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Ultraschall Med 2012; 33(7): E218-E224
DOI: 10.1055/s-0032-1312958
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Preoperative T Staging of Advanced Gastric Cancer using Double Contrast-Enhanced Ultrasound

Präoperatives T-Staging bei fortgeschrittenem Magenkarzinom mittels doppelt-kontrastverstärkter Sonografie
S. Li
1   Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine
,
P. Huang
2   Department of Ultrasonography, the 2nd Affiliated Hospital Zhejiang University College of Medicine
,
Z. Wang
3   Department of Pathology, the 2nd Affiliated Hospital of Wenzhou Medical College
,
J. Chen
4   Department of General Surgery, the 2nd Affiliated Hospital Zhejiang University College of Medicine
,
H. Xu
1   Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine
,
L. Wang
5   Department of Ultrasonography, the 2nd Affiliated Hospital of Wenzhou Medical College
,
Y. Zhang
2   Department of Ultrasonography, the 2nd Affiliated Hospital Zhejiang University College of Medicine
,
G. Mo
2   Department of Ultrasonography, the 2nd Affiliated Hospital Zhejiang University College of Medicine
,
J. Zhu
2   Department of Ultrasonography, the 2nd Affiliated Hospital Zhejiang University College of Medicine
,
D. Cosgrove
6   Imaging Sciences Department, Imperial College, Hammersmith Hospital
› Author Affiliations
Further Information

Publication History

07 January 2012

17 May 2012

Publication Date:
28 June 2012 (online)

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Abstract

Purpose: To determine the accuracy of double contrast-enhanced ultrasound (DCEUS), in which intravenous microbubbles are used together with an oral contrast agent, in the preoperative T staging of advanced gastric cancer.

Materials and Methods: This prospective, ethics committee-approved study recruited 350 patients who gave informed consent. All had gastric cancer proved by endoscopic biopsy and underwent preoperative ultrasound staging using the TNM classification (UICC 2002). The results of DCEUS were compared with postoperative pathologic findings. The staging accuracy of oral contrast-enhanced ultrasound (OCEUS) and DCEUS were compared to each other. Sensitivity and specificity for assessing serosal involvement by DCEUS were evaluated, and the concordance of this method was analyzed using Kappa statistics.

Results: The accuracies of OCEUS and DCEUS in determining the T stage of advanced gastric cancer were 75.1 % (70.4 % for T2, 79.5 % for T3, 68.1 % for T4) and 87.4 % (83.3 % for T2, 89.7 % for T3, 87.2 % for T4), respectively, and the difference between the two methods was statistically significant (χ2 = 17.364, p< 0.001). The performance of DCEUS for staging lesions in the cardia (69.81 %), fundus (85.71 %) and body (85.56 %) had lower accuracy than that of other parts (93.94 % for antrum; 92.11 % for pylorus). Sensitivity and specificity for assessing serosal involvement by DCEUS were 98.76 % and 83.33 % respectively. The reliability was almost perfect with Kappa values of 0.89 (p< 0.001) for intra-observer and 0.82 (p< 0.001) for inter-observer agreement.

Conclusion: DCEUS could be considered as an accurate, non-invasive, and reliable diagnostic method for preoperative staging of advanced gastric cancer.

Zusammenfassung

Ziel: Bestimmung der Genauigkeit des doppelt-kontrastverstärkten Ultraschalls (DCEUS) unter Verwendung von intravenös verabreichten Mikrobläschen zusammen mit einem oralen Kontrastmittel beim präoperativen T-Staging des fortgeschrittenen Magenkarzinoms.

Material und Methoden: In diese prospektive, von der Ethikkommission anerkannte Studie wurden 350 Patienten nach Abgabe der Einverständniserklärung aufgenommen. Alle hatten ein durch eine endoskopische Biopsie bestätigtes Magenkarzinom und unterzogen sich der präoperativen Stadieneinteilung unter Verwendung der TNM-Klassifikation (UICC 2002). Die DCEUS-Befunde wurden mit den postoperativen pathologischen Befunden verglichen. Die Genauigkeit des Stagings mittels oralen kontrastverstärkten Ultraschalls (OCEUS) und DCEUS wurden miteinander verglichen. Die Sensitivität und Spezifität des DCEUS im Hinblick auf die Beurteilung der Beteiligung der Serosa wurde ermittelt und die Übereinstimmung dieser Methode mittels Kappa-Statistik analysiert.

Ergebnisse: Für die Bestimmung der T-Stadien bei fortgeschrittenem Magenkarzinom betrug die Genauigkeit von OCEUS 75,1 % (70,4 % für T2, 79,5 % für T3, 68,1 % für T4), die von DCEUS 87,4 % (83,3 % für T2, 89,7 % für T3, 87,2 % für T4) und der Unterschied zwischen beiden Methoden war statistisch signifikant (χ2 = 17,364, p< 0,001). Die Durchführung von DCEUS beim Staging zeigte bei Läsionen im Bereich des Mageneingangs (69,81 %), des Fundus (85,71 %) und des Corpus (85,56 %) im Vergleich zu anderen Bereichen des Magens (93,94 % für das Antrum; 92,11 % für den Pylorus) eine geringere Genauigkeit. In Bezug auf die Abschätzung der Beteiligung der Serosa betrug die Sensitivität von DCEUS 98,76 % und dessen Spezifität 83,33 %. Die Reliabilität war bei einem Kappa-Wert von 0,89 (p< 0,001) für die Intraobserver- und von 0,82 (p< 0,001) für Interobserver-Übereinstimmung beinahe perfekt.

Schlussfolgerung: DCEUS kann als treffsichere, nicht invasive und verlässliche Diagnostik bei der präoperativen Stadieneinteilung bei fortgeschrittenem Magenkarzinom in Betracht gezogen werden.

Key words

stomach - ultrasound - tumor staging - CEUS
 

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