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Limitations of EUS and CT for Preoperative Staging of Gastric Cancer
Mark Fairweather*1, Kunal Jajoo2, Sainani I. Nisha3, Monica M. Bertagnolli1, Jiping Wang1
1Department of Surgery, Brigham and Women's Hospital, Boston, MA; 2Department of Gastroenterology, Brigham and Women's Hospital, Boston, MA; 3Department of Radiology, Brigham and Women's Hospital, Boston, MA
Background: Neoadjuvant therapy has been recommended for locally advanced gastric cancer patients (stage IB-IIIC, AJCC 7th edition). Accurate preoperative staging is critical for the implementation of this recommendation. This study was to determine the accuracy of endoscopic ultrasound (EUS) and CT imaging in evaluating depth of tumor invasion (T stage) and lymph node status (N stage) for gastric cancer patients.
Methods: Between 2000 and 2013, 49 gastric adenocarcinoma patients who underwent preoperative staging by EUS followed by a radical gastrectomy with curative intent were included. CT scans of adequate quality available in 25 patients were reviewed by a radiologist blinded to the EUS and pathology results. The results of preoperative EUS/CT staging were compared with surgical pathologic staging to determine the accuracy of the imaging results.
Results: The accuracy of EUS in identifying each individual T and N stage was 41.0% and 42.9% respectively. The accuracy in differentiating locally advanced from early (stage 0-IA) disease was 77.6%. For each individual T and N stage, the accuracy of CT imaging was 4.0% and 56% respectively. CT scan had low accuracy in differentiating locally advanced from early disease (44.0%). When combining EUS and CT staging, the accuracy of identifying early vs. locally advanced disease increased to 76%.
Conclusion: EUS and CT imaging have suboptimal performance to identify each individual T and N stage although EUS had moderate accuracy in identifying patients with locally advanced diseases. CT does not improve the staging accuracy when combined with EUS. Efforts are needed to improve the performance of both preoperative staging modalities. Accuracy of preoperative EUS (38/49=77.6%) and CT imaging (15/25=44.0%) in predicting early (0-IA0) and locally advanced (IB-IIIC) disease | EUS Stage | Pathologic Staging | CT Stage | Pathologic Staging | | 0-IA | IB-IIIC | Total | 0-IA | IB-IIIC | Total | | 0-IA | 9 | 9 | 18 | | 4 | 7 | 11 | | IB-IIIC | 2 | 29 | 31 | 3 | 11 | 14 | | Total | 11 | 38 | 49 | 7 | 18 | 25 |
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