Does endoscopy really help the surgeon evaluate gastric cancer?

To determine whether gastroscopy helps the surgeon in preoperative planning and decision-making in patients with gastric cancer, the authors reviewed the charts of 100 consecutive patients with surgically proven gastric cancer. The findings from gastroscopy, upper gastrointestinal series and computed tomography were evaluated for their ability to define the anatomic site of the lesion, proximal and distal extent of gastric involvement, presence of a mass or ulceration and the sensitivity of diagnosis. The sensitivity of endoscopic biopsy and brush cytology were also determined. Gastroscopy was found to be the most sensitive diagnostic test, both in recognizing the presence of an abnormality (100% versus 86% versus 76% respectively) and the possibility of a malignant condition (88% versus 71% versus 76%); in addition, endoscopic biopsy and brush cytology were diagnostic in 90% and 70% of patients, respectively. Gastroscopy and upper gastrointestinal series were equally accurate in determining proximal or distal extent of tumour. The authors concluded that gastroscopy is the most sensitive diagnostic test in patients with gastric cancer; upper gastrointestinal series does not add significantly useful information to the preoperative evaluation. Computed tomography can assess regional and distant metastasis, but its contribution as to the local extent of the tumour is limited.