Endoscopic ultrasonography in preoperative staging of gastric cancer: determination of tumor invasion depth, nodal involvement and surgical resectability

Abstract

Aim: Current study was aimed to evaluate the usefulness of EUS in TNM staging of gastric cancer by comparing EUS preoperative staging with pathological findings, and the preliminary exploration of possible reasons for overstaging and understaging phenomenon was especially intended.

Methods: A total of 35 patients with histologically confirmed gastric adenocarcinoma were referred to EUS and staged preoperatively by using the TNM system. The preoperative endosonographic results were compared with the histopathological staging.

Results: The overall accuracy of EUS for determination of the T stage was 80.0 %, and for T1, T2, T3, and T4 was 100 %, 71.4 %, 87.5 % and 72.7 %, respectively. For N stage, EUS had the accuracy of 68.6 %, with sensitivity and specificity of 66.7 % and 73.7 %, respectively. Resectability was predicted with sensitivity and specificity of 87.5 % and 100 %, respectively.

Conclusion: EUS is an accurate staging modality in most cases, with a few exceptions of overstaging and understaging. Patients with gastric cancers can benefit from preoperative EUS staging for establishing individualized therapy. However, EUS criteria to differentiate benign from malignant nodes still need to be further defined by future studies.