Accuracy of EUS and CT imaging in preoperative gastric cancer staging

Neoadjuvant therapy is recommended for locally advanced gastric cancer patients (stage IB-IIIC). The objective of this study is to evaluate the accuracy of endoscopic ultrasound (EUS) and computed tomography (CT) in identifying patients with locally advanced gastric cancer.

Patients with gastric adenocarcinoma who underwent gastrectomy at our institution were reviewed. Preoperative EUS and CT staging were compared with pathologic staging to determine accuracy.

Between 2001 and 2013, 280 patients were identified. Forty-nine patients (18%) who underwent preoperative staging by EUS were analyzed. The accuracy of EUS in identifying individual T stage and N stage was 41.0% and 42.9%, respectively. EUS had moderate accuracy in differentiating locally advanced from early (stage 0-IA) disease (75.5%, area under curve (AUC) 0.772). For individual T stage and N stage, the accuracy of CT was 4.0% and 56%, respectively. CT had relatively poor accuracy in differentiating locally advanced from early disease (60.0%, AUC 0.649).

EUS and CT had poor performance in identifying individual T and N stage although EUS demonstrated moderate accuracy in identifying patients with locally advanced disease. A combined staging approach, in addition to further optimization of staging modalities, is required for accurate staging for patients with gastric cancer.