title: Correlation between preoperative endoscopic ultrasound and surgical pathology staging of gastric adenocarcinoma: A single institution retrospective review.
abstract: BACKGROUND
  Recent evidence validates the effectiveness of neoadjuvant chemotherapy in the treatment of gastric adenocarcinoma. Endoscopic ultrasonographic (EUS) staging has been proposed as a useful adjunct in this setting.
  
  
  METHODS
  We performed a retrospective review of patients treated at our institution for gastric adenocarcinoma between July 2005 and January 2014. We identified patients referred for EUS before surgery as part of a prospective treatment plan. Histopathologic staging was compared to EUS staging, with a focus on T- and N-stage. Agreement between the two modalities was examined using kappa-statistics.
  
  
  RESULTS
  We identified 614 patients with biopsy-proven gastric adenocarcinoma; 145 underwent curative-intent surgery. Surgical pathology and EUS results were available from 69 patients. The accuracy of EUS for the evaluation of T- and N-stage was 44.9% and 56.5%, respectively. EUS demonstrated greater concordance with histopathology at evaluating T-stage (κ = 0.3469) than N-stage (κ = 0.1316). EUS underestimated T- and N-stage in 40.8% and 30.4% of patients, respectively.
  
  
  CONCLUSIONS
  EUS seems to correlate poorly with pathology in the preoperative staging of gastric adenocarcinoma. In the majority of inaccurate cases, EUS underestimates T-stage and N-stage, limiting its utility in the neoadjuvant setting.
authors.affiliation: Department of Surgery, Montefiore Einstein Center for Cancer Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York.|Albert Einstein College of Medicine, New York, New York.
authors.forename: Oscar K
authors.initials: OK
authors.lastname: Serrano
authors.affiliation: Albert Einstein College of Medicine, New York, New York.
authors.forename: Kevin
authors.initials: K
authors.lastname: Huang
authors.affiliation: Albert Einstein College of Medicine, New York, New York.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ng
authors.affiliation: Albert Einstein College of Medicine, New York, New York.|Department of Gastroenterology, Montefiore Einstein Center for Cancer Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York.
authors.forename: Julie
authors.initials: J
authors.lastname: Yang
authors.affiliation: Albert Einstein College of Medicine, New York, New York.
authors.forename: Patricia
authors.initials: P
authors.lastname: Friedmann
authors.affiliation: Department of Surgery, Montefiore Einstein Center for Cancer Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York.|Albert Einstein College of Medicine, New York, New York.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Libutti
authors.affiliation: Department of Surgery, Montefiore Einstein Center for Cancer Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York.|Albert Einstein College of Medicine, New York, New York.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Kennedy
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D019160:Endosonography; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery
keywords: adenocarcinoma; endoscopic ultrasound; gastric cancer