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Li T, Li J, Hu Z, Lu M. An ultrasound based method for predicting the malignant potential of primary gastrointestinal stromal tumors preoperatively. Abdom Radiol (NY) 2024:10.1007/s00261-024-04341-5. [PMID: 38849537 DOI: 10.1007/s00261-024-04341-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE Gastrointestinal stromal tumors (GISTs) are difficult to identify the risk level accurately without surgical pathological confirmation. The purpose of our study was to propose a noninvasive prediction method for predicting the malignant potential of GISTs preoperatively by using contrast-enhanced ultrasound (CEUS) with gastric distention. METHODS We reviewed 47 GISTs who underwent CEUS from April 2017 to August 2023 retrospectively, all the lesions were certificated by pathology after surgery. The age of the patient, size of the lesion, shape, necrosis, calcification in the lesion, perfusion parameters including arrival time (AT), peak intensity (PI), time to peak (TTP), and area under the curve (AUC) of the lesion and surrounding normal tissue were analyzed. Logistic regression analyses were performed. Of the 47 GISTs, 26 were high-risk and 21 low-risk tumors respectively. RESULTS Compared with low-risk GISTs, high-risk GIST had faster AT (7.7s vs. 11.5s, p < 0.05), higher PI (15.2dB vs. 12.5dB, p < 0.05), and larger size (4.4 cm vs. 2.2 cm, p < 0.001). In multivariate logistic regression, AT, PI, and size were significant features. The corresponding regression equation In (p/(1-p)=-5.9 + 4.5 size + 4.6 PI + 4.0 AT). CONCLUSION The size, AT, and PI of the GISTs on CEUS can be used as parameters for a noninvasive risk level prediction model of GISTs. This model may help identify the different risk levels of GISTs before surgery.
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Affiliation(s)
- Tingting Li
- Department of Ultrasound, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Juan Li
- Department of Ultrasound, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - ZiYue Hu
- Department of Ultrasound, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Man Lu
- Department of Ultrasound, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
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Zhong Y, Xiao YY, Ye JY, Jian GL, Huang WJ. Diagnostic efficacy of contrast-enhanced gastric ultrasonography in staging gastric cancer: a meta-analysis. BMC Cancer 2024; 24:422. [PMID: 38580944 PMCID: PMC10998428 DOI: 10.1186/s12885-024-12210-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/01/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND As comprehensive surgical management for gastric cancer becomes increasingly specialized and standardized, the precise differentiation between ≤T1 and ≥T2 gastric cancer before endoscopic intervention holds paramount clinical significance. OBJECTIVE To evaluate the diagnostic efficacy of contrast-enhanced gastric ultrasonography in differentiating ≤T1 and ≥T2 gastric cancer. METHODS PubMed, Web of Science, and Medline were searched to collect studies published from January 1, 2000 to March 16, 2023 on the efficacy of either double contrast-enhanced gastric ultrasonography (D-CEGUS) or oral contrast-enhanced gastric ultrasonography (O-CEGUS) in determining T-stage in gastric cancer. The articles were selected according to specified inclusion and exclusion criteria, and the quality of the included literature was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 scale. Meta-analysis was performed using Stata 12 software with data from the 2 × 2 crosslinked tables in the included literature. RESULTS In total, 11 papers with 1124 patients were included in the O-CEGUS analysis, which revealed a combined sensitivity of 0.822 (95% confidence interval [CI] = 0.753-0.875), combined specificity of 0.964 (95% CI = 0.925-0.983), and area under the summary receiver operating characteristic (sROC) curve (AUC) of 0.92 (95% CI = 0.89-0.94). In addition, five studies involving 536 patients were included in the D-CEGUS analysis, which gave a combined sensitivity of 0.733 (95% CI = 0.550-0.860), combined specificity of 0.982 (95% CI = 0.936-0.995), and AUC of 0.93 (95% CI = 0.91-0.95). According to the I2 and P values of the forest plot, there was obvious heterogeneity in the combined specificities of the included papers. Therefore, the two studies with the lowest specificities were excluded from the O-CEGUS and D-CEGUS analyses, which eliminated the heterogeneity among the remaining literature. Consequently, the combined sensitivity and specificity of the remaining studies were 0.794 (95% CI = 0.710-0.859) and 0.976 (95% CI = 0.962-0.985), respectively, for the O-CEDUS studies and 0.765 (95% CI = 0.543-0.899) and 0.986 (95% CI = 0.967-0.994), respectively, for the D-CEGUS studies. The AUCs were 0.98 and 0.99 for O-CEGUS and D-CEGUS studies, respectively. CONCLUSION Both O-CEGUS and D-CEGUS can differentiate ≤T1 gastric cancer from ≥T2 gastric cancer, thus assisting the formulation of clinical treatment strategies for patients with very early gastric cancer. Given its simplicity and cost-effectiveness, O-CEGUS is often favored as a staging method for gastric cancer prior to endoscopic intervention.
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Affiliation(s)
- Yuan Zhong
- Department of Medical Ultrasound, The First People's Hospital of Foshan, No. 81 Lingnan Avenue North, Foshan, 528010, China
| | - Yan-Yan Xiao
- Department of Medical Ultrasound, The First People's Hospital of Foshan, No. 81 Lingnan Avenue North, Foshan, 528010, China
| | - Jie-Yi Ye
- Department of Medical Ultrasound, The First People's Hospital of Foshan, No. 81 Lingnan Avenue North, Foshan, 528010, China
| | - Guo-Liang Jian
- Department of Medical Ultrasound, The First People's Hospital of Foshan, No. 81 Lingnan Avenue North, Foshan, 528010, China
| | - Wei-Jun Huang
- Department of Medical Ultrasound, The First People's Hospital of Foshan, No. 81 Lingnan Avenue North, Foshan, 528010, China.
