evaluated, the findings at endoscopic US and those at pathologic examination were concordant in 46 of 50 patients (92%), and the findings at dynamic CT and those at pathologic examination, in 14 of 33 patients (42%) (P less than .00042). Evaluation of regional lymph node metastases showed a concordance of 78% with endoscopic US and 48% with dynamic CT (P less than .038). Overall determination of stage with both dynamic CT and endoscopic US showed a concordance of 73%, compared with a concordance of 45% for dynamic CT alone (P less than .028).

Laparoscopy significantly improves the perceived preoperative stage of gastric cancer

“…Specific areas of fat plane effacement were also compared with adjacent evidence of fat plane preservation. Lymph nodes were considered to be involved if they were greater than 1 cm in diameter [11][12][13]. A radiological audit meeting was held prior to the start of this study in order to review the accuracy of CT as a staging investigation for patients with gastric cancer at the Royal Gwent Hospital.…”

Preoperative assessment of gastric carcinoma: value of two-phase dynamic CT with mechanical iv. injection of contrast material.

“…Accurate preoperative staging of gastric cancers is important in planning the most appropriate therapy [1]. CT and sonography have been used for preoperative staging in patients with gastric cancers [1][2][3]; however, the role of CT in staging gastric cancer is controversial.…”

“…CT and sonography have been used for preoperative staging in patients with gastric cancers [1][2][3]; however, the role of CT in staging gastric cancer is controversial.…”

High curative resection rate with weekly cisplatin, 5-fluorouracil, epidoxorubicin, 6S-leucovorin, glutathione, and filgastrim in patients with locally advanced, unresectable gastric cancer: a report from the Italian Group for the Study of Digestive Tract Cancer (GISCAD)

“…Demonstration exists that these procedures can improve staging of the primary tumour and detect unsuspected metastatic disease with interesting sensitivity and specificity, thus allowing a better patient selection and confrontation between different series. Particularly promising seemed data with regard to the use of EUS in preoperative staging of stomach tumours (Lightdale et al, 1989;Botet et al, 1991). Endoscopy and endoscopic ultrasonography showed an accuracy of 75 -85% in predicting tumour stage before surgery, but its use in the evaluation of response to treatment in patients, who received preoperative chemotherapy, was disappointing and unreliable probably due to chemotherapy-induced changes in the physical pattern of the tumour (Kelsen et al, 1996;Ajani et al, 1999).…”