[Endosonography in diagnosis and staging of malignant tumors of the stomach. A prospective comparative study between endosonography, computerized tomography and conventional ultrasonography]

Abstract

78 patients with histologically proven malignant tumors of the stomach (64 carcinomas, 10 non-Hodgkin lymphomas [NHL], 4 sarcomas) were investigated by endosonography (EUS), computed tomography (CT) and conventional ultrasound (US) during TN-staging (TNM-classification/UICC-1987 for carcinomas and NHL, TNMG-classification for sarcomas). In 60 patients (50 carcinomas, 6 NHL, 4 sarcomas) an operative resection was performed and the histological findings were compared with the results of preoperative staging. Demonstration of tumor was successful with EUS in 77 (99%), with CT in 33 (42%) and with US in 18 (23%) cases. The T-stage was correctly determined preoperatively by EUS in 50 (81%), by CT and US only in 15 (24%) and in 7 (11%) patients respectively. The accuracy of EUS in determining the T-stage of carcinomas and NHL amounted to 79% in T1-, 92% in T2-, 92% in T3- and 67% in T4-stage. In gastric sarcomas infiltrative destruction of the gastric wall could be demonstrated with EUS in all patients and with CT in 3 of 4 cases. With EUS and CT two smaller tumors were correctly delineated as submucous tumors while with US this was not possible in any case. In demonstrating local lymph node metastasis EUS achieved a sensitivity of 85%, CT of 29% and US of 13%. The specificity of EUS was 72%, of CT 79% and of US 100%. The overall accuracy for the pN-stage was 79.7% for EUS, 51.6% for CT and 42.2% for US. EUS proves to be an efficient method in the local TN-staging of gastric carcinomas an NHL.(ABSTRACT TRUNCATED AT 250 WORDS)