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Wang CY, Fan XJ, Wang FL, Ge YY, Cai Z, Wang W, Zhou XP, Du J, Dai DW. Clinical value of oral contrast-enhanced ultrasonography in diagnosis of gastric tumors. World J Gastrointest Oncol 2024; 16:110-117. [PMID: 38292839 PMCID: PMC10824109 DOI: 10.4251/wjgo.v16.i1.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The incidence of gastric cancer remains high, and it is the sixth most common cancer and the fourth leading cause of cancer deaths worldwide. Oral contrast-enhanced ultrasonography is a simple, non-invasive, and painless method for the diagnosis of gastric tumors. AIM To explore the diagnostic value of oral contrast-enhanced ultrasonography for the detection of gastric tumors. METHODS The screening results based on oral contrast-enhanced ultrasonography and electronic gastroscopy were compared with those of the postoperative pathological examination. RESULTS Among 42 patients with gastric tumors enrolled in the study, the diagnostic accordance rate was 95.2% for oral contrast-enhanced ultrasonography (n = 40) and 90.5% for electronic gastroscopy (n = 38) compared with postoperative pathological examination. The Kappa value of consistency test with pathological findings was 0.812 for oral contrast-enhanced ultrasonography and 0.718 for electronic gastroscopy, and there was no significant difference between them (P = 0.397). For the TNM staging of gastric tumors, the accuracy rate of oral contrast-enhanced ultrasonography was 81.9% for the overall T staging and 50%, 77.8%, 100%, and 100% for T1, T2, T3, and T4 staging, respectively. The sensitivity and specificity were both 100% for stages T3 and T4. The diagnostic accuracy rate of oral contrast-enhanced ultrasonography was 93.8%, 80%, 100%, and 100% for stages N0, N1-N3, M0, and M1, respectively. CONCLUSION The accordance rate of qualitative diagnosis by oral contrast-enhanced ultrasonography is comparable to that of gastroscopy, and it could be used as the preferred method for the early screening of gastric tumors.
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Affiliation(s)
- Chuan-Yu Wang
- Department of Ultrasound Medicine, Beijing Hospital, Beijing 100005, China
| | - Xiao-Jing Fan
- Department of Ultrasound Medicine, Beijing Hospital, Beijing 100005, China
| | - Fei-Liang Wang
- Department of Ultrasound Medicine, Beijing Hospital, Beijing 100005, China
| | - Yue-Yue Ge
- Department of Ultrasound Medicine, Beijing Hospital, Beijing 100005, China
| | - Zhao Cai
- Department of Ultrasound Medicine, Beijing Hospital, Beijing 100005, China
| | - Wei Wang
- Department of Gastroscopy, Beijing Hospital, Beijing 100005, China
| | - Xin-Ping Zhou
- Department of General Surgery, Beijing Hospital, Beijing 100005, China
| | - Jun Du
- Department of Pathology, Beijing Hospital, Beijing 100005, China
| | - De-Wei Dai
- Department of Ultrasound Medicine, Beijing Hospital, Beijing 100005, China
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Guan S, Yan R, Chen X, Chen W, Zhou X, Zhou M, Xie Z, Tan W, He Y, Fu J, Yuan F, Xu E. Risk stratification of gastric cancer screening in community population based on oral contrast-enhanced ultrasonography examination: A 3-year follow-up analysis report. Front Oncol 2023; 13:1218800. [PMID: 38023168 PMCID: PMC10643155 DOI: 10.3389/fonc.2023.1218800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This study aimed to retrospectively investigate the use of oral contrast-enhanced ultrasonography (O-CEUS) in assessing the thickness of the gastric wall for gastric cancer (GC) screening and to establish screening strategies for GC with different risk stratifications based on the gastric wall thickness. Methods From January 2015 to March 2020, people who underwent O-CEUS at the Physical Examination Center of our hospital with at least three years of follow-up were included in this study. The thickness of the gastric wall measured by O-CEUS was divided into three groups using 6 mm and 9 mm as cutoff values. The occurrence of GC in each group was observed. The imaging and clinical information of these populations were recorded and analyzed. Kaplan-Meier survival analysis and Cox's proportional hazards regression were performed to calculate the risk of GC occurrence. Results A total of 4,047 people were finally included in this study. During the follow-up period, GC occurred in 7 individuals (incidence rate 0.17%). Among them, according to the thickness of the gastric wall, one case occurred in Group A (< 6 mm), two cases occurred in Group B (6-9 mm), and four cases occurred in Group C (>9mm). Based on Kaplan-Meier survival analysis, the curves of the three groups were significantly different (P < 0.01). The risk of GC occurrence in Group C and Group B were higher than that in Group A (4.76E+2-fold and 1.50E+2-fold). Conclusion O-CEUS is a convenient, economical, safe, and noninvasive screening method for GC. Measuring the thickness of the gastric wall is helpful to predict the risk of GC occurrence according to our stratification screening system.
