Linear EUS Accuracy in Gastric Cancer Preoperative Staging: A Retrospective Multicentric Study

Aims Gastric cancer (GC) staging is the most reliable prognostic factor that affects therapeutic choices. Contrast enhanced computed tomography (CECT) and radial endoscopic ultrasound (R-EUS) are the most used staging tools. The accuracy of linear EUS (L-EUS) in this setting is still controversial.

Aim of this retrospective multicentric study was to determine L-EUS accuracy compared to CECT one regarding tumor depth and nodal status in patients with gastric cancer.

Methods One-hundred-ninety-one patients with GC, who underwent surgical resection between April 2017 and April 2020 in two Northern Italy hospitals, were considered. Preoperative staging was performed with L-EUS and CECT (according to TNM classification) and compared to histological analysis on surgical specimen.

Results

Tab. 1

Diagnostic accuracy parameters in N staging, % (CI95 %)	L-EUS	CECT
Accuracy	85 % (80-90 %)	61 % (54-68 %)
Sensitivity	80 % (72-87 %)	44 % (35-53 %)
Negative predictive value	73 % (62-81 %)	48 % (39-56 %)
Negative likelihood ratio	0.20 (0.14-0.29)	0.59 (0.50-0.70)

Of 191 GC, 79 (41 %) were localized in corpus, 65 (34 %) in antrum, 32 (16 %) in angulus, 12 (6 %) in fundus, 2 (2 %) in cardia and 1 (1 %) in pylorus. Patients mean age was 66 years (range 38-91) and tumor mean size was 43 mm (range 10-80 mm). L-EUS overall diagnostic accuracy for depth of invasion was 100 %, 60 %, 74 %, 80 % for T1, T2, T3 and T4, respectively. L-EUS diagnostic accuracy in evaluating nodal status was 95 % for N0 and 80 % for N+, with an overall accuracy and sensitivity of 85 % and 80 %, respectively. CECT performance in T-staging was 78 %, 55 %, 45 %, 10 % for T1, T2, T3 and T4, respectively. Regarding N-staging, CECT diagnostic accuracy and sensitivity were 61 % and 43 %, respectively, both significantly lower than L-EUS.

Conclusions Our experience suggests that L-EUS is superior to CECT in both preoperative T and N GC staging. Furthermore, our data with L-EUS are also comparable to R-EUS ones reported in literature in this setting.

Citation De Nucci G, Impellizzeri G, Gabbani T et al. eP376 LINEAR EUS ACCURACY IN GASTRIC CANCER PREOPERATIVE STAGING: A RETROSPECTIVE MULTICENTRIC STUDY. Endoscopy 2021; 53: S219.

Publication History

Article published online:
19 March 2021