Endoscopic ultrasonography for preoperative locoregional staging and assessment of resectability in gastric cancer

We performed a prospective study from November 1989 to December 1996 to assess the accuracy of endoscopic ultrasonography (EUS) in the locoregional staging and resectability of patients with gastric carcinoma. One hundred and nineteen patients with gastric cancer who received preoperative assessment by EUS underwent subsequent surgery. The endosonographic tumor-node-metastasis (TNM) classification was used for comparison with the histopathologic findings of the resected specimens. The ability of EUS to accurately predict the T stage (depth of tumor invasion) and N stage (involvement of lymph node) was 70% and 65%, respectively. EUS dis- played a tendency to overestimate T stage and underestimate N stage. The differentiation of early gastric cancer from advanced gastric cancer showed a concordance rate of 89% with an overestimation rate of 8% and underestimation rate of 3%. The accuracy of EUS in predicting the stage T1 to T3, which correspond to D0 resectability (no macroscopic or microscopic tumor remains), was 91%. In conclusion, these results revealed EUS as a valuable tool for evaluating the local staging and resectability of gastric cancer. We suggest that EUS should be introduced in the preoperative assessment of patients with gastric cancer.