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Affiliation(s)
- Sainan Guan
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Ronghua Yan
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xiaomin Chen
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Weiqiang Chen
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Xi Zhou
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Minghui Zhou
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Zhengneng Xie
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Wen Tan
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yongyan He
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Juan Fu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Fan Yuan
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Erjiao Xu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
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Sun C, Niu P, Zhang X, Zhao L, Wang W, Luan X, Han X, Chen Y, Zhao D. Concurrent clinical and pathological response predicts favorable prognosis of patients with gastric cancer after neoadjuvant therapy: a real-world study. BMC Cancer 2023; 23:996. [PMID: 37853387 PMCID: PMC10585908 DOI: 10.1186/s12885-023-11508-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Response of locally advanced gastric cancer (LAGC) to neoadjuvant therapy (NAT) may be associated with prognosis, but which of the clinical or pathological evaluation can accurately predict a favorable prognosis is still controversial. This study aims to compare the effect of clinical and pathological response on the prognosis of patients with gastric cancer. METHODS This study retrospectively analyzed LAGC patients who underwent NAT followed by surgery in the China National Cancer Center from January 2004 to January 2021. Clinical and pathological responses after NAT were evaluated using RECIST 1.1 and Mandard tumor regression grade system (TRG) respectively. Complete response (CR) and partial response (PR) assessed by computed tomography were regarded as clinical response. For histopathology regression assessment, response was defined as Mandard 1, 2, 3 and non-response as Mandard 4, 5. Furthermore, we combined clinical and pathological evaluation results into a variable termed "comprehensive assessment" and divided it into four groups based on the presence or absence of response (concurrent response, only clinical response, only pathological response, both non-response). The association between the prognosis and clinicopathological factors was assessed in univariate and multivariate Cox regression analysis. RESULTS In total, 238 of 1073 patients were included in the study after screening. The postoperative pathological response rate and clinical response rate were 50.84% (121/238) and 39.92% (95/238), respectively. 154 patients got consistent results in clinical and pathological evaluation (66 were concurrent response and 88 were both non-response), while the other 84 patients did not. The kappa value was 0.297(p < 0.001), which showed poor consistency. Multivariate Cox regression analysis revealed that comprehensive assessment (P = 0.03), clinical N stage(P < 0.001), vascular or lymphatic invasion (VOLI) (HR 2.745, P < 0.001), and pre-CA724(HR 1.577, P = 0.047) were independent factors for overall survival in patients with gastric cancer. Among four groups in the comprehensive assessment, concurrent response had significantly better survival (median OS: 103.5 months) than the other groups (P = 0.008). CONCLUSION Concurrent clinical and pathological response might predict a favorable prognosis of patients with gastric cancer after neoadjuvant therapy, further validation is needed in prospective clinical trials with larger samples.
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Affiliation(s)
- Chongyuan Sun
- National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Penghui Niu
- National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaojie Zhang
- National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lulu Zhao
- National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wanqing Wang
- National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyi Luan
- National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue Han
- National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingtai Chen
- National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Dongbing Zhao
- National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Nan M, Ye W, Liu Y, Zhang Z. Diagnostic accuracy of gastric filling ultrasonography in preoperative invasion depth (T stage) of gastric cancer: Meta-analysis. Medicine (Baltimore) 2022; 101:e31066. [PMID: 36281081 PMCID: PMC9592522 DOI: 10.1097/md.0000000000031066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the diagnostic value of gastric filling ultrasonography in the preoperative invasion depth (T staging) of gastric cancer. METHODS We systematically searched several online electronic databases including CNKI, Wanfang Medical Database, VIP, CBM, Pubmed, Embase, Cochrane Library, and Web of Science from January 2010 to December 2021, identifying the study about gastric filling ultrasonography for diagnostic of invasion depth of gastric cancer. Using bivariate mixed effect model to calculate the sensitivity (Sen), specificity (spe), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) with 95% confidence interval (CI). Draw the summary receiver operating characteristic (sROC) curve, likelihood ratio matrix and fagan diagram to evaluate the diagnostic value of gastric filling ultrasonography in the preoperative invasion depth of gastric cancer. Sen analysis and Publication bias tests were performed. RESULTS This study obtained 21 literatures and the quality were good. The pooled Sen and spe of gastric filling ultrasonography was: T1: 0.63 (95% CI:0.51-0.73), 0.96 (95% CI:0.94-0.98); T2: 0.67 (95% CI:0.62-0.71), 0.90 (95% CI:0.88-0.93); T3: 0.79 (95% CI:0.75-0.82), 0.83 (95% CI:0.80-0.86); T4: 0.80 (95% CI:0.73-0.86), 0.96 (95% CI:0.94-0.97), respectively. In addition, the PLR and NLR of gastric filling ultrasonography was: T1: 16.74 (95% CI:9.98-28.09), 0.39 (95% CI:0.29-0.52); T2: 6.98 (95% CI:5.20-9.38), 0.36 (95% CI:0.31-0.42); T3: 4.65 (95% CI:3.78-5.73), 0.26 (95% CI:0.21-0.31); T4: 18.51 (95% CI:12.77-26.83), 0.20 (95% CI: 0.15-0.29), respectively. The DOR of gastric filling ultrasonography in T1-T4 was: 43.17 (95% CI:20.62-90.41),19.13 (95% CI:12.61-29.03), 18.15 (95% CI:12.86-25.62), 90.63 (95% CI:47.36-173.41), respectively. The sROC curve revealed that the area under the curve (AUC) of T1-T4 was: 0.93, 0.82, 0.87, 0.97, respectively. Sen analysis indicated that the study was steadily. And there is no publication bias in this study. But the study has some heterogeneity. CONCLUSION Gastric filling ultrasonography is useful for clinical preoperative T staging of gastric cancer, and the result indicate that the accuracy of gastric filling ultrasonography in discriminating T1-T4 is higher than that in discriminating T2 - T3. It can be used as an imaging diagnostic method for preoperative T staging of gastric cancer.
