Department of Gastroenterological Surgery, Kinan Hospital, Wakayama, Japan.
Department of Gastroenterological Surgery, Saiseikai Senri Hospital, 1-1-6 Tsukumodai, Suita, Osaka, 565-0862, Japan.
Surg Endosc. 2023 May;37(5):3807-3813. doi: 10.1007/s00464-023-09883-1. Epub 2023 Jan 23.
An accurate evaluation method for preoperative diagnosis has not yet been established in patients with gastric cancer (GC), though it is essential for optimal treatment. Current standard modalities are endoscopy and contrast computed tomography (CT). In this study, we investigated the efficacy and limitations of transabdominal ultrasonography (TUS) for the assessment of tumor invasion.
We enrolled 178 consecutive patients with GC evaluated by TUS, endoscopy, and contrast CT before gastrectomy. For the TUS examination, patients ingested water to fill their stomachs. The clinical staging determined using these modalities was compared to the pathological staging.
The overall accuracy of clinical T staging using TUS was 47.8% (pT1a: 5.8% (2/35); pT1b: 58.8% (20/35); pT2: 69.6% (16/23); pT3: 66.7% (22/33); pT4a: 46% (23/50); pT4b: 100% (2/2)). Using endoscopy, contrast CT, and TUS, the overall accuracy was 60.7%. The accuracy of TUS was associated with the tumor region (U region: 50% (14/28); M: 31.8% (14/44); L: 53.7% (57/106); P = 0.048), but not with the cross-sectional parts (P = 0.49). Multivariate analysis identified inaccurate TUS as independently correlating with tumor region (M vs. U/L, odds ratio (OR) = 3.11, 95% confidence interval (CI) 1.41-6.87; P = 0.005) and pT (pT1 vs. pT2-4, OR = 3.00, 95%CI 1.31-6.87; P = 0.009).
The present study demonstrated the importance of TUS in evaluating GC. Thus, TUS may be useful for clinical T staging in certain circumstances, leading to treatment optimization.
尽管术前诊断对于优化治疗至关重要，但目前尚未建立用于胃癌（GC）的准确评估方法。当前的标准方式是内窥镜检查和对比计算机断层扫描（CT）。在这项研究中，我们研究了经腹超声（TUS）评估肿瘤侵袭的功效和局限性。
我们纳入了 178 例在接受胃切除术前通过 TUS、内窥镜和对比 CT 进行评估的 GC 连续患者。对于 TUS 检查，患者饮用大量水以充盈胃部。比较了这些方式确定的临床分期与病理分期。
TUS 临床 T 分期的总体准确性为 47.8%（pT1a：5.8%（2/35）；pT1b：58.8%（20/35）；pT2：69.6%（16/23）；pT3：66.7%（22/33）；pT4a：46%（23/50）；pT4b：100%（2/2））。使用内窥镜、对比 CT 和 TUS，总体准确性为 60.7%。TUS 的准确性与肿瘤区域有关（U 区：50%（14/28）；M 区：31.8%（14/44）；L 区：53.7%（57/106）；P=0.048），但与横切面部分无关（P=0.49）。多变量分析确定不准确的 TUS 与肿瘤区域独立相关（M 与 U/L，比值比（OR）=3.11，95%置信区间（CI）1.41-6.87；P=0.005）和 pT（pT1 与 pT2-4，OR=3.00，95%CI 1.31-6.87；P=0.009）。
本研究表明 TUS 在评估 GC 中的重要性。因此，TUS 可能在某些情况下有助于临床 T 分期，从而优化治疗。
