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Comparison of endoscopic ultrasonography and multislice spiral computed tomography for the preoperative staging of gastric cancer - results of a single institution study of 610 Chinese patients.

Feng XY, Wang W, Luo GY, Wu J, Zhou ZW, Li W, Sun XW, Li YF, Xu DZ, Guan YX, Chen S, Zhan YQ, Zhang XS, Xu GL, Zhang R, Chen YB - PLoS ONE (2013)

Bottom Line: The results from the imaging modalities were compared with the postoperative histopathological outcomes.The overall accuracy of MSCT was 67.2% when using the 13th edition Japanese classification, and this percentage was significantly higher than the accuracy of EUS (49.3%) and MSCT (44.6%) when using the 6th edition UICC classification (P<0.001 for both values).Our results demonstrated that the overall accuracies of EUS and MSCT for preoperative staging were not significantly different.

View Article: PubMed Central - PubMed

Affiliation: State Key Laboratory of Oncology in South China, Guangzhou, China ; Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.

ABSTRACT

Background: This study compared the performance of endoscopic ultrasonography (EUS) and multislice spiral computed tomography (MSCT) in the preoperative staging of gastric cancer.

Methodology/principal findings: A total of 610 patients participated in this study, all of whom had undergone surgical resection, had confirmed gastric cancer and were evaluated with EUS and MSCT. Tumor staging was evaluated using the Tumor-Node-Metastasis (TNM) staging and Japanese classification. The results from the imaging modalities were compared with the postoperative histopathological outcomes. The overall accuracies of EUS and MSCT for the T staging category were 76.7% and 78.2% (P=0.537), respectively. Stratified analysis revealed that the accuracy of EUS for T1 and T2 staging was significantly higher than that of MSCT (P<0.001 for both) and that the accuracy of MSCT in T3 and T4 staging was significantly higher than that of EUS (P<0.001 and 0.037, respectively). The overall accuracy of MSCT was 67.2% when using the 13th edition Japanese classification, and this percentage was significantly higher than the accuracy of EUS (49.3%) and MSCT (44.6%) when using the 6th edition UICC classification (P<0.001 for both values).

Conclusions/significance: Our results demonstrated that the overall accuracies of EUS and MSCT for preoperative staging were not significantly different. We suggest that a combination of EUS and MSCT is required for preoperative evaluation of TNM staging.

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Related in: MedlinePlus

T staging using MSCT and EUS.A. MSCT-T1 tumor: Transverse CT image shows an elevated lesion (arrow) of the gastric mucosa of the lesser curvature with a clear fat plane. The elevated gastric mucosa shows strong enhancement, and the tumor is confined to the mucosa. B. MSCT-T2 tumor: Transverse CT image shows an elevated lesion (arrow) of the gastric mucosa of the lesser curvature with a clear fat plane. The elevated gastric mucosa shows strong enhancement, and the tumor is considered as the invasion into the muscular layer but not the serosa.C. MSCT-T3 tumor: Transverse CT image shows a markedly thickened gastric wall (arrow) of the lesser curvature. The tumor extends beyond the serosal layer and affects the fat plane. Its relation with adjacent organs can be distinguished.D. MSCT-T4 tumor: Transverse CT image of a transmural tumor of the gastric antrum (arrow) with a markedly thickened gastric wall and invasion of the head of the pancreas.E. EUS-T1 cancer: Endosonographic image of T1 gastric cancer showing hypoechogenic wall thickening with infiltration of the mucosal and submucosal layers (arrow).F. EUS-T2 cancer: Gastric carcinoma with infiltration of the muscularis propria (arrow).G. EUS-T3 cancer: Transmural hypoechoic tumor with penetration into serosa (arrow).H. EUS-T4 cancer: EUS showing advanced gastric cancer with infiltration of the head of the pancreas (arrow).
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pone-0078846-g001: T staging using MSCT and EUS.A. MSCT-T1 tumor: Transverse CT image shows an elevated lesion (arrow) of the gastric mucosa of the lesser curvature with a clear fat plane. The elevated gastric mucosa shows strong enhancement, and the tumor is confined to the mucosa. B. MSCT-T2 tumor: Transverse CT image shows an elevated lesion (arrow) of the gastric mucosa of the lesser curvature with a clear fat plane. The elevated gastric mucosa shows strong enhancement, and the tumor is considered as the invasion into the muscular layer but not the serosa.C. MSCT-T3 tumor: Transverse CT image shows a markedly thickened gastric wall (arrow) of the lesser curvature. The tumor extends beyond the serosal layer and affects the fat plane. Its relation with adjacent organs can be distinguished.D. MSCT-T4 tumor: Transverse CT image of a transmural tumor of the gastric antrum (arrow) with a markedly thickened gastric wall and invasion of the head of the pancreas.E. EUS-T1 cancer: Endosonographic image of T1 gastric cancer showing hypoechogenic wall thickening with infiltration of the mucosal and submucosal layers (arrow).F. EUS-T2 cancer: Gastric carcinoma with infiltration of the muscularis propria (arrow).G. EUS-T3 cancer: Transmural hypoechoic tumor with penetration into serosa (arrow).H. EUS-T4 cancer: EUS showing advanced gastric cancer with infiltration of the head of the pancreas (arrow).

Mentions: An AUM-2000 set at variable frequencies of 5, 7.5, 15, and 20 MHz and a UM-2R miniprobe set at 12 or 20 MHz (Olympus, Tokyo, Japan) were used for the EUS examinations. Conventional gastroscopic inspection equipment, including a GIF-XQ240 and a GIF-XQ260 (Olympus, Tokyo, Japan), was used. Patient preparation for EUS was identical to that for conventional endoscopy. Conventional endoscopy was performed to obtain general information about the stomach, and clean food residues and mucus. Endoscopic ultrasonography was performed proximal to the descending portion of the duodenum, except in patients with gastric outlet obstruction. We inspected the stomach during echoendoscope removal. De-aerated water was instilled to improve the transmission of the ultrasound beam. Acoustic coupling with the gastric wall was obtained by instilling 500-800 ml of de-aerated water into the gastric cavity or 200-500 ml into the duodenum. The ultrasonic aspect of tumors and their contiguous structures were assessed by moving the endoscope tip along the entire stomach. The pancreatic body and tail, spleen, splenic hilar lymph nodes, left liver and hilus hepatis lymph nodes, stomach retinal left and right lymph nodes, stomach left and right lymph nodes, celiac lymph nodes, cardiac lymphatic loop and subcarinal lymph nodes were successively assessed. Generally, endoscopic ultrasonography was used to scan larger lesions and lymph nodes. The miniprobe was used with endoscopic ultrasonography for relatively smaller lesions. The same group of expert endoscopists performed endoscopic ultrasonography imaging. Local tumor infiltration was determined using the five-layer structure of the gastric wall [14,15]. Briefly, the mucosal (M) layer was visualized as a combination of the first and second hypoechoic layers, and the submucosal (SM) layer corresponded to the third hyperechoic layer. The muscularis propria (MP) layer was visualized as the fourth hypoechoic layer, while the fifth hyperechoic layer included the serosa and subserosa (Figure 1. E, F, G, H). EUS assessment of the N stage was based on the number of metastatic perigastric lymph nodes. A lymph node metastasis was established using two or more of the following criteria: (1) size greater than 5 mm, (2) round shape, (3) hypoechoic pattern, and (4) smooth border [16,17] (Figure 2. B). T and N staging were assessed using the 6th UICC classification [18].


Comparison of endoscopic ultrasonography and multislice spiral computed tomography for the preoperative staging of gastric cancer - results of a single institution study of 610 Chinese patients.

Feng XY, Wang W, Luo GY, Wu J, Zhou ZW, Li W, Sun XW, Li YF, Xu DZ, Guan YX, Chen S, Zhan YQ, Zhang XS, Xu GL, Zhang R, Chen YB - PLoS ONE (2013)