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Affiliation(s)
- Mengmeng Nan
- Department of Ultrasonic, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Weihua Ye
- Department of Ultrasonic, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- * Correspondence: Weihua Ye, Department of Ultrasonic, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China (e-mail: )
| | - Yu Liu
- Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zibo Zhang
- Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Solaini L, Bencivenga M, D'ignazio A, Milone M, Marino E, De Pascale S, Rosa F, Sacco M, Romario UF, Graziosi L, De Palma G, Marrelli D, Morgagni P, Ercolani G. Which gastric cancer patients could benefit from staging laparoscopy? A GIRCG multicenter cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1778-1784. [PMID: 35101316 DOI: 10.1016/j.ejso.2022.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/29/2021] [Accepted: 01/19/2022] [Indexed: 02/07/2023]
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PET imaging of gastric cancer. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Nawab K, Athwani R, Naeem A, Hamayun M, Wazir M. A Review of Applications of Artificial Intelligence in Gastroenterology. Cureus 2021; 13:e19235. [PMID: 34877212 PMCID: PMC8642128 DOI: 10.7759/cureus.19235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) is the science that deals with creating 'intelligent machines'. AI has revolutionized medicine because of its application in several fields across medicine like radiology, neurology, ophthalmology, orthopedics and gastroenterology. In this review, we intend to summarize the basics of AI, the application of AI in various gastrointestinal pathologies till date as well as challenges/ problems related to the application of AI in medicine. Literature search using keywords like artificial intelligence, gastroenterology, applications, etc. were used. The literature search was done using Google Scholar, PubMed and ScienceDirect. All the relevant articles were gathered and relevant data were extracted from them. We concluded AI has achieved major feats in the past few decades. It has helped clinicians in diagnosing complex diseases, managing treatments as well as in predicting outcomes, all in all, which helps doctors from all over the globe in dispensing better healthcare services.
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Affiliation(s)
- Khalid Nawab
- Internal Medicine, Penn State Holy Spirit Hospital, Camp Hill, USA
| | - Ravi Athwani
- Internal Medicine, Penn State Holy Spirit Hospital, Camp Hill, USA
| | - Awais Naeem
- Internal Medicine, Khyber Medical University, Peshawar, PAK
| | | | - Momna Wazir
- Internal Medicine, Hayatabad Medical Complex, Peshawar, PAK
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10
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Xu L, Wang X, Wu W, Li Y. Diagnostic Accuracy of Double Contrast-Enhanced Ultrasonography in Clarifying Tumor Depth (T Stage) of Gastric Cancer: Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2483-2493. [PMID: 34172338 DOI: 10.1016/j.ultrasmedbio.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 06/13/2023]
Abstract
This study aimed to quantitatively analyze published data regarding the ability of double contrast-enhanced ultrasonography (DCEUS) to clarify tumor depth (T stage) in primary gastric carcinoma patients. We obtained six studies, including 926 gastric cancer (GC) patients who were diagnosed by DCEUS from the Cochrane Library "Cochrane Central Register of Controlled Trials (CENTRAL)," OVID MEDLINE, EMBASE, PUBMED and EBSCOhost, to 2019. Sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), forest plot analysis and summary receiver operating characteristic (SROC) curve analysis were used to evaluate the diagnostic accuracy of DCEUS. In our study, all the patients were examined by DCEUS. The quality of all included studies was good. The meta-analysis of six studies (n = 926) revealed that the summary sensitivity and specificity of DCEUS in discriminating T1-T2 versus T3-T4 gastric carcinomas were 0.94 and 0.91, respectively. The pooled sensitivity and specificity of DCEUS were 0.67 and 0.98 for T1 stage, 0.81 and 0.95 for T2 stage, 0.89 and 0.86 for T3 stage and 0.87 and 0.96 for T4 stage, respectively. The SROC curve revealed that the areas under the curve (AUC) of T1-T2 were 0.97 for each stage and 0.82 (T1), 0.84 (T2), 0.91 (T3) and 0.97 (T4). These results indicate that the accuracy of DCEUS in discriminating T1-T2 is higher than that in discriminating T3-T4, and the diagnostic value of DCEUS in discriminating the T3 stage requires further consideration. Finally, our analysis suggested that the diagnostic accuracy of DCEUS is available to guide surgeons in the pre-operative diagnosis of GC patients for more precise treatment.
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Affiliation(s)
- Lifeng Xu
- Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China; Department of General Surgery, Anhui Second Provincial People's Hospital, Hefei, Anhui, People's Republic of China
| | - Xiaodong Wang
- Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Wenzhou Wu
- Department of General Surgery, Anhui Second Provincial People's Hospital, Hefei, Anhui, People's Republic of China
| | - Yongxiang Li
- Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.
