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World J Gastroenterol. Oct 14, 2014; 20(38): 13775-13782
Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.13775
Is endoscopic ultrasonography still the modality of choice in preoperative staging of gastric cancer?
Sung Wook Hwang, Dong Ho Lee
Sung Wook Hwang, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 110-744, South Korea
Dong Ho Lee, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do 463-707, South Korea
Author contributions: Hwang SW and Lee DH equally wrote the paper.
Correspondence to: Dong Ho Lee, MD, Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do 463-707, South Korea. dhljohn@yahoo.co.kr
Telephone: + 82-31-7877008 Fax: +82-31-7874051
Received: October 28, 2013
Revised: April 30, 2014
Accepted: June 20, 2014
Published online: October 14, 2014
Processing time: 352 Days and 19.3 Hours
Abstract

The treatment option for gastric cancer is usually based on preoperative staging by imaging modalities. Endoscopic ultrasonography (EUS) and computed tomography (CT) have been used as the diagnostic modality of choice in preoperative staging of gastric cancer. Magnetic resonance imaging (MRI) has been employed in several studies, and (18F) 2-Fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) has emerged as a new promising imaging modality. The purpose of this article is to provide summarized information on preoperative staging using EUS, multi-detector row CT (MDCT), MRI and PET for gastric cancer. In T staging, both EUS and MDCT show high accuracy. MRI seemed to have better performance, but the number of MRI studies is limited. FDG-PET is not able to properly evaluate the depth of invasion. In N staging, the diagnostic accuracy of EUS, MDCT and MRI is not sufficient. In preoperative M staging, MDCT and FDG-PET showed similar diagnostic accuracies. FDG-PET/CT fusion could be expected to show better performance in the future. Physicians should keep in mind that each diagnostic modality has advantages and limitations and choose an appropriate diagnostic strategy tailored for each patient.

Keywords: Gastric cancer; Endoscopic ultrasonography; Computed tomography; Magnetic resonance imaging; Positron emission tomography

Core tip: Endoscopic ultrasonography (EUS) and computed tomography (CT) have been used as the diagnostic modality of choice in preoperative staging of gastric cancer. Magnetic resonance imaging (MRI) and (18F) 2-Fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) were also employed. The purpose of this article is to provide concisely summarized information in preoperative staging of EUS, multi-detector row CT (MDCT), MRI and PET for gastric cancer. In T staging, both EUS and MDCT show high accuracy. In N staging, the diagnostic accuracy of EUS, MDCT and MRI is not sufficient, but the specificity of FDG-PET was the highest among the modalities.