Endoscopic ultrasonography in the preoperative staging of gastric cancer -Accuracy and impact on surgical therapy

Background: Endoscopic ultrasonography (EUS) is a standard procedure in the preoperative staging of patients with gastric carcinomas. Herein we presen t our experience with EUS and discuss the results and their implications fo r surgical therapy. Methods: A total of 116 patients with histologically confirmed gastric aden ocarcinoma were referred to EUS and classified prospectively by the TNM sys tem. The results of the preoperative endosonographic staging were compared with the definitive histopathological results after the operation. Results: The overall accuracy of EUS for determination of the T stage was 7 8%. The accuracy for the T1 and T2 stages was 80% and 63%, respectively. Wi th 20% and 30%, there was a relatively high rate of overstaging in these ca ses. The accuracy for T3 and T4 tumors was 95% and 83%, respectively The ac curacy of EUS for determination of the N stage was 77%, with a sensitivity of 91% and a specificity of 84%. Resectability was predicted correctly with a sensitivity of 94% and a specificity of 83%. Conclusions: Generally accepted standards for the therapy of advanced gastr ic carcinomas do not exist. In cases where the therapeutic strategy is surg ical exploration, no preoperative staging is necessary. In cases with diffe rentiated treatment strategies, the accuracy of EUS is not sufficient for t he selection of patients for endoscopic resection. Its accuracy for submuco sal cancer invasion and for the detection of lymph node metastases needs to be further enhanced. If only multimodal therapy is considered, EUS staging seems to be absolutely mandatory. Patients classified preoperatively as TI to T3 can be operated on primarily with sufficient security. In patients w here radical resection of the tumor seems doubtful, we recommend that a dia gnostic laparoscopy be performed to confirm the diagnosis.