A comparison of computerised tomography, laparoscopic ultrasound and endoscopic ultrasound in the preoperative staging of oesophago-gastric carcinoma.
OBJECTIVE
Oesophago-gastric carcinoma is associated with a poor prognosis despite advances in diagnosis and treatment. Accurate preoperative staging of gastro-oesophageal carcinoma is, therefore, essential in order to determine patient selection for potentially curative resection. The aim of this study was to evaluate and compare the role of computerised tomography (CT), laparoscopic ultrasound (LapUS) and endoscopic ultrasound (EUS) in the staging of oesophago-gastric carcinoma.


METHODS
Thirty-six patients with histologically proven carcinoma of the oesophagus or stomach who were considered fit for surgical resection were identified from a prospectively collected database. All patients underwent spiral CT, LapUS and EUS as part of their preoperative staging investigations. RESULTS from the staging modalities were compared retrospectively with final histopathology where available and to intraoperative findings where the tumour was irresectable.


RESULTS
Locally advanced tumours (T3/T4) were accurately identified by CT in 15/16 (94%) and by EUS in 14/16 (88%). LapUS was unable to detect 11 tumours (of which five were T3/T4) because they were above the diaphragm, but in the locally advanced cases where the tumour could be seen the accuracy was 10/12 (83%). EUS was the best modality for assessing early tumours and locoregional nodal involvement with accuracies of 8/13 (62%) and 21/29 (72%), respectively. EUS accuracies rose to 64, 92 and 83% for T1/T2, T3/T4 and N staging with the exclusion of those patients (n=6) in whom strictures prevented full assessment. LapUS had a specificity of 100%, compared to 90% for CT and was more accurate than CT for assessing distant metastases (accuracy of 26/32 (81%) compared to 23/32 (72%) for CT).


CONCLUSIONS
Although this study is small it has confirmed that CT, EUS and LapUS act in a complimentary manner to provide the most complete preoperative staging for patients with oesophago-gastric cancer.
Wakelin
Sonia J
SJ
Department of Surgery, The Royal Infirmary, Lauriston Place, Edinburgh EH3 9YW, UK. sonia.wakelin@btinternet.com
Deans
Chris
C
Crofts
Trevor J
TJ
Allan
Paul L
PL
Plevris
John N
JN
Paterson-Brown
Simon
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging*; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed