title: Accuracy of linear-array EUS for preoperative staging of gastric cardia cancer.
abstract: BACKGROUND
  The feasibility of a less invasive operation for early stage cancer of the gastric cardia with a low frequency of lymph node involvement has been previously demonstrated by us. Precise discrimination among mucosal, submucosal, and advanced cancers, as well as accurate evaluation of the proximal tumor margin are prerequisites for such stage-specific treatment. EUS is considered the most reliable staging modality. However, there is no EUS study specifically of cardia cancer.
  
  
  METHODS
  Forty-five patients with gastric cardia cancer who underwent gastrectomy with at least first-tier lymphadenectomy were retrospectively analyzed. The results of preoperative linear-array echoendoscopy (7.5 MHz) with respect to cancer depth, lymph node involvement, and esophageal invasion were compared with postoperative histopathologic findings.
  
  
  RESULTS
  Overall diagnostic accuracy for depth of invasion was 71%. Sensitivity for T1, T2, and T3 lesions was 100%, 31% and 75%, respectively. Overstaging of T2 cancers was the main diagnostic error. Mucosal (pT1-m) and submucosal (pT1-sm) cancers were correctly discriminated in 81% of patients. Diagnostic accuracy for lymph node involvement was 80%. EUS had positive and negative predictive values of 90% and 80%, respectively, for esophageal invasion.
  
  
  CONCLUSIONS
  For gastric cardia cancer, the linear-array echoendoscope yielded satisfactory results with respect to depth of invasion, lymph node involvement, and esophageal invasion evaluation. The information obtained is useful to the performance of stage-specific treatment.
authors.affiliation: Department of Gastrointestinal Surgery, University of Tokyo, Japan.
authors.forename: Shouji
authors.initials: S
authors.lastname: Shimoyama
authors.forename: Hidemitsu
authors.initials: H
authors.lastname: Yasuda
authors.forename: Masanori
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tatsutomi
authors.forename: Fumio
authors.initials: F
authors.lastname: Aoki
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Mafune
authors.forename: Michio
authors.initials: M
authors.lastname: Kaminishi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002299:Cardia; D019160:Endosonography; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*