The Study Of Endoscopic Ultrasonography And Multi-Slice Spiral CT In The Diagnosis And Stage Of Gastric Cancer

BankgroundGastric cancer is one of the most common digestive malignancy in the world.The early gastric cancer can be resected by endoscopic mucosal resection and the advanced gastric cancer mostly depend on operation. The prognosis of patients is strictly dependent on the staging and the correct therapy. The accurate preoperative staging is not only important for prediction of the progonosis,but also nearly to establishment of individualized cancer therapy. EUS and MSCT were two mainly detection methods in TNM staging of gastric cancer currently.ObjectiveThis study is to evaluate the accuracy of EUS and MSCT in the preoperative TNM staging of gastric cancer.MethodsEUS and MSCT were performed in 48 cases of gastric cancer one week prior to the operation.Each case was staged according to the TNM classification system with both methods.All these findings were compared with the histopathological staging.ResultsThe sensitivities of EUS in TNM stage were 89.6%(43/48),79.2%(38/48) and 79.2%(38/48),respectively.The sensitivities and specificities of EUS in T1-T4 stage metastasis were:100%(4/4),100%(4/4);88.2%(15/17),93.8%(15/16);90.0%(18/20),85.7% (18/21);85.7%(6/7) and 85.7%(6/7),respectively. The sensitivities and specificities of EUS in N0-N2 stage metastasis were:92.9%(13/14),81.3%(13/16);81.0%(17/21),73.9% (17/23);61.5%(8/13)and 88.9%(8/94),respectively. The sensitivities and specificities of EUS in M0-M1 stage metastasis were:97.1%(34/35),79.1%(34/43);44.4%(4/13),80.0% (4/5).The sensitivities of MSCT in T,N and M stage were:68.8%(33/48),81.3% (39/48) and 93.8%(45/48).The sensitivities and specificities of MSCT in T1-T4 stage metastasis were:75.0%(3/4),60.0%(3/5);70.6%(12/17),75.0%(12/16);65.0% (13/20),72.2%(13/18);71.4%(5/7) and 55.6%(5/9),respectively. The sensitivities and specificities of MSCT in N0-N2 stage metastasis were:85.7%(12/14),75.0%(12/16);76.2 %(16/21),80.0%(16/20);84.6%(11/13)and 81.8%(11/12),respectively. The sensitivities and specificities of MSCT in M0-M1 stage metastasis were:94.3%(33/35),97.1% (33/34);92.3%(12/13),85.7%(12/14).Conclusions1.Compared with MSCT,EUS shows the prominent advantage in preoperative evaluation of the staging of gastric cancer on the diagnosis of the depth of tumor invasion, especially on early gastric cancer.2.There are no obvious difference between using EUS and MSCT to detect the N stages of gastric cancer.MSCT shows the advantage in preoperative evaluation of the N2 staging of in diagnosis of gastric cancer.3.MSCT is better than EUS for the diagnosis of M stages.4.EUS combined with MSCT is superior in TNM staging which can be used to optimize the therapeutic strategy.