Endoscopic ultrasonography (EUS) in preoperative staging of gastric cancer--demand and reality.
Exact pretherapeutic staging is considered to be essential for decision-making in the therapeutic algorithm of gastric cancer. THE AIM OF THE STUDY was to characterize the role and value of EUS in the diagnostic and therapeutic management of gastric cancer in daily surgical practice.


METHODS
Thousand one hundred thirty nine patients with primary gastric cancer from 80 hospitals of each profile of care were enrolled in this systematic clinical prospective multicenter observational study over a time period of 12 months. The characteristics of the diagnostic management, in particular, of EUS were documented. The preoperative EUS findings were compared with the T stage (T1 to T4) and the N category (N+ or N-) revealed by the histopathologic investigation of the surgical specimen. By the mean of χ² test, the impact of EUS on the therapeutic decision-making was determined.


RESULTS
Pretherapeutic EUS was only performed in 27.4% (n=312) of all patients. Overall, the diagnostic accuracy for the T stage was 42.6% in average. The subgroup analysis showed the following results: T1, 31.5%; T2, 42.6%; T3, 65.2%; T4, 17.6%. The correct predictive value of the N category was 71.3% reaching a sensitivity of 69.7% and a specificity of 73.3%. Overstaging was observed in 45.8%, understaging in only 10.8%. Additional diagnostic information by EUS was only provided in 4.7% of subjects.


CONCLUSIONS
The present study indicates the variability, limited reliability and only moderate acceptance of EUS in diagnosing gastric cancer in daily practice. In particular, the prediction of the T stage does not reach the data reported in the literature, which were mostly achieved in specific EUS studies.
Institute for Quality Control, University Hospital, Magdeburg Department of Surgery, Municipal Hospital-HELIOS, Plauen, Germany.
Lutz
L
Meyer
Frank
F
Meyer
Uwe
U
Schmidt
Ingo
I
Gastinger
Hans
H
Lippert
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology