Preoperative endoscopic ultrasonography in patients with gastric cancer

Aims and background: There is a need to assess the accuracy of endoscopic u ltrasonography (EUS) in the diagnosis and staging of gastric cancer, especi ally in the early and very advanced stages of the disease when the therapeu tic approach is still controversial, Methods: A retrospective study was performed on 79 patients with gastric ca ncer in order to compare the stage defined by preoperative EUS with that as sessed histopathologically. All patients underwent laparotomy for final dia gnosis, staging, and eventually treatment. The results of EUS were correlat ed with the histologic findings of the resected specimens. Results: In the uT1 group, which corresponds to early gastric cancer, the d iagnosis was histologically confirmed in 85.7% of the cases, In patients wi th advanced tumors defined as uT3-uT4, i.e., tumors infiltrating the serosa or neighboring structures, the diagnostic concordance was 91.1%. In contra st, concordance for less advanced lesions confined to the muscular layer wa s only 31.2%. As regards the lymph nodes, they were defined metastatic in 3 1 patients and confirmed to be histologically involved in 77.4%, In contras t, when the lymph nodes were assessed as negative at EUS, they proved to be metastatic in more than half the cases, Conclusions: From the data it appears that EUS has proven to be valuable in correctly staging most of the patients. EUS shows not only tumor depth and local spread but also the passage from a pathologic to a normal wall and l ymph node metastasis. EUS appears to represent an important advance in the staging and follow-up of patients with gastric cancer. Instruments and tech niques will continue to evolve, but the next level of research should be de signed to show that the improved staging provided by EUS has clinical utili ty and can affect patient outcome. It is noteworthy that the highest accura cy of EUS has been shown in those conditions (uT1 and uT3-4) which currentl y are under consideration for a therapeutic approach that differs from the standard one.