Usefulness of endoscopic ultrasonography in preoperative gastric cancer staging: diagnostic yield and therapeutic impact.

OBJECTIVES: To evaluate the diagnostic yield of endoscopic ultrasonography in loco-regional staging of gastric cancer in our medium and to determine the impact of this technique on later therapeutic management. MATERIAL AND METHODS: This is a retrospective study carried out on patients histologically diagnosed with gastric adenocarcinoma who had been referred for endoscopic ultrasonographic examination. The technique results were compared with those obtained from surgical samples and/or from exploratory laparoscopy- laparotomy. We compared the initial therapeutic decision based on conventional diagnostic techniques with the final therapeutic management based on the endoscopic ultrasonography results. RESULTS: Forty-six patients with gastric adenocarcinoma were included in the study (a reference exploration was available in 36 cases). Diagnostic precision was 70% in stage T, while in stages T1, T2, T3 y T4 was 100, 38, 82, and 100%, respectively. The sensitivity and specificity to differentiate T1-2 from T3-4 was 94 and 85%, respectively. We could not identify factors associated with obtaining a correct diagnosis in staging T. Diagnostic precision was 72% for stage N (N0: 58%; Nx 88%). The presence of free perigastric fluid was identified in 7 cases; the presence of peritoneal carcinomatosis was later confirmed in 5 of these. The result of endoscopic ultrasonography led to a modification in the subsequent therapeutic management in 13 patients (28%). CONCLUSIONS: Endoscopic ultrasonography is a useful technique for loco-regional staging of gastric adenocarcinoma, which may have important implications in the therapeutic management of these patients.

Utilidad de la ecoendoscopia en la estadificiación preoperatoria del cáncer gástrico: rentabilidad diagnóstica e impacto terapéutico / No disponible

Objetivos: valorar la rentabilidad diagnóstica de la ecoendoscopiaen la estadificación locorregional del cáncer gástrico ennuestro medio y determinar el impacto de la técnica sobre el manejoterapéutico posterior.Material y métodos: estudio retrospectivo realizado en pacientesdiagnosticados histológicamente de adenocarcinoma gástricoque habían sido remitidos para la realización de ecoendoscopia.Se comparó el resultado de la técnica con el estudio final obtenidoen la pieza operatoria y/o laparoscopia-laparotomía exploradora.Se comparó la decisión terapéutica inicial basada en los resultadosde las técnicas diagnósticas convencionales, con el manejo terapéuticofinal basado en el resultado de la ecoendoscopia.Resultados: se incluyeron en el estudio 46 pacientes conadenocarcinoma gástrico (en 36 de los cuales se disponía de exploraciónde referencia). La precisión diagnóstica fue del 70%para el estadio T, y para T1, T2, T3 y T4 del 100, 38, 82 y100%, respectivamente. La sensibilidad y especificidad para diferenciarel estadio T1-2 del T3-4 fue del 94 y 85% respectivamente.No se identificaron factores relacionados con la obtención deun diagnóstico correcto en la estadificación T. La precisión diagnósticafue del 72% para el estadio N (N0: 58%; Nx 88%). En 7pacientes se identificó la presencia de líquido libre perigástrico, en5 de los cuales se confirmó posteriormente la existencia de carcinomatosisperitoneal. En 13 pacientes (28%) del resultado de laecoendoscopia se derivó una modificación en el manejo terapéuticoposterior.Conclusiones: la ecoendoscopia es una técnica útil en la estadificaciónlocorregional del adenocarcinoma gástrico, lo quepuede tener importantes implicaciones en el manejo terapéuticode estos pacientes(AU)

Objectives: to evaluate the diagnostic yield of endoscopic ultrasonographyin loco-regional staging of gastric cancer in ourmedium and to determine the impact of this technique on latertherapeutic management.Material and methods: this is a retrospective study carriedout on patients histologically diagnosed with gastric adenocarcinomawho had been referred for endoscopic ultrasonographic examination.The technique results were compared with those obtainedfrom surgical samples and/or from exploratory laparoscopylaparotomy.We compared the initial therapeutic decision basedon conventional diagnostic techniques with the final therapeuticmanagement based on the endoscopic ultrasonography results.Results: forty-six patients with gastric adenocarcinoma wereincluded in the study (a reference exploration was available in 36cases). Diagnostic precision was 70% in stage T, while in stagesT1, T2, T3 y T4 was 100, 38, 82, and 100%, respectively. Thesensitivity and specificity to differentiate T1-2 from T3-4 was 94and 85%, respectively. We could not identify factors associatedwith obtaining a correct diagnosis in staging T. Diagnostic precisionwas 72% for stage N (N0: 58%; Nx 88%). The presence offree perigastric fluid was identified in 7 cases; the presence of peritonealcarcinomatosis was later confirmed in 5 of these. The resultof endoscopic ultrasonography led to a modification in thesubsequent therapeutic management in 13 patients (28%).Conclusions: endoscopic ultrasonography is a useful techniquefor loco-regional staging of gastric adenocarcinoma, whichmay have important implications in the therapeutic managementof these patients(AU)