Essential pre-treatment imaging examinations in patients with endoscopically-diagnosed early gastric cancer.
BACKGROUND
There have been no reports discussing which imaging procedures are truly necessary before treatment of endoscopically-diagnosed early gastric cancer (eEGC). The aim of this pilot study was to show which imaging examinations are essential to select indicated treatment or appropriate strategy in patients with eEGC.


METHODS
In 140 consecutive patients (95 men, 45 women; age, 66.4 +/- 11.3 years [mean +/- standard deviation], range, 33-90) with eEGC which were diagnosed during two years, the pre-treatment results of ultrasonography (US) and contrast-enhanced computed tomography (CT) of the abdomen, barium enema (BE) and chest radiography (CR) were retrospectively reviewed. Useful findings that might affect indication or strategy were evaluated.


RESULTS
US demonstrated useful findings in 13 of 140 patients (9.3%): biliary tract stones (n = 11) and other malignant tumors (n = 2). Only one useful finding was demonstrated on CT (pancreatic intraductal papillary mucinous tumor) but not on US (0.7%; 95% confidential interval [CI], 2.1%). BE demonstrated colorectal carcinomas in six patients and polyps in 10 patients, altering treatment strategy (11.4%; 95%CI, 6.1-16.7%). Of these, only two colorectal carcinomas were detected on CT. CR showed three relevant findings (2.1%): pulmonary carcinoma (n = 1) and cardiomegaly (n = 2). Seventy-nine patients (56%) were treated surgically and 56 patients were treated by endoscopic intervention. The remaining five patients received no treatment due to various reasons.


CONCLUSIONS
US, BE and CR may be essential as pre-treatment imaging examinations because they occasionally detect findings which affect treatment indication and strategy, although abdominal contrast-enhanced CT rarely provide additional information.
Horisoko
Eri
E
Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan. heri@trad.ocn.ne.jp
Tsushima
Yoshito
Y
Taketomi-Takahashi
Ayako
A
Tokunaga
Mari
M
Endo
Keigo
K
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D023881:Colonography, Computed Tomographic / Q000379:methods; D003287:Contrast Media; D004733:Enema; D005260:Female; D005773:Gastroscopy; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010865:Pilot Projects; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014463:Ultrasonography
D003287:Contrast Media; D001466:Barium Sulfate