T staging using MSCT and EUS.A. MSCT-T1 tumor: Transverse CT image shows an elevated lesion (arrow) of the gastric mucosa of the lesser curvature with a clear fat plane. The elevated gastric mucosa shows strong enhancement, and the tumor is confined to the mucosa. B. MSCT-T2 tumor: Transverse CT image shows an elevated lesion (arrow) of the gastric mucosa of the lesser curvature with a clear fat plane. The elevated gastric mucosa shows strong enhancement, and the tumor is considered as the invasion into the muscular layer but not the serosa.C. MSCT-T3 tumor: Transverse CT image shows a markedly thickened gastric wall (arrow) of the lesser curvature. The tumor extends beyond the serosal layer and affects the fat plane. Its relation with adjacent organs can be distinguished.D. MSCT-T4 tumor: Transverse CT image of a transmural tumor of the gastric antrum (arrow) with a markedly thickened gastric wall and invasion of the head of the pancreas.E. EUS-T1 cancer: Endosonographic image of T1 gastric cancer showing hypoechogenic wall thickening with infiltration of the mucosal and submucosal layers (arrow).F. EUS-T2 cancer: Gastric carcinoma with infiltration of the muscularis propria (arrow).G. EUS-T3 cancer: Transmural hypoechoic tumor with penetration into serosa (arrow).H. EUS-T4 cancer: EUS showing advanced gastric cancer with infiltration of the head of the pancreas (arrow).
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pone-0078846-g001: T staging using MSCT and EUS.A. MSCT-T1 tumor: Transverse CT image shows an elevated lesion (arrow) of the gastric mucosa of the lesser curvature with a clear fat plane. The elevated gastric mucosa shows strong enhancement, and the tumor is confined to the mucosa. B. MSCT-T2 tumor: Transverse CT image shows an elevated lesion (arrow) of the gastric mucosa of the lesser curvature with a clear fat plane. The elevated gastric mucosa shows strong enhancement, and the tumor is considered as the invasion into the muscular layer but not the serosa.C. MSCT-T3 tumor: Transverse CT image shows a markedly thickened gastric wall (arrow) of the lesser curvature. The tumor extends beyond the serosal layer and affects the fat plane. Its relation with adjacent organs can be distinguished.D. MSCT-T4 tumor: Transverse CT image of a transmural tumor of the gastric antrum (arrow) with a markedly thickened gastric wall and invasion of the head of the pancreas.E. EUS-T1 cancer: Endosonographic image of T1 gastric cancer showing hypoechogenic wall thickening with infiltration of the mucosal and submucosal layers (arrow).F. EUS-T2 cancer: Gastric carcinoma with infiltration of the muscularis propria (arrow).G. EUS-T3 cancer: Transmural hypoechoic tumor with penetration into serosa (arrow).H. EUS-T4 cancer: EUS showing advanced gastric cancer with infiltration of the head of the pancreas (arrow).
Mentions: An AUM-2000 set at variable frequencies of 5, 7.5, 15, and 20 MHz and a UM-2R miniprobe set at 12 or 20 MHz (Olympus, Tokyo, Japan) were used for the EUS examinations. Conventional gastroscopic inspection equipment, including a GIF-XQ240 and a GIF-XQ260 (Olympus, Tokyo, Japan), was used. Patient preparation for EUS was identical to that for conventional endoscopy. Conventional endoscopy was performed to obtain general information about the stomach, and clean food residues and mucus. Endoscopic ultrasonography was performed proximal to the descending portion of the duodenum, except in patients with gastric outlet obstruction. We inspected the stomach during echoendoscope removal. De-aerated water was instilled to improve the transmission of the ultrasound beam. Acoustic coupling with the gastric wall was obtained by instilling 500-800 ml of de-aerated water into the gastric cavity or 200-500 ml into the duodenum. The ultrasonic aspect of tumors and their contiguous structures were assessed by moving the endoscope tip along the entire stomach. The pancreatic body and tail, spleen, splenic hilar lymph nodes, left liver and hilus hepatis lymph nodes, stomach retinal left and right lymph nodes, stomach left and right lymph nodes, celiac lymph nodes, cardiac lymphatic loop and subcarinal lymph nodes were successively assessed. Generally, endoscopic ultrasonography was used to scan larger lesions and lymph nodes. The miniprobe was used with endoscopic ultrasonography for relatively smaller lesions. The same group of expert endoscopists performed endoscopic ultrasonography imaging. Local tumor infiltration was determined using the five-layer structure of the gastric wall [14,15]. Briefly, the mucosal (M) layer was visualized as a combination of the first and second hypoechoic layers, and the submucosal (SM) layer corresponded to the third hyperechoic layer. The muscularis propria (MP) layer was visualized as the fourth hypoechoic layer, while the fifth hyperechoic layer included the serosa and subserosa (Figure 1. E, F, G, H). EUS assessment of the N stage was based on the number of metastatic perigastric lymph nodes. A lymph node metastasis was established using two or more of the following criteria: (1) size greater than 5 mm, (2) round shape, (3) hypoechoic pattern, and (4) smooth border [16,17] (Figure 2. B). T and N staging were assessed using the 6th UICC classification [18].

Bottom Line: The results from the imaging modalities were compared with the postoperative histopathological outcomes.The overall accuracy of MSCT was 67.2% when using the 13th edition Japanese classification, and this percentage was significantly higher than the accuracy of EUS (49.3%) and MSCT (44.6%) when using the 6th edition UICC classification (P<0.001 for both values).Our results demonstrated that the overall accuracies of EUS and MSCT for preoperative staging were not significantly different.

View Article: PubMed Central - PubMed

Affiliation: State Key Laboratory of Oncology in South China, Guangzhou, China ; Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.

ABSTRACT

Background: This study compared the performance of endoscopic ultrasonography (EUS) and multislice spiral computed tomography (MSCT) in the preoperative staging of gastric cancer.

Methodology/principal findings: A total of 610 patients participated in this study, all of whom had undergone surgical resection, had confirmed gastric cancer and were evaluated with EUS and MSCT. Tumor staging was evaluated using the Tumor-Node-Metastasis (TNM) staging and Japanese classification. The results from the imaging modalities were compared with the postoperative histopathological outcomes. The overall accuracies of EUS and MSCT for the T staging category were 76.7% and 78.2% (P=0.537), respectively. Stratified analysis revealed that the accuracy of EUS for T1 and T2 staging was significantly higher than that of MSCT (P<0.001 for both) and that the accuracy of MSCT in T3 and T4 staging was significantly higher than that of EUS (P<0.001 and 0.037, respectively). The overall accuracy of MSCT was 67.2% when using the 13th edition Japanese classification, and this percentage was significantly higher than the accuracy of EUS (49.3%) and MSCT (44.6%) when using the 6th edition UICC classification (P<0.001 for both values).

Conclusions/significance: Our results demonstrated that the overall accuracies of EUS and MSCT for preoperative staging were not significantly different. We suggest that a combination of EUS and MSCT is required for preoperative evaluation of TNM staging.

Show MeSH
Related in: MedlinePlus