COMPUTED-TOMOGRAPHY OR ENDOSCOPIC ULTRASONOGRAPHY IN PREOPERATIVE STAGING OF GASTRIC AND ESOPHAGEAL TUMORS

Background. Accurate preoperative staging of tumors of the esophagus a nd stomach is important in selecting treatment and determining prognos is. To date, no exact preoperative test has been useful in assessing s tage of these tumors. Until recently, computed tomographic (CT) scanni ng has been the most frequently used examination to predict operative findings. Endoscopic ultrasonography (EUS) is a relatively new modalit y used by some centers to assess extramural anatomy of tumors in these two locations. Methods. We described 28 patients with tumors involvin g the esophagus and gastroesophageal junction, and the stomach, who un derwent both EUS and CT before surgical exploration. We compared these two tests with the final pathologic interpretation and paid particula r attention to presence of lymph nodes and wall penetration by primary tumor. Results. For wall penetration by an esophageal-gastroesophagea l junction carcinoma, EUS was 85% accurate versus 15% for CT. For abse nce of nodal spread by these tumors, EUS was 100% accurate versus 67% for CT. In the presence of nodal spread EUS was 60% accurate versus 50 % for CT. For wall penetration by a gastric carcinoma, EUS was 71% acc urate versus 0% for CT, In the absence of nodal spread EUS and CT were both 100% accurate. In the presence of nodal spread EUS was 50% accur ate versus 25% for CT. Conclusions. EUS is more accurate than CT in th e preoperative staging of upper gastrointestinal malignancies.