Comparative Study Of Preoperative TNM Staging In Patients With Gastric Cancer By Endoscopic Ultrasonography And Multi-slice Spiral CT

Research background and purpose:The accuracy of preoperative staging is crucial for the choice of treatment options and prognosis of gastric cancer,and can significantly improve the postoperative survival and quality of life.Inaccurate clinical staging may lead to under-treatment or over-treatment.Endoscopic Ultrasonography(EUS)and multislice spiral computed tomography(MSCT)are the most commonly used techniques for preoperative staging of gastric cancer patients.This study was to investigate the accuracy of endoscopic ultrasonography and multi-slice spiral CT in the diagnosis of preoperative TNM staging in patients with gastric cancer,and to analyze the correlation between clinicopathological features and staging accuracy,and to evaluate the reliability of two different detection techniques.It provides a reference for selecting a reasonable treatment plan for patients with gastric cancer.Methods:In this study,60 patients with gastric cancer who underwent gastrointestinal surgery in our hospital from October 2016 to April 2018 were enrolled,including 37 males and 23 females,aged 40-64(mean 57.32+3.21 years).All patients underwent EUS and MSCT examination 1 week before surgery.All the results were interpreted by two clinically experienced doctors to evaluate the depth of tumor invasion,lymph node metastasis,invasion of peripheral organs and distant metastasis.TNM staging and the staging results were compared with postoperative pathology.Results:(1)60 patients with gastric cancer,13 cases of T1 stage,20 cases of T2 stage,15 cases of T3 stage,12 cases of T4 stage by postoperative pathology.Compared with postoperative histopathological results,the total accuracy of EUS for T staging was 75%,of which T1?T2?T3?T4 are respectively 84.61%?85%?60%?66.67%.The total accuracy of MSCT for T staging was 73.33%,of which T1?T2?T3?T4 are respectively 61.54%?65%?86.67%?83.33%?EUS had the lowest accuracy(44.44%)for T-stage disease in patients with gastric lesions,followed by cardiac disease(62.5%).MSCT had the lowest accuracy(37.5%)for T-stage disease in patients with cardiac disease,followed by lesions at the gastric angle(55.56%).In terms of lesion size,the accuracy of the two examination methods decreased with the increase of tumors.EUS and MSCT have higher accuracy of T staging for patients with lesions?20mm.EUS showed significantly lower accuracy for lesions with ulceration changes compared to lesions without ulceration.In contrast,there was no significant difference in the accuracy of MSCT with or without ulceration.There was no significant difference in the accuracy of T-segmentation between the two techniques.(2)60 patients with gastric cancer,18 cases of NO stage,19 cases of N1 stage,14 cases of N2 stage,9 cases of N3 stage.Compared with postoperative histopathological results,the total accuracy of EUS for N staging was 76.67%,of which N0?N1?N2?N3 are respectively 88.87%?84.21%?64.28%and 55.56%.The total accuracy of MSCT vs.N staging was 75%,of which NO?Nl?N2?N3 are respectively 88.87%?84.21%?64.28%and 55.56%(3)60 patients with gastric cancer,44 cases of M0 stage and 16 cases of M1 stage after pathological examination.Compared with postoperative histopathological results,the total accuracy of EUS for M staging was 81.67%,of which the accuracy of M0 staging was 88.63%,and the M1 staging was 62.5%.The total accuracy of MSCT for M staging was 86.67%.The accuracy of M0 staging is 90.91%,and the M1 staging is 75%.(4)The total accuracy of preoperative T staging of EUS combined with MSCT was 85%,the total accuracy of N staging was 81.66%,and the total accuracy of M staging was 86.67%?including T1(84.61%)and T2(85%).NO(88.87%)and N1(84.21%)stages are mainly determined based on EUS,while T3(86.67),T4(83.33%),N2(71.42%),N3(66.67)and MO(90.91%),M1(75%)The staging is mainly based on MSCT.Conclusions:(1)For different degrees of T staging,the accuracy and advantages of EUS and MSCT are different.The diagnostic accuracy of EUS for T1 and T2 staging was significantly higher than that of MSCT.The accuracy of EUS for T3 and T4 staging was significantly lower than that of MSCT;As the degree of N staging is deeper,the accuracy of EUS and MSCT is reduced;The total accuracy of EUS was higher in both EUS and MSC T diagnostic techniques.The accuracy of MSCT was better than EUS,and the difference was statistically significant.(2)EUS combined with MSCT examination can significantly improve the overall accuracy of preoperative TNM staging in patients with gastric cancer.