LAPAROSCOPIC ULTRASONOGRAPHY FOR STAGING GASTROESOPHAGEAL CANCER

Background. TNM staging of gastroesophageal cancer is improved by the use of laparoscopy for the detection of occult metastases and endoscop ic ultrasonography for T and possibly N staging. Laparoscopic ultrason ography may combine the strengths of both of these techniques. The pur pose of this study was to compare TNM staging by means of laparoscopic ultrasonography (Lap US), laparoscopy, and conventional computed tomo graphy (CT). Methods. TNM stage was determined by using Lap US, laparo scopy, and CT scanning in 26 surgical candidates with gastric or esoph ageal cancer in a blinded fashion. CT scans were also reviewed separat ely by an expert radiologist. Validation of findings was by means of f inal pathologic examination. Results. Resectability for potential cure was determined by means of Lap US with a sensitivity of 100% and spec ificity of 91% versus 100% and 73% for laparoscopy and 75% and 60% for CT, respectively. Overall TNM staging was 82% accurate for Lap US ver sus 67% for laparoscopy and 47% for CT (chi-squared, 8.64, p < 0.005, and 10.4, p < 0.005, respectively). Accuracies for Lap US versus lapar oscopy versus CT for N stage were 92% versus 84% versus 70%, respectiv ely, for T stage were 92% versus 42% versus 60%, respectively, and for M stage were 89% versus 44% vers rcs 62%, respectively. Conclusions. T and N staging by Lap US were comparable to published results for end oscopic ultrasonography, and overall TNM staging was better. Lap US ma y provide the optimal preoperative staging for gastric cancer and has the potential to complement endoscopic ultrasonography in staging esop hageal cancer.