Accuracy of endoscopic ultrasound in gastric adenocarcinoma patient selection for neoadjuvant therapy

Abstract

Background: Recent studies demonstrated the positive impact of neoadjuvant treatment in locally advanced gastric cancer. Objective: To assess the accuracy of endoscopic ultrasound (EUS) in the selection of patients with gastric adenocarcinoma for neoadjuvant therapy (T ! 2 and/or Nþ). Methods: Retrospective analysis of patients with an anatomopathological diagnosis of gastric adenocarcinoma between January 2011 and June 2017, who had EUS for staging and underwent surgery as a first therapeutic attempt. The concordance (k) and accuracy (area under the curve (AUC)) of EUS for T ! 2 and/or Nþ were assessed using the anatomopathological staging of the resected surgical specimen as the gold standard. Results: The final sample included 152 patients (66.4% male, 67.1 AE 12.2 years). The concordance, accuracy, sensitivity and specificity of the EUS for T ! 2 and/or Nþ were 0.72, 0.86 AE 0.03, 88.5% and 83.1%, respectively. The results were higher in proximal (k ¼ 0.93, AUC ¼ 0.96 AE 0.05, sensitivity (S) ¼ 99.0% and specificity (E) ¼ 90.9%) compared with distal lesions (k ¼ 0.67, AUC ¼ 0.84 AE 0.04, S ¼ 85.7% and E ¼ 81.5%), and in intestinal subtype (k ¼ 0.77, AUC ¼ 0.88 AE 0.04, S ¼ 92.6% and E ¼ 84.1%) compared with diffuse (k ¼ 0.58, AUC ¼ 0.79 AE 0.10, S ¼ 85.0% and E ¼ 72.7%) or mixed-subtype tumours (k ¼ 0.65, AUC ¼ 0.84 AE 0.10, S ¼ 76.9% and E ¼ 90.0%). Conclusion: In one of the largest series of patients, we showed that EUS has overall high agreement and accuracy in the selection of patients with gastric adenocarcinoma for neoadjuvant therapy, although the agreement and accuracy are greater for proximal and intestinal lesions.

Preceding endoscopic submucosal dissection in submucosal invasive gastric cancer patients does not impact clinical outcomes

“…However, the pre-operative diagnosis of tumor invasion by conventional endoscopy and/or EUS does not have the same level of diagnostic performance, with a rate of accurate diagnosis of tumor invasion depth ranging between 62–81% for convention endoscopy and 67–85% for EUS 25 – 28 . Moreover, several studies have reported on the difficulty in performing accurate diagnosis for the lesions in the cardia of the stomach, as well as lesions with ulceration or perifocal inflammatory, and large lesions (> 30 mm) 24 , 29 – 31 . In our study, 78 lesions (77%) that were diagnosed as M or SM1 cancer were resect by ESD and finally diagnosed as T1b2 carcinoma by pathological examination.…”

Setting the stage for research in endoscopy

“…Furthermore, large, randomised, multi centre trials are warranted for evaluation of new endoscopic techniques and tools in clinical practice. Last but not least, as also highlighted in the present issue of United European Gastroenterology Journal , we should constantly evaluate the efficacy of certain endoscopic procedures in a ‘real life setting’ 8–10 …”

Diagnostic Endoscopic Ultrasound (EUS) of the Luminal Gastrointestinal Tract

“…Costa et al [93] found an accuracy of 86% in the selection of patients with gastric adenocarcinoma for neoadjuvant therapy (T2 and/or N+). The sensitivity and specificity were 88.5% and 83.1% with a better performance in the proximal location and intestinal type.…”