Enhancement Patterns of Gastric Carcinoma on Contrast-Enhanced Ultrasonography: Relationship with Clinicopathological Features

Abstract

The aim of this study was to assess the relationship between the enhancement patterns and clinicopathological features of gastric cancer using intravenous contrast-enhanced ultrasonography (CEUS). In this Ethics Committee-approved prospective study, five hundred fifty two patients with gastric cancer who gave informed consent were examined preoperatively with CEUS. The enhancement pattern of each tumor was analyzed visually. Gross and histopathological findings on the postoperative specimens were compared with the preoperative CEUS findings. The most common CEUS pattern in differentiated gastric cancer was homogeneous enhancement, whereas heterogeneous enhancement was the most common pattern in undifferentiated gastric cancer. The proportion of heterogeneous enhancement was significantly different between the two histological subtypes (Chi- square = 146.735, P<0.001). The sensitivity and specificity of early heterogeneous enhancement on CEUS in diagnosing undifferentiated gastric cancer were 78.84% and 72.59% respectively. Gastric cancers with heterogeneous enhancement were more often Borrmann III and IV macroscopic types than those with homogeneous enhancement (66.56% vs. 30.80%, P<0.001), more commonly T3 and T4 depth of invasion than those with homogeneous enhancement (71.52% vs. 59.60%, P<0.05), more often showed lymphatic invasion than those with homogeneous enhancement (84.44% vs. 76.40%, P<0.05), and were less likely to receive curative gastrectomy than those with homogeneous enhancement (74.83% vs. 86.40%, P<0.005). The intra- and inter-observer reproducibility were both almost perfect for assessing enhancement patterns, with Kappa values of 0.916 (P<0.001) for intra-observer and 0.842 (P<0.001) for inter-observer reproducibility. CEUS provided detailed information about tumor vascularity and contrast enhancement patterns in gastric cancer. CEUS is promising as a new and useful method to predict the histological type of gastric cancer.

Greyscale and contrast enhanced ultrasonography for characterization of gastric malignant tumors

“…US and CEUS allowed us a good appraisal of Borrmann macroscopic types, tumor size, lymph node involvement, and a fair measurement of depth invasion, consistent with the results obtained by Fang Wei et al [33]. A step forward may have been the use of CEUS in following the response to neoadjuvant chemotherapy before surgical resection in patients with locally-advanced gastric cancer [34].…”

“…At the moment, there are several studies regarding the preoperative diagnosis of gastric tumors using CEUS in patients with stomach cancer [14][15][16][17]. These studies are focused on highlighting the tumoral mass and less on finding a correlation between tumor histology and the behavior of the tumoral tissue on contrast administration.…”

Detection of gastric cancer using transabdominal ultrasonography is associated with tumor diameter and depth of invasion

“…In future studies, more patients should be enrolled, and loss of stratification should be investigated with color Doppler imaging and contrast enhancement (26,27).…”

Evaluation of Transabdominal Ultrasound with Oral Cellulose-Based Contrast Agent in the Detection and Surveillance of Gastric Ulcer

“…Considering the remarkable advances in ultrasound technology, transabdominal ultrasound after oral administration of an echoic, cellulose-based, gastric ultrasound contrast agent (TUS-OCCA) has recently been suggested as a valuable initial screening tool for gastric lesions in selected patients Liu et al 2014aLiu et al , 2014bLiu et al , 2015aLiu et al , 2015bShen et al 2014;Shi et al 2012;Wei et al 2013). However, the value of TUS-OCCA in the detection and surveillance of gastric ulcer remains unclear.…”