Abstract
The correct staging is of crucial importance in the choice of surgical treatment in patients affected by stomach carcinoma. In an attempt to achieve a greater accuracy in the diagnosis of depth of tumor invasion, we propose to perform ultrasonography of the gastric wall during surgery (in vitro ultrasonography). Immediately after removal by the surgeon, the portion of the stomach containing the tumor is submitted to ultrasonography with a linear 7.5-MHz probe. To obtain good ultrasonographic images it was necessary to interpose an echo-free standoff pad between the probe and the gastric wall and between the latter and support surface. On completion of ultrasonography, the surgical specimen was sent to the pathologist, who was unaware of the diagnosis formulated on the basis of in vitro ultrasonography (VUS). The VUS diagnosis of T corresponded to the pathological diagnosis in 87/93 cases (93.5% accuracy). In the early cancers the diagnosis was correct in 24/28 cases (85.7%); in the advanced cancers the diagnosis was correct in 63/65 cases (96.9%). In comparison with the results of the other preoperative and intraoperative techniques the accuracy of in vitro ultrasonography in diagnosing the depth of tumor invasion was clearly superior. We feel that VUS may become a basic instrument in T staging and an aid to the surgeon in deciding the extent of the resection and of lymphadenectomy in patients with gastric cancer.
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References
Bolondi L, Casanova P, Santi V, Caletti GC, Barbara L, Labò G (1986) Sonographic appearance of the normal gastric wall: an in vitro study. Ultrasound Med Biol 12: 991–998
de Manzoni G, Cordiano C (1990) Intraoperative staging in gastric cancer surgery. In: Reed PI, Carboni M, Johnston B, Guadagni S (eds) New trends in gastric cancer. Kluwer Academic Publishers, London, pp 79–86
de Manzoni G, Borzellino G, Macrì A, Cordiano C (1991) La stadiazione intraoperatoria del T nel cancro gastrico. Arch ed Atti 93esimo Congresso S.I.C. 5: 306–312
Fracastoro G, de Manzoni G, Mazzeo GI, Macrì A (1991) Staging of gastric cancer and surgical choices. In: Cordiano C, de Manzoni G (eds) Staging and treatment of gastric cancer. Piccin, Padova, pp 190–198
Hermanek P, Sobin LH (1987) UICC: TNM classification of malignant tumours. Springer-Verlag, New York
Hiki Y, Kida M (1991) Preoperative staging of T by endoscopy and endoscopic ultrasonography for diagnosing the degree of gastric cancer invasion. In: Cordiano C, de Manzoni G (eds) Staging and treatment of gastric cancer. Piccin, Padova, pp 161–166
JRSGC (1981) The general rules for the gastric cancer study in surgery and pathology. Jpn J Surg 11: 127–139
Kodama I, Machi J, Tanaka M, Yoshida C, Hashimoto K, Takeda J, Kakegawa T, Sigel B (1992) The value of operative ultrasonography in diagnosing tumor extension of carcinoma of the stomach. Surg Gyn Obstet 172: 479–484
Machi J, Takeda J, Kakegawa T, Yamana H, Fujita H, Kuroiji T, Yamashita Y (1987) The detection of gastric and esophageal tumour extension by high resolution ultrasound during surgery. World J Surg 11: 664–671
Maruyama K (1986) Results of surgery correlated with staging. In: Preece PE, Cuschieri A, Wellwood JM (eds) Cancer of the stomach. Grune & Stratton, London, pp
Miyamoto Y, Nakatani M, Ida M, Takashi I, Ocazawa N, Ariizumi M, Tsujimoto F, Mizunuma K, Fukuda Y, Tada S, Chiba S (1989) Ultrasonographic findings in gastric cancer: in vitro and in vivo studies. JCU 17: 309–318
Sussman SK, Halvorsen RA, Illescas FF, Cohan RA, Saeed M, Silverman PM, Thompson WM, Meyers WC (1988) Gastric adenocarcinoma CT versus surgical staging, Radiology 167: 335–340
Tio TL, Coene PPLO, Schouwink MH, Tytgat GNJ (1989) Esophagogastric carcinoma: preoperative TNM classification with endosonography. Radiology 167: 335–340
Valette JP, Souquet JC, Lambert R, Bret P (1988) L'echoendoscopie: ses indications en pathologie oesophagienne et gastrique. J Radio 69: 235–242
Yasuda K, Kiyota K, Nakajima M, Kawai K (1987) Fundamentals of endoscopic laser therapy (ELT) for G.I. tumours. New aspects with endoscopic ultrasonography (EUS). Endoscopy 19: 2–6
Yasuda K, Nakajima M, Cho E, Kobajashi M, Kawai K (1987) Benign versus malignant gastric ulcers: a role of endoscopic ultrasonography. In: Dancygier H, Classen M (eds) 5th International symposium on endoscopic ultrasonography. Demeter-Verlag, Heidelberg, pp 45–52
Yoshida S, Miyamato K, Hijikata A (1990) Endosonography: its diagnostic utilities for gastric cancer. In: Reed PI, Carboni M, Johnston B, Guadagni S (eds) New trends in gastric cancer. Kluwer Academic Publishers, London, pp 79–86
Ziegler K, Sanft C, Zeitz M, Riecken ED (1990) Preoperative staging of gastrointestinal tumours by endosonography. Surg Endosc 4: 154–160
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de Manzoni, G., Macrì, A., Borzellino, G. et al. The value of in vitro ultrasonography in the intraoperative staging of gastric cancer. Surg Endosc 8, 765–769 (1994). https://doi.org/10.1007/BF00593437
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DOI: https://doi.org/10.1007/BF00593437