Accuracy of endoscopic ultrasound staging of gastric cancer in routine clinical practice in Singapore.
OBJECTIVE
Endoscopic ultrasound has emerged as the leading modality to assess the T and N stage in gastric cancer. This study aimed to assess the accuracy of TN staging by endoscopic ultrasound in routine clinical practice in Singapore.


METHODS
Over a period of 7 years, 77 patients (male: 70%; median age 62.8 years) with gastric cancer underwent preoperative staging with endoscopic ultrasound. Fifty-seven patients eventually underwent surgery with tissues available for histopathological staging and comparison.


RESULTS
The tumor locations were: cardia: 13; corpus: 20; incisura: 19; antrum: 25. The majority was poorly differentiated (57.1%); 26% were moderately differentiated and 16.9% were well differentiated adenocarcinoma. Compared to pathological staging, the overall accuracy of T staging by endoscopic ultrasound was 77.2% (17.5% under-staged: 5.3% over-staged). The staging accuracy of T1 (92.9%) and T3 (81.8%) was higher than T2 (57.1%) and T4. For N staging, the accuracy of endoscopic ultrasound was 59.6% (26.3% under-staged; 14% over-staged); this was significantly superior to computer tomography (43.9%).


CONCLUSIONS
Endoscopic ultrasound is useful for the T staging of gastric cancer, with an overall accuracy rate of 77%, and up to 93% for T1 lesions. Under-staging may occur due to microscopic tumor infiltration, while over-staging may arise due to inflammatory reactions. The accuracy of N staging is lower at 60%, but could be further improved with the use of fine needle aspiration.
Ang
Tiing Leong
TL
Division of Gastroenterology, Changi General Hospital, Singapore. tiing_leong_ang@cgh.com.sg
Ng
Tay Meng
TM
Fock
Kwong Ming
KM
Teo
Eng Kiong
EK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011300:Preoperative Care; D015203:Reproducibility of Results; D012846:Singapore; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed