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

Abstract

Objectives: to evaluate the diagnostic yield of endoscopic ultrasonography in loco-regional staging of gastric cancer in our medium and to determine the impact of this technique on later therapeutic management.Material and methods: this is a retrospective study carried out on patients histologically diagnosed with gastric adenocarcinoma who had been referred for endoscopic ultrasonographic examination. The technique results were compared with those obtained from surgical samples and/or from exploratory laparoscopylaparotomy. We compared the initial therapeutic decision based on conventional diagnostic techniques with the final therapeutic management based on the endoscopic ultrasonography results.Results: forty-six patients with gastric adenocarcinoma were included in the study (a reference exploration was available in 36 cases). Diagnostic precision was 70% in stage T, while in stages T1, T2, T3 y T4 was 100, 38, 82, and 100%, respectively. The sensitivity and specificity to differentiate T1-2 from T3-4 was 94 and 85%, respectively. We could not identify factors associated with obtaining a correct diagnosis in staging T. Diagnostic precision was 72% for stage N (N0: 58%; Nx 88%). The presence of free perigastric fluid was identified in 7 cases; the presence of peritoneal carcinomatosis was later confirmed in 5 of these. The result of endoscopic ultrasonography led to a modification in the subsequent therapeutic management in 13 patients (28%).Conclusions: endoscopic ultrasonography is a useful technique for loco-regional staging of gastric adenocarcinoma, which may have important implications in the therapeutic management of these patients.Key words: Gastric cancer. Endoscopic ultrasonography. Treatment. RESUMENObjetivos: valorar la rentabilidad diagnóstica de la ecoendoscopia en la estadificación locorregional del cáncer gástrico en nuestro medio y determinar el impacto de la técnica sobre el manejo terapéutico posterior.Material y métodos: estudio retrospectivo realizado en pacientes diagnosticados histológicamente de adenocarcinoma gástri-co que habían sido remitidos para la realización de ecoendoscopia. Se comparó el resultado de la técnica con el estudio final obtenido en la pieza operatoria y/o laparoscopia-laparotomía exploradora. Se comparó la decisión terapéutica inicial basada en los resultados de las técnicas diagnósticas convencionales, con el manejo terapéu-tico final basado en el resultado de la ecoendoscopia.Resultados: se incluyeron en el estudio 46 pacientes con adenocarcinoma gástrico (en 36 de los cuales se disponía de exploración de referencia). La precisión diagnóstica fue del 70% para el estadIo T, y para T1, T2, T3 y T4 del 100, 38, 82 y 100%, respectivamente. La sensibilidad y especificidad para diferenciar el estadio T1-2 del T3-4 fue del 94 y 85% respectivamente. No se identificaron factores relacionados con la obtención de un diagnóstico correcto en la estadificación T. La precisión diagnóstica fue del 72% para el estadio N (N0: 58%; Nx 88%). En 7 pacientes se identificó la pr...

Efficacy of Endoscopic Ultrasonography for Prediction of Tumor Depth in Gastric Cancer

“…Until now, most clinical studies that examined the accuracy of EUS were conducted exclusively on the specific part of depth of invasion or studies that analyzed the accuracy on T stages. (4,5,16,17) It could be anticipated that in our study, it was analyzed including all types of infiltration depth that could be classified, and thus lower concurrence rates were shown in comparison with past studies.…”

“…Hence, in the preoperative diagnosis of disease stage of gastric cancer, attentions have been focused on the accuracy and usefulness of EUS, and several studies have reported that EUS is useful for the diagnosis of local disease stage of gastric cancer. (2,4,5,16) EUS diagnoses the T stage of tumors depending on the depth of infiltration that destroys the normal layer structure of stomach wall by the low echo irregular mass findings. (17) Although it is different depending on the literature, for the diagnosis of the T stage of gastric cancer, the accuracy of EUS has been reported to be 65-92%, and it may be influenced by several factors.…”

Sentinel lymph node mapping and biopsy using radioactive tracer in gastric cancer

“…In our study, most of the patients who were diagnosed for gastric cancer and sent to the clinic for surgery were in advanced stages so reliable staging devices such as endoscopic ultrasonography, which can demonstrate the depth of invasion, seem to be a good option before deciding lymphatic mapping and using SLN biopsy for planning the extension of lymphadenectomy. We used frozen section biopsies for evaluating SLN status intraoperatively and micrometastases were assessed using multiple sections and IHC in negative nodes.…”

Current management of gastric cancer

“…The reliability of endoscopic ultrasound depends on the specialist who performs it (7). This test can have sensitivity for clinical T staging between 65-92% and for N stage between 50-95% and can result in a change in therapeutic management in approximately 25% of cases (8). CT (computed axial tomography) is used for the diagnosis of distant spread of the disease, with a sensitivity for clinical T staging between 43-82%.…”