Preoperative evaluation of gastric cancer by endoscopic ultrasound.

Abstract

The preoperative use of endoscopic ultrasound was evaluated in 74 patients with confirmed gastric cancer. It was used in diagnosing the depth of invasion in the gastric wall, the infiltration to the adjacent organs, and the involvement of the perigastric lymph nodes. Results were compared with histological findings in resected specimens. Accuracy in staging gastric cancer using the T grade of the 1987 TNM system was 81-1% (60 of 74 patients MethodsBetween October 1986 and March 1990, we performed preoperative endoscopic ultrasound in 74 patients with a diagnosis of gastric cancer that had been confirmed by endoscopic biopsy specimen. There were 49 men and 25 women whose ages ranged from 17 to 85 years (mean 60 years). They underwent surgery after preoperative examinations including upper gastrointestinal series, endoscopy, endoscopic ultrasound, conventional transcutaneous ultrasound, and computed tomography. All the resected specimens, including lymph nodes, were examined histopathologically and results of the preoperative endoscopic ultrasound scanning were compared with both the intraoperative macroscopic findings and the pathology of the resected specimens. Echoendoscopes with radial sector scan transducers (GF-UM2, UM3, frequency 7 5 or 12 MHz) manufactured by Olympus (Tokyo, Japan) were used. The maximal penetration of the ultrasonic beam is 10 cm with 7 5 MHz and 3 cm with 12 MHz.To evaluate the gastric cancer, the echoendoscope was introduced into the stomach after premedication. The lesions were first observed endoscopically. Next the stomach was filled with deaerated water via the echoendoscope in sufficient quantity to allow us to see the lesion through the water occasionally. In addition the water filled balloon method'4 was used to confirm small lesions. Thereafter, we used the endoscopic ultrasound scanning technique to obtain an image of the lesion and of the normal gastric wall through the water. The entire procedure took about 20 minutes and there were no complications.

Endoscopic ultrasound-guided fine-needle aspiration biopsy

“…[1][2][3][4][5] EUS is superior to the CT scan, transabdominal ultrasonography, and endoscopic cholangiopancreatography in the detection of pancreatic tumors and adenopathy. 4,8 -11 However, the reliability of endosonographic features to differentiate between an inflammatory process and malignancy has been questioned.…”

“…EUS is useful for the diagnosis and staging of GI and pancreatic malignancies. [1][2][3][4][5] However, EUS is limited in its ability to distinguish an inflammatory/reactive process from a malignancy, particularly in evaluating lymph nodes and small lesions within the pancreas. 6,7 Similarly, EUS may be useful to identify submucosal masses but it is only diagnostic in a limited number of conditions such as varices and leiomyoma of the GI tract.…”

Ecoendoscopia na avaliação pré-operatória do estádio em doentes com câncer gástrico: correlação com os achados cirúrgicos e/ou histopatológicos

“…A US intraoperatória da peça cirúrgica ressecada, por outro lado, atinge 93,5% de concordância com os achados histopatológicos (23) . Na avaliação da categoria T, nesta casuística, a EE concordou em 83,3% dos casos com a histopatologia e/ou cirurgia, concordante com os dados de literatura, variáveis de 71% a 92% (1,16,29,41,47,48) . Avaliou-se para cada subdivisão desta categoria a sensibilidade, a especificidade, o valor preditivo positivo, o valor preditivo negativo e a exatidão, uma vez que se estudavam apenas casos confirmados pela histopatologia e/ou cirurgia.…”

Evaluation of preoperative staging in advanced gastric cancer with MRI

“…It is also helpful for patients who have to undergo radiotherapy [8] . There have been many reports about preoperative staging in advanced gastric cancer with CT [1,7,9] and endoscopic US [2,3] . The staging accuracy by CT and US is 42%-69% and 81%-92%, respectively.…”

“…Nevertheless, computed tomography and ultrasonography are used for diagnosis in patients with known gastric cancer as well as in complementary studies for the evaluation of extraserosal invasion, metastasis to lymph nodes and other organs [1][2][3] . However, there have only been a few studies that have utilized magnetic resonance imaging (MRI) for gastric cancer.…”