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Yun WG, Lim MH, Kim S, Kim SH, Park JH, Kong SH, Park DJ, Lee HJ, Yang HK. Oncologic Feasibility of Proximal Gastrectomy in Upper Third Advanced Gastric and Esophagogastric Junctional Cancer. J Gastric Cancer 2021; 21:169-178. [PMID: 34234978 PMCID: PMC8255306 DOI: 10.5230/jgc.2021.21.e15] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 01/15/2023] Open
Abstract
Purpose The aim of this study was to investigate the oncologic safety and identify potential candidates for proximal gastrectomy (PG) in upper third advanced gastric cancer (AGC) and esophagogastric junction (EGJ) cancers. Materials and Methods Among 5,665 patients who underwent gastrectomy for gastric adenocarcinoma between January 2011 and December 2017, 327 patients who underwent total gastrectomy with standard lymph node (LN) dissection for upper third AGC and Siewert type II EGJ cancers were enrolled. We analyzed the correlation between the metastatic rates of distal LNs (No. 4d, 5, 6, and 12a) around the lower part of the stomach and the clinicopathological characteristics. We identified subgroups with no metastasis to the distal LNs. Results The metastatic rate of distal LNs in proximal AGC and Siewert type II EGJ cancers was 7.0% (23 of 327 patients). On multivariate analysis, pathological T stage (P=0.001), tumor size (P=0.043), and middle third invasion (P=0.003) were significantly associated with distal LN metastases. Pathological ‘T2 stage’ (n=88), or ‘T3 stage with ≤5 cm tumor size’ (n=87) showed no metastasis in distal LNs, regardless of middle third invasion. Pathological T3 stage with tumor size > 5 cm (n=61) and T4 stage (n=91) had metastasis in the distal LNs. Conclusions In the upper third AGC and Siewert type II EGJ cancer, pathological T2 and small-sized T3 stage groups are possible candidates for PG in cases without distal LN metastasis. Further validation studies are required for clinical application.
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Affiliation(s)
- Won-Gun Yun
- Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-Hoon Lim
- Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sarah Kim
- Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sa-Hong Kim
- Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Hyeon Park
- Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seong-Ho Kong
- Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Do Joong Park
- Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk-Joon Lee
- Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Kwang Yang
- Division of Gastrointestinal Surgery, Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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12
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Yu C, Helwig EJ. Artificial intelligence in gastric cancer: a translational narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:269. [PMID: 33708896 PMCID: PMC7940908 DOI: 10.21037/atm-20-6337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Increasing clinical contributions and novel techniques have been made by artificial intelligence (AI) during the last decade. The role of AI is increasingly recognized in cancer research and clinical application. Cancers like gastric cancer, or stomach cancer, are ideal testing grounds to see if early undertakings of applying AI to medicine can yield valuable results. There are numerous concepts derived from AI, including machine learning (ML) and deep learning (DL). ML is defined as the ability to learn data features without being explicitly programmed. It arises at the intersection of data science and computer science and aims at the efficiency of computing algorithms. In cancer research, ML has been increasingly used in predictive prognostic models. DL is defined as a subset of ML targeting multilayer computation processes. DL is less dependent on the understanding of data features than ML. Therefore, the algorithms of DL are much more difficult to interpret than ML, even potentially impossible. This review discussed the role of AI in the diagnostic, therapeutic and prognostic advances of gastric cancer. Models like convolutional neural networks (CNNs) or artificial neural networks (ANNs) achieved significant praise in their application. There is much more to be fully covered across the clinical administration of gastric cancer. Despite growing efforts, adapting AI to improving diagnoses for gastric cancer is a worthwhile venture. The information yield can revolutionize how we approach gastric cancer problems. Though integration might be slow and labored, it can be given the ability to enhance diagnosing through visual modalities and augment treatment strategies. It can grow to become an invaluable tool for physicians. AI not only benefits diagnostic and therapeutic outcomes, but also reshapes perspectives over future medical trajectory.
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Affiliation(s)
- Chaoran Yu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ernest Johann Helwig
- Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Diaz LI, Mony S, Klapman J. Narrative review of the role of gastroenterologist in the diagnosis, treatment and palliation in gastric and gastroesophageal cancer. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1106. [PMID: 33145325 PMCID: PMC7575985 DOI: 10.21037/atm-20-4143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal cancer (EC) and gastric cancer (GC) carry a high mortality rate. Unfortunately, a majority of patients are asymptomatic and at the time of diagnosis, the disease may invariably be in its advanced stages with limited curative options. Thus, it is imperative to recognize certain risk factors including gastroesophageal reflux disease (GERD), male gender, pre-existing Barrett’s esophagus, smoking history, obesity, Helicobacter pylori infection, atrophic gastritis among others for both EC and GC, intervene on time with screening and surveillance modalities if indicated and optimize treatment plans. With advances in endoscopic techniques, early neoplastic lesions are increasingly managed by gastroenterologists, offering an alternative to surgery. The gold standard for diagnosis of EC and GC is high definition endoscopy with adequate targeted biopsies. Endoscopic ultrasound (EUS) is a key in the staging of early cancers dictating the pathway for treatment options. We also play a key role in palliation cases with the aim to reduce the symptoms like nausea, vomiting and even when possible, restore oral intake and improve nutrition in both advanced GC and EC. This review article discusses the risk factors, diagnostic and endoscopic treatment modalities of early EC and GC and palliation of advanced cancer where gastroenterologists play a key role.
