title: Accuracy of EUS and CT imaging in preoperative gastric cancer staging.
abstract: BACKGROUND
  Neoadjuvant therapy is recommended for locally advanced gastric cancer patients (stage IB-IIIC). The objective of this study is to evaluate the accuracy of endoscopic ultrasound (EUS) and computed tomography (CT) in identifying patients with locally advanced gastric cancer.
  
  
  METHODS
  Patients with gastric adenocarcinoma who underwent gastrectomy at our institution were reviewed. Preoperative EUS and CT staging were compared with pathologic staging to determine accuracy.
  
  
  RESULTS
  Between 2001 and 2013, 280 patients were identified. Forty-nine patients (18%) who underwent preoperative staging by EUS were analyzed. The accuracy of EUS in identifying individual T stage and N stage was 41.0% and 42.9%, respectively. EUS had moderate accuracy in differentiating locally advanced from early (stage 0-IA) disease (75.5%, area under curve (AUC) 0.772). For individual T stage and N stage, the accuracy of CT was 4.0% and 56%, respectively. CT had relatively poor accuracy in differentiating locally advanced from early disease (60.0%, AUC 0.649).
  
  
  CONCLUSIONS
  EUS and CT had poor performance in identifying individual T and N stage although EUS demonstrated moderate accuracy in identifying patients with locally advanced disease. A combined staging approach, in addition to further optimization of staging modalities, is required for accurate staging for patients with gastric cancer.
authors: Department of Surgery, Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Mark
authors: M
authors: Fairweather
authors: Department of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Kunal
authors: K
authors: Jajoo
authors: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Nisha
authors: N
authors: Sainani
authors: Department of Surgery, Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Monica M
authors: MM
authors: Bertagnolli
authors: Department of Surgery, Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Jiping
authors: J
authors: Wang
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019160:Endosonography; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: N stage; T stage; computed tomography; endoscopic ultrasound; neoadjuvant