Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Department of Surgery, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea.
Eur J Surg Oncol. 2021 Aug;47(8):1969-1975. doi: 10.1016/j.ejso.2021.02.031. Epub 2021 Mar 10.
With the introduction of new therapeutic options for gastric cancer treatment, more precise preoperative staging of gastric cancer is needed. The purpose of this study was to evaluate the role of endoscopic ultrasonography (EUS) for improving the accuracy of clinical T staging by computed tomography (CT) for gastric cancer.
A total of 2636 patients underwent stomach protocol CT (S-CT) and EUS, followed by gastrectomy for primary gastric adenocarcinoma between September 2012 and February 2018 at Seoul National University Hospital. The results of preoperative S-CT and EUS were compared to the postoperative pathologic staging.
The overall accuracy of S-CT and EUS for T staging were 69.4% and 70.4%, respectively. When T staging was divided into T1-2 and T3-4 for clinically advanced gastric cancer (AGC), the positive predictive value for T3-4 using S-CT, EUS, and a combination of both modalities was 73.8%, 79.3%, and 85.6%, respectively. In 114 cases of indeterminate lesions between cT1 and cT2 by S-CT, EUS had a better prediction rate than the final decision based on endoscopy or the agreement between the two experts (Match rate: EUS vs. final decision, 69.3% vs. 58.8%).
EUS can be a complementary diagnostic tool to clinical T staging of gastric cancer by CT for selecting T3-4 lesion.
随着胃癌治疗新的治疗选择的引入，需要更精确的术前胃癌分期。本研究旨在评估内镜超声（EUS）对提高胃癌 CT 临床 T 分期准确性的作用。
2012 年 9 月至 2018 年 2 月期间，在首尔国立大学医院，共有 2636 名接受胃方案 CT（S-CT）和 EUS 检查的原发性胃腺癌患者接受了胃切除术。将术前 S-CT 和 EUS 的结果与术后病理分期进行比较。
S-CT 和 EUS 对 T 分期的总体准确性分别为 69.4%和 70.4%。当 T 分期分为临床进展期胃癌（AGC）的 T1-2 和 T3-4 时，S-CT、EUS 和两种方式联合使用对 T3-4 的阳性预测值分别为 73.8%、79.3%和 85.6%。在 114 例 S-CT 诊断为 cT1 和 cT2 之间的不确定病变中，EUS 的预测率优于最终基于内镜或两位专家之间的一致性的决策（匹配率：EUS 与最终决策，69.3%比 58.8%）。
EUS 可以作为 CT 临床 T 分期的补充诊断工具，用于选择 T3-4 病变。