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Affiliation(s)
- Liege I Diaz
- Department of Endoscopic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Shruti Mony
- Division of Digestive Diseases and Nutrition, University of South Florida, Tampa, FL, USA
| | - Jason Klapman
- Department of Endoscopic Oncology, Moffitt Cancer Center, Tampa, FL, USA
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14
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Tingting LMD, Xiaoyan LMD, Man LMD, Ji-Bin LMD, Wenming LMD, Lixue YMD, Changjun WMD, Zhiqing CMD, Guangxia WMD, Liying MMD, Jingyu WMD, Dong XMD, Jianqiang MMD, Jin YMD, Kang WMD, Zhi DMD, Ling GMD, Lina TMD, Shengjun MMD, Yinrong CMD, Kairong LMD, Yanfang ZMD, Xingxing DMD, Xuemei HMD, Xiaoxia DMD, Yuan LMD, Lu WMD. Chinese Expert Consensus and Guidelines on Oral Contrast Gastric Ultrasonography for Scanning Technique and Imaging Acquisition. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.200061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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15
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He P, Miao LY, Ge HY, Wang TL, Ye JX, Meng LM, Xue H, Zhang F, Zhao B. Preoperative Tumor Staging of Gastric Cancer: Comparison of Double Contrast-Enhanced Ultrasound and Multidetector Computed Tomography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3203-3209. [PMID: 31115090 DOI: 10.1002/jum.15028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/28/2019] [Accepted: 05/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The purpose of this study was to compare the sensitivity and specificity of double contrast-enhanced ultrasound (CEUS) and multidetector computed tomography (MDCT) in the preoperative tumor staging of gastric cancer (GC) to stratify patients for suitable treatment. METHODS Fifty-four patients with GC proved by histologic findings were included. The sensitivity and specificity of double CEUS and MDCT for tumor staging were calculated and compared. The differences between these methods were evaluated by using the area under the curve (AUC) from a receiver operating characteristic curve analysis. RESULTS There were no significant differences in AUC values for T1 and T2 stages between double CEUS and MDCT (P = .190 and .256, respectively). However, the sensitivity of double CEUS in the detection of the T1 stage was higher than that of MDCT (88% versus 75%). The AUC values of MDCT for T3 and T4 stages were 0.833 and 0.905, which were both significantly higher than those of double CEUS (0.759 and 0.696; P < .05). The sensitivities of double CEUS and MDCT for the T3 stage were both 89%, but the accuracy and specificity of double CEUS were lower than those of MDCT (76% versus 83% and 63% versus 78%). The specificities of double CEUS and MDCT for the T4 stage were both 98%, but the accuracy and sensitivity of double CEUS were lower than those of MDCT (85% versus 94% and 42% versus 83%). CONCLUSIONS Multidetector CT is superior to double CEUS for T3 and T4 GC, and double CEUS may be regarded as an important complementary method to MDCT.
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Affiliation(s)
- Ping He
- Departments of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Li-Ying Miao
- Departments of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Hui-Yu Ge
- Departments of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Tian-Li Wang
- Departments of Radiology, Peking University Third Hospital, Beijing, China
| | - Ju-Xiang Ye
- Departments of Pathology, Peking University Third Hospital, Beijing, China
| | - Ling-Mei Meng
- Departments of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - Heng Xue
- Departments of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Fan Zhang
- Departments of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Bo Zhao
- Departments of Ultrasound, Peking University Third Hospital, Beijing, China
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16
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Chen J, Zhou C, He M, Zhen Z, Wang J, Hu X. A Meta-Analysis And Systematic Review Of Accuracy Of Endoscopic Ultrasound For N Staging Of Gastric Cancers. Cancer Manag Res 2019; 11:8755-8764. [PMID: 31632135 PMCID: PMC6774993 DOI: 10.2147/cmar.s200318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 09/12/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Endoscopic ultrasonography (EUS) is widely used as a staging modality for gastric cancer. However, the results of studies on the use of EUS for N staging in gastric cancer vary. This study aimed at studying the overall diagnostic accuracy of EUS for N staging of gastric cancer. METHODS Published studies were identified through searching the MEDLINE, Web of Science, EMBASE, SpringerLink and ScienceDirect databases. A bivariate random effect model was used to estimate the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). A hierarchical summary receiver operating characteristic curves (HSROC) based on the pooled data was also computed. RESULTS Fifty studies (5223 patients) were included in this analysis. The pooled sensitivity, specificity, PLR, NLR and DOR of EUS for N staging were 0.82 (95% CI 0.78 to 0.85), 0.68 (0.63 to 0.73), 2.6 (2.2 to 3.0), 0.27 (0.22 to 0.32), and 10 (8 to 12), respectively. The area under the HSROC was 0.83. CONCLUSION The EUS may provide a clinically useful tool to guide physicians in the N staging of gastric cancer. However, physicians must note that the EUS has a relatively low specificity.
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Affiliation(s)
- Jiafei Chen
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Chaoyang Zhou
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Min He
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Zhiming Zhen
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Jie Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Xiaofei Hu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
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Young JJ, Pahwa A, Patel M, Jude CM, Nguyen M, Deshmukh M, Huang L, Mohammad SF. Ligaments and Lymphatic Pathways in Gastric Adenocarcinoma. Radiographics 2019; 39:668-689. [DOI: 10.1148/rg.2019180113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jennifer J. Young
- From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.)
| | - Anokh Pahwa
- From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.)
| | - Maitraya Patel
- From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.)
| | - Cecilia M. Jude
- From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.)
| | - Michael Nguyen
- From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.)
| | - Monica Deshmukh
- From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.)
| | - Lizhou Huang
- From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.)
| | - Shaden F. Mohammad
- From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View–UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.)
