ENDOSCOPIC ULTRASONOGRAPHY FOR PREOPERATIVE LOCOREGIONAL STAGING AND ASSESSMENT OF RESECTABILITY IN GASTRIC CANCER JAW-YUAN WANG, MD, JAN-SING HSIEH, MD, YU-SHENG HUANG, MD, CHE-JEN HUANG, MD, MING-FENG HOU, MD, AND TSUNG-JEN HUANG, MD KEY WORDS: We performed a prospective study from November 1989 to December 1996 to assess the accuracy of en- Gastric cancer; Endoscopic ultrasonography; Staging doscopic ultrasonography (EUS) in the locoregional staging and resectability of patients with gastric car- cinoma. One hundred and nineteen patients with INTRODUCTION gastric cancer who received preoperative assessment Although the incidence of gastric cancer is declining by EUS underwent subsequent surgery. The endoso- worldwide, this disease is still one of the most preva- nographic tumor-node-metastasis (TNM) classifica- lent malignant tumors (1–3). In recent years, significant tion was used for comparison with the histopatho- advances in diagnosis, such as fiberoptic endoscopy logic findings of the resected specimens. The ability and double-contrast hypotonic upper gastrointestinal of EUS to accurately predict the T stage (depth of tu- series, currently allow early detection of the lesions mor invasion) and N stage (involvement of lymph with increased accuracy. However, about 15%–30% node) was 70% and 65%, respectively. EUS dis- of the patients undergo only exploratory laparotomy played a tendency to overestimate T stage and un- because the unresectable tumor is discovered during derestimate N stage. The differentiation of early gas- surgery (4, 5). An accurate preoperative assessment tric cancer from advanced gastric cancer showed a of the significant prognostic factors of gastric cancer, concordance rate of 89% with an overestimation rate such as depth of tumor invasion (T category) and of 8% and underestimation rate of 3%. The accuracy involvement of lymph nodes (N category), would of EUS in predicting the stage T1 to T3, which corre- greatly facilitate the planning of the therapy and spond to D0 resectability (no macroscopic or micro- would prevent unnecessary surgery for those whose scopic tumor remains), was 91%. In conclusion, cancer may be treated by the other modalities. these results revealed EUS as a valuable tool for eval- Conventional endoscopy permits an examination uating the local staging and resectability of gastric of only the surface of the stomach; thus, important cancer. We suggest that EUS should be introduced in data such as infiltration of the wall, local spread, and the preoperative assessment of patients with gastric lymph node involvement are not available with this cancer.  Elsevier Science Inc., 1998 technique. Computed tomography (CT) and magnetic resonance imaging (MRI) have been used for preopera- From the Department of Surgery, Kaohsiung Medical College, tive tumor staging. However, all but a few exceptions Kaohsiung, Taiwan. have yielded disappointing results, especially in de- Address reprint requests to: Jaw-Yuan Wang, MD, Department of Surgery, Kaohsiung Medical College, No. 100, Shih Chuan 1st termining the depth of tumor invasion and regional Road, Kaohsiung City 807, Taiwan. Telephone: 886-7-3122805; lymph node metastases (6–8). fax: 886-7-3114679; e-mail: cy614112@ms14.hinet.net. Received December 20, 1997; accepted January 25, 1998. The application of endosonography in the past CLINICAL IMAGING 1998;22:355–359  Elsevier Science Inc., 1998. All rights reserved. 0899-7071/98/$–see front matter 655 Avenue of the Americas, New York, NY 10010 PII S0899-7071(98)00033-3