Endoscopic ultrasonography for preoperative locoregional staging and assessment of resectability in gastric cancer


      We performed a prospective study from November 1989 to December 1996 to assess the accuracy of endoscopic ultrasonography (EUS) in the locoregional staging and resectability of patients with gastric carcinoma. One hundred and nineteen patients with gastric cancer who received preoperative assessment by EUS underwent subsequent surgery. The endosonographic tumor-node-metastasis (TNM) classification was used for comparison with the histopathologic findings of the resected specimens. The ability of EUS to accurately predict the T stage (depth of tumor invasion) and N stage (involvement of lymph node) was 70% and 65%, respectively. EUS dis- played a tendency to overestimate T stage and underestimate N stage. The differentiation of early gastric cancer from advanced gastric cancer showed a concordance rate of 89% with an overestimation rate of 8% and underestimation rate of 3%. The accuracy of EUS in predicting the stage T1 to T3, which correspond to D0 resectability (no macroscopic or microscopic tumor remains), was 91%. In conclusion, these results revealed EUS as a valuable tool for evaluating the local staging and resectability of gastric cancer. We suggest that EUS should be introduced in the preoperative assessment of patients with gastric cancer.


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        • Hirayama T
        Epidemiology of cancer of the stomach with special reference to its recent decrease in Japan.
        Cancer Res. 1975; 35: 3460-3463
        • Sipponen P
        • Jarvi O
        • Kekki M
        • Siurala M
        Decreased incidence of intestinal and diffuse types of gastric carcinoma in Finland during 20 year period.
        Scand J Gastroenterol. 1987; 22: 865-871
        • Silverberg E
        Cancer statistics 1980.
        Cancer J Clinicians. 1980; 30: 23-38
        • Cassell P
        • Robinson J.O
        Cancer of the stomach.
        Br J Surg. 1976; 63: 603-607
        • Lundh G
        • Burn J.I
        • Kolig G
        • et al.
        A co-operative international study of gastric cancer.
        Ann R Coll Surg Engl. 1974; 54: 219-228
        • Halvorsen R.A
        • Thompson W.M
        Computed tomographic staging of gastrointestinal tract malignancies.
        Invest Radiol. 1987; 103: 344-350
        • Kleinhaus U
        • Militianu D
        Computed tomography in the preoperative evaluation of gastric carcinoma.
        Gastrointest Radiol. 1988; 13: 97-101
        • Winkler M.L
        • Hricak H
        • Higgins C.B
        MR imaging of diffusely infiltrating gastric carcinoma.
        J Comput Assist Tomogr. 1987; 11: 337-339
        • Tio T.L
        • Tytgat G.N.J
        Endoscopic ultrasonography of normal and pathologic upper gastrointestinal wall structure.
        Scand J Gastroenterol. 1986; 21: 27-33
        • Heintz A
        • Mildenberger P
        • Georg M
        • Braunstein S
        • Junginger T
        Endoscopic ultrasonography in the diagnosis of regional lymph nodes in esophageal and gastric cancer—results of studies in vitro.
        Endoscopy. 1993; 25: 231-235
        • American Joint Committee on Cancer
        Manual for Staging of Cancer. 3. Lippincott, Philadelphia, PA1988 (pp. 69–74)
        • Tio T.L
        • Tytgat G.N
        Endoscopic ultrasonography in the assessment of intra and transmural infiltration of tumors in the esophagus, stomach and papilla of vater and in the detection of extra oesophageal lesions.
        Endoscopy. 1984; 16: 203-210
        • Abie T
        • Fuji T
        • Okita K
        • Takemoto T
        A fundamental study of normal layer structure of the gastrointestinal wall visualized by endoscopic ultrasonography.
        Scand J Gastroenterol. 1986; 21: 6-15
        • Shorvon P.J
        • Lees W.R
        • Frost R.A
        • Cotton P.B
        Upper gastrointestinal endoscopic ultrasonography in gastroenterology.
        Br J Radiol. 1987; 60: 429-438
        • Grimm H
        • Binmoeller K.F
        • Hamper K
        • Koch J
        • Henne-Bruns D
        • Soehendra N
        Endosonography for preoperative locoregional staging of esophageal and gastric cancer.
        Endoscopy. 1993; 25: 224-230
        • Dittler H.J
        • Siewert J.R
        Role of endoscopic ultrasonography in gastric carcinoma.
        Endoscopy. 1993; 25: 162-166
        • Tio T.L
        • Coene P.P.L.O
        • Luiken G.J.H.M
        • Tytgat G.N.J
        Endosonography in the clinical staging of esophagogastric carcinoma.
        Gastrointest Endosc. 1990; 36: S2-S10