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Mucinous adenocarcinoma and non-mucinous adenocarcinoma: differing clinicopathological characteristics and computed tomography features in gastric cancer. Oncotarget 2018; 8:45698-45709. [PMID: 28501848 PMCID: PMC5542219 DOI: 10.18632/oncotarget.17389] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 04/06/2017] [Indexed: 02/06/2023] Open
Abstract
Mucinous gastric carcinoma (MGC) is a rare histological subtype of gastric cancer. The clinicopathological characteristics and CT features of MGC remain controversial. This study aimed to determine the clinicopathological characteristics and CT features of MGC. We reviewed 62 patients with MGC and 104 patients with non-mucinous gastric carcinoma (NMGC), pathologically confirmed between 2003 and 2015. There are significant differences in some clinicopathological characteristics and CT features between MGC and NMGC. NMGC occurs preferentially in males and more frequently in the lower third of the stomach. Patients with MGC were characterized by larger tumor size, more advanced tumor stages (II and III) and fewer lymphatic invasions. Layered enhancement (83.3%) was the main pattern of MGC, while the most common pattern in NMGC was homogeneous enhancement (52.6%), followed by heterogonous enhancement (34.6%). The degree of enhancement of the inner layer in MGC was significantly higher than in NMGC (ΔCT of portal venous phase: 54.57 Hu vs. 47.19 Hu, P = 0.034), while the middle or outer layer in MGC was significantly less enhanced (ΔCT of portal venous phase: 19.07 Hu vs. 33.09 Hu, P <0.001). Calcifications were more common in MGC (P <0.001). ROC curves revealed that the most effective variables in distinguishing MGC and NMGC were ΔCT of the middle or outer layer in the arterial phase (AUC=0.774) and portal venous phase (AUC=0.774), followed by the attenuation value of the middle or outer layer in the unenhanced phase (AUC=0.763). Calcifications had a high specificity (98.7%) in the diagnosis of MGC. The accuracy (86.1%), sensitivity (83.3%) and specificity (87.2%) of layered enhancement in diagnosing MGC were all high. Therefore, MGC was more likely to have larger tumor size and more advanced tumor stage (II and III) than NMGC. The thicker gastric wall, layered enhancement pattern and calcification were highly suggestive CT features for differentiating MGC from NMGC.
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He X, Sun J, Huang X, Zeng C, Ge Y, Zhang J, Wu J. Comparison of Oral Contrast-Enhanced Transabdominal Ultrasound Imaging With Transverse Contrast-Enhanced Computed Tomography in Preoperative Tumor Staging of Advanced Gastric Carcinoma. JOURNAL OF ULTRASOUND IN MEDICINE 2017; 36:2485-2493. [DOI: 10.1002/jum.14290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Xuemei He
- Departments of Ultrasound Imaging, First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Jing Sun
- Departments of Ultrasound Imaging, First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Xiaoling Huang
- Departments of Ultrasound Imaging, First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Chun Zeng
- Department of Radiology, First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Yinggang Ge
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Jun Zhang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Jingxian Wu
- Department of Pathology; Chongqing Medical University; Chongqing China
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20
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Shen L, Zhou C, Liu L, Zhang L, Lu D, Cai J, Zhao L, Chu R, Zhou J, Zhang J. Application of oral contrast trans-abdominal ultrasonography for initial screening of gastric cancer in rural areas of China. Dig Liver Dis 2017; 49:918-923. [PMID: 28487084 DOI: 10.1016/j.dld.2017.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 04/09/2017] [Accepted: 04/10/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The present study is aimed at assessing the efficacy of oral contrast trans-abdominal ultrasonography (OCTU) as an initial screening tool for gastric cancer in rural areas of China. METHODS All subjects that were enrolled from Chongming County, Shanghai, China. Subjects in the symptomatic group underwent both OCTU and gastroscopic biopsy. OCTU was performed by experienced ultrasonic physicians in a blinded fashion. RESULTS In the symptomatic group, 643 patients were enrolled; diagnoses included low risk diseases gastritis (68.9%), polyps (4.0%) and benign ulcers (8.7%), and high risk diseases intraepithelial neoplasia (1.9%), cancer (15.9%) and other lesions (0.6%). Abnormalities were detected by OCTU in 404 subjects (62.8%). High risk diseases were significantly correlated with objective OCTU parameters, including thickness of stomach wall, loss of stratification and hypoechoic mess. With the cut-off value of thickness being set at 7mm, the sensitivity and specificity of OCTU for detecting high risk diseases were 81.3% and 68.8%, respectively. When cut-off value of risk index based on OCTU parameters was set at 3 points, the sensitivity and specificity were 94.1% and 71.4%, respectively. CONCLUSION OCTU can detect high risk gastric diseases with high sensitivity and specificity providing an initial screening tool for gastric cancer.
