Imaging in Gastric Cancer: Current Practice and Future Perspectives

Abstract

Gastric cancer represents one of the most common oncological causes of death worldwide. In order to treat patients in the best possible way, the staging of gastric cancer should be accurate. In this regard, endoscopy ultrasound (EUS) has been considered the reference standard for tumor (T) and nodal (N) statuses in recent decades. However, thanks to technological improvements, computed tomography (CT) has gained an important role, not only in the assessment of distant metastases (M status) but also in T and N staging. In addition, magnetic resonance imaging (MRI) can contribute to the detection and staging of primary gastric tumors thanks to its excellent soft tissue contrast and multiple imaging sequences without radiation-related risks. In addition, MRI can help with the detection of liver metastases, especially small lesions. Finally, positron emission tomography (PET) is still considered a useful diagnostic tool for the staging of gastric cancer patients, with a focus on nodal metastases and peritoneal carcinomatosis. In addition, it may play a role in the treatment of gastric cancer in the coming years thanks to the introduction of new labeling peptides. This review aims to summarize the most common advantages and pitfalls of EUS, CT, MRI and PET in the TNM staging of gastric cancer patients.

Gastric Cancer: A Comprehensive Literature Review

“…Endoscopic ultrasound (EUS) provides detailed images of the gastrointestinal tract and nearby structures, aiding in the evaluation of tumour depth and lymph node involvement. Blood tests may be conducted to assess markers associated with gastric cancer, such as carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) [ 20 , 21 ].…”

Gastric cystica profunda: Another indication for minimally invasive endoscopic resection techniques?

“…Although EUS is reliable for investigation of depth of most small and non-ulcerated gastric lesions, it has been shown to have poor accuracy determining the depth of gastric lesions greater than 20mm, those with ulceration, and/or non-flat morphology, which usually make up the expanded criteria outlined by JGES[ 45 , 46 ]. CT of the abdomen can assist in identifying associated lymph nodes and metastasis[ 47 ]. Despite the availability of various diagnostic techniques, there are no clear guidelines on the approach to diagnosing GCP.…”

Applications and Prospects of Artificial Intelligence-Assisted Endoscopic Ultrasound in Digestive System Diseases

“…EUS can visualize the entire gastric wall and has higher accuracy in distinguishing EGC from advanced gastric cancer. EUS has become the preferred tool for local staging of gastric cancer nowadays [37]. Previous studies have reported an accuracy of 67% to 72% in determining the depth of infiltration by EUS for EGC.…”