Endoscopic Ultrasound Predicts Risk of Occult Intra-Abdominal Metastases in Localized Gastric Cancer : A Validation Study
Copyright 2023, Ayoub et al..
Background: In gastric cancer (GC) patients without imaging evidence of distant metastasis, diagnostic staging laparoscopy (DSL) is recommended to detect radiographically occult peritoneal metastasis (M1). DSL carries a risk for morbidity and its cost-effectiveness is unclear. Use of endoscopic ultrasound (EUS) to improve patient selection for DSL has been proposed but not validated. We aimed to validate an EUS-based risk classification system predicting risk for M1 disease.
Methods: We retrospectively identified all GC patients without positron emission tomography (PET)/computed tomography (CT) evidence of distant metastasis who underwent staging EUS followed by DSL between 2010 and 2020. T1-2, N0 disease was EUS "low-risk"; T3-4 and/or N+ disease was "high-risk".
Results: A total of 68 patients met inclusion criteria. DSL identified radiographically occult M1 disease in 17 patients (25%). Most patients had EUS T3 tumors (n = 59, 87%) and 48 (71%) patients were node-positive (N+). Five (7%) patients were classified EUS "low-risk" and 63 (93%) were classified "high-risk". Of 63 "high-risk" patients, 17 (27%) had M1 disease. The ability of "low-risk" EUS to predict M0 disease at laparoscopy was 100% and DSL would have been avoided in five patients (7%). This stratification algorithm showed a sensitivity of 100% (95% confidence interval (CI): 80.5-100%) and a specificity of 9.8% (95% CI: 3.3-21.4%).
Conclusions: Use of an EUS-based risk classification system in GC patients without imaging evidence of metastasis helps identify a subset of patients at low-risk for laparoscopic M1 disease who may avoid DSL and proceed directly to neoadjuvant chemotherapy or resection with curative intent. Larger, prospective studies are needed to validate these findings.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:16 |
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| Enthalten in: |
Gastroenterology research - 16(2023), 1 vom: 02. Feb., Seite 9-16 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ayoub, Fares [VerfasserIn] |
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| Links: |
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| Themen: |
Diagnostic staging laparoscopy |
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| Anmerkungen: |
Date Revised 11.03.2023 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.14740/gr1589 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM354013939 |
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| 520 | |a Copyright 2023, Ayoub et al. | ||
| 520 | |a Background: In gastric cancer (GC) patients without imaging evidence of distant metastasis, diagnostic staging laparoscopy (DSL) is recommended to detect radiographically occult peritoneal metastasis (M1). DSL carries a risk for morbidity and its cost-effectiveness is unclear. Use of endoscopic ultrasound (EUS) to improve patient selection for DSL has been proposed but not validated. We aimed to validate an EUS-based risk classification system predicting risk for M1 disease | ||
| 520 | |a Methods: We retrospectively identified all GC patients without positron emission tomography (PET)/computed tomography (CT) evidence of distant metastasis who underwent staging EUS followed by DSL between 2010 and 2020. T1-2, N0 disease was EUS "low-risk"; T3-4 and/or N+ disease was "high-risk" | ||
| 520 | |a Results: A total of 68 patients met inclusion criteria. DSL identified radiographically occult M1 disease in 17 patients (25%). Most patients had EUS T3 tumors (n = 59, 87%) and 48 (71%) patients were node-positive (N+). Five (7%) patients were classified EUS "low-risk" and 63 (93%) were classified "high-risk". Of 63 "high-risk" patients, 17 (27%) had M1 disease. The ability of "low-risk" EUS to predict M0 disease at laparoscopy was 100% and DSL would have been avoided in five patients (7%). This stratification algorithm showed a sensitivity of 100% (95% confidence interval (CI): 80.5-100%) and a specificity of 9.8% (95% CI: 3.3-21.4%) | ||
| 520 | |a Conclusions: Use of an EUS-based risk classification system in GC patients without imaging evidence of metastasis helps identify a subset of patients at low-risk for laparoscopic M1 disease who may avoid DSL and proceed directly to neoadjuvant chemotherapy or resection with curative intent. Larger, prospective studies are needed to validate these findings | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Diagnostic staging laparoscopy | |
| 650 | 4 | |a Endoscopic ultrasound | |
| 650 | 4 | |a Gastric cancer | |
| 650 | 4 | |a Imaging | |
| 650 | 4 | |a Laparoscopy | |
| 650 | 4 | |a Metastasis | |
| 650 | 4 | |a Staging | |
| 700 | 1 | |a Chapman, Christopher G |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Heather |e verfasserin |4 aut | |
| 700 | 1 | |a Setia, Namrata |e verfasserin |4 aut | |
| 700 | 1 | |a Roggin, Kevin |e verfasserin |4 aut | |
| 700 | 1 | |a Siddiqui, Uzma D |e verfasserin |4 aut | |
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| 773 | 1 | 8 | |g volume:16 |g year:2023 |g number:1 |g day:02 |g month:02 |g pages:9-16 |
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