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Affiliation(s)
- Li Shen
- Department of Ultrasonography, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine Chongming Branch, Shanghai, China
| | - Chenfei Zhou
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lan Liu
- Department of Ultrasonography, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine Chongming Branch, Shanghai, China
| | - Li Zhang
- Department of Ultrasonography, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine Chongming Branch, Shanghai, China
| | - Dianyuan Lu
- Department of Ultrasonography, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine Chongming Branch, Shanghai, China
| | - Jianrong Cai
- Department of Ultrasonography, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine Chongming Branch, Shanghai, China
| | - Liying Zhao
- Department of Ultrasonography, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine Chongming Branch, Shanghai, China
| | - Rongrong Chu
- Department of Ultrasonography, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine Chongming Branch, Shanghai, China
| | - Junyu Zhou
- Department of Ultrasonography, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine Chongming Branch, Shanghai, China
| | - Jun Zhang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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21
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Li CF, Zheng J, Xue YW. The value of contrast-enhanced computed tomography in predicting gastric cancer recurrence and metastasis. Cancer Biomark 2017; 19:327-333. [PMID: 28482620 DOI: 10.3233/cbm-160528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Chun-Feng Li
- A Gastrointestinal Surgical Ward, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang, China
- A Gastrointestinal Surgical Ward, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang, China
| | - Jian Zheng
- A Gastrointestinal Surgical Ward, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang, China
- A Gastrointestinal Surgical Ward, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang, China
| | - Ying-Wei Xue
- Department of Diagnostic Radiology, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang, China
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22
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Nie RC, Yuan SQ, Chen XJ, Chen S, Xu LP, Chen YM, Zhu BY, Sun XW, Zhou ZW, Chen YB. Endoscopic ultrasonography compared with multidetector computed tomography for the preoperative staging of gastric cancer: a meta-analysis. World J Surg Oncol 2017; 15:113. [PMID: 28577563 PMCID: PMC5457601 DOI: 10.1186/s12957-017-1176-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 05/22/2017] [Indexed: 02/07/2023] Open
Abstract
Background The current study sought to perform a meta-analysis to compare the preoperative staging of endoscopic ultrasonography (EUS) and multidetector computed tomography (MDCT) in gastric carcinoma. Methods Articles published between January 1, 2000, and April 1, 2016, that compared EUS with MDCT were included, and data were presented as 2 × 2 tables. The sensitivities, specificities and summary receiver operating characteristic (ROC) curves for T and N staging were calculated using a bivariate mixed effects model. Data were weighted by generic variance and then pooled by random-effects modeling. Results Eight studies comprising 1736 patients were included in this meta-analysis. For T1 staging, the sensitivity value for EUS (82%) was significantly higher than that for MDCT (41%) (relative risk (RR): 2.06, 95% confidence interval (CI) 1.07–3.94; P = 0.030). For lymph node involvement, the sensitivity value for EUS (91%) was also significantly higher than that for MDCT (77%) (RR 1.14, 95% CI 1.05–1.23; P = 0.001). However, the specificity values of both EUS and MDCT were quite low, at 49 and 63%, respectively. No significant differences in T2–4 staging between EUS and MDCT were noted. Conclusion This meta-analysis indicates that EUS may be superior to MDCT in preoperative T1 and N staging. Additionally, the low specificity values of EUS and MDCT for N staging merits attention.
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Affiliation(s)
- Run-Cong Nie
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China
| | - Shu-Qiang Yuan
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China
| | - Xiao-Jiang Chen
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China
| | - Shi Chen
- Department of Gastric Surgery, The 6th Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li-Pu Xu
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China
| | - Yong-Ming Chen
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China
| | - Bao-Yan Zhu
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China
| | - Xiao-Wei Sun
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China
| | - Zhi-Wei Zhou
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China
| | - Ying-Bo Chen
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 E Dongfeng Road, Guangzhou, Guangdong, 510060, China.
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Zheng XZ, Zhang LJ, Wu XP, Lu WM, Wu J, Tan XY. Oral Contrast-Enhanced Gastric Ultrasonography in the Assessment of Gastric Lesions: A Large-Scale Multicenter Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:37-47. [PMID: 27943376 DOI: 10.7863/ultra.16.01053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/05/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the diagnostic efficiency of oral contrast-enhanced gastric ultrasonography in the evaluation of gastric lesions, based on large-scale multicenter study. METHODS The study enrolled 383,945 patients with suspect gastric lesions who underwent complete oral contrast-enhanced gastric ultrasonography and endoscopic evaluation. Two operators, unaware of the results of other diagnostic procedures, performed each examination independently. The accuracies of conventional ultrasonography, oral contrast-enhanced gastric ultrasonography, and upper gastrointestinal endoscopy were determined. RESULTS After oral contrast, the anatomy of the stomach and morphologic features of gastric lesions were clearly visualized. The sensitivities, specificities, positive predictive values, negative predictive values and accuracies of oral contrast-enhanced ultrasonography in detecting the sites, sizes, numbers, and the extent of gastric lesions,were similar to those of upper gastrointestinal endoscopy (P > .05) and far greater than those of conventional ultrasonography (P < .01). Moreover, oral contrast-enhanced ultrasonography was far better than upper gastrointestinal endoscopy (P < .01) and was better than conventional ultrasonography (P < .05) in detecting the submucosal abnormalities (<5mm) and the adjacent structures abnormalities identified in surgical pathology. However, oral contrast-enhanced ultrasonography was a bit poorer than upper gastrointestinal endoscopy (P < .05) and far better than conventional ultrasonography (P < .01) in detecting the minor mucosal abnormalities (<5mm). CONCLUSION Oral contrast-enhanced gastric ultrasonography is superior to conventional gastric ultrasonography in defining the anatomic location and extension of gastric lesions. Its diagnostic performance is not worse than upper gastrointestinal endoscopy and it can be used as a useful supplement to upper gastrointestinal endoscopy.
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Affiliation(s)
- Xiao-Zhi Zheng
- Department of Ultrasound, The First People's Hospital of Yancheng, Yancheng, P.R. China
- Department of Ultrasound, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, P.R. China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, P.R. China
| | - Li-Juan Zhang
- Department of Ultrasound, Pukou Hospital (The Fourth Affiliated Hospital with Nanjing Medical University), Nanjing, P.R. China
| | - Xin-Ping Wu
- Department of Ultrasound, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, P.R. China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, P.R. China
| | - Wen-Ming Lu
- Department of Ultrasound, The First People's Hospital of Huzhou, Huzhou, P.R. China
| | - Jing Wu
- Department of Ultrasound, The First People's Hospital of Yancheng, Yancheng, P.R. China
| | - Xu-Yan Tan
- Department of Ultrasound, Jiangsu Province Tumor Hospital, Nanjing, P.R. China
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