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Min L, Jin Y, Chen J, Zhu H, Liang C, Lv L, Wang Y, Liu D, Zhou Y, Chu Y, Tan Y. Endoscopic ultrasound-guided bite-on-bite biopsy and endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of gastric tumors with negative malignant endoscopy biopsies: a retrospective cohort study. MINIM INVASIV THER 2024:1-11. [PMID: 39046283 DOI: 10.1080/13645706.2024.2381103] [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: 03/21/2024] [Accepted: 06/09/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Specific types of gastric tumors, including gastric linitis plastica and lymphoma, may cause extensive deep-layer infiltration, impeding an accurate diagnosis with endoscopic biopsy. This study aims to evaluate the efficacy of endoscopic ultrasound (EUS)-guided bite-on-bite biopsy and EUS-guided fine-needle aspiration (EUS-FNA) in diagnosing gastric malignancies with negative endoscopic biopsies. METHODS We retrospectively analyzed suspicious malignant gastric lesion cases in our hospital from October 2017 to August 2023. Clinical manifestations, radiographical examinations, endoscopic examinations, histopathological results, and therapeutic strategies were recorded and analyzed. RESULTS Forty malignant gastric tumor cases with negative endoscopic biopsies were incorporated into our study. EUS-guided bite-on-bite biopsy was performed in 16 cases exclusively, whereas 17 patients received EUS-FNA exclusively, and seven patients underwent both simultaneously. Among the 23 patients who received the EUS-guided bite-on-bite biopsy, 22 (95.7%) were diagnosed with malignancies. Among the 24 patients who received EUS-FNA, a total of 19 cases with malignancies (79.2%) were confirmed by EUS-FNA (p = 0.11): 13 gastric adenocarcinomas, five metastatic malignancies, and one malignant stromal tumor. No adverse events were observed in any of the cases. CONCLUSIONS EUS-guided bite-on-bite biopsy and EUS-FNA possess their advantages and disadvantages. EUS-guided bite-on-bite biopsy could serve as a reliable diagnostic method for shallow lesions with negative malignant endoscopic biopsies.
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Affiliation(s)
- Liang Min
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Yan Jin
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Jiefei Chen
- Department of Laboratory Medicine, Xiangya School of Medicine, Central South University, Changsha, China
| | - Hongyi Zhu
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Chengbai Liang
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Liang Lv
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Yongjun Wang
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Deliang Liu
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Yuqian Zhou
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Yi Chu
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
| | - Yuyong Tan
- Department of Gastroenterology, Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Digestive Disease, Central South University, Changsha, China
- Clinical Research Center for Digestive Disease in Hunan Province, Changsha, China
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Xu YF, Ma HY, Huang GL, Zhang YT, Wang XY, Wei MJ, Pei XQ. Double contrast-enhanced ultrasonography improves diagnostic accuracy of T staging compared with multi-detector computed tomography in gastric cancer patients. World J Gastroenterol 2024; 30:3005-3015. [PMID: 38946876 PMCID: PMC11212705 DOI: 10.3748/wjg.v30.i23.3005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/24/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Gastric cancer (GC) is the most common malignant tumor and ranks third for cancer-related deaths among the worldwide. The disease poses a serious public health problem in China, ranking fifth for incidence and third for mortality. Knowledge of the invasive depth of the tumor is vital to treatment decisions.
AIM To evaluate the diagnostic performance of double contrast-enhanced ultrasonography (DCEUS) for preoperative T staging in patients with GC by comparing with multi-detector computed tomography (MDCT).
METHODS This single prospective study enrolled patients with GC confirmed by preoperative gastroscopy from July 2021 to March 2023. Patients underwent DCEUS, including ultrasonography (US) and intravenous contrast-enhanced ultrasonography (CEUS), and MDCT examinations for the assessment of preoperative T staging. Features of GC were identified on DCEUS and criteria developed to evaluate T staging according to the 8th edition of AJCC cancer staging manual. The diagnostic performance of DCEUS was evaluated by comparing it with that of MDCT and surgical-pathological findings were considered as the gold standard.
RESULTS A total of 229 patients with GC (80 T1, 33 T2, 59 T3 and 57 T4) were included. Overall accuracies were 86.9% for DCEUS and 61.1% for MDCT (P < 0.001). DCEUS was superior to MDCT for T1 (92.5% vs 70.0%, P < 0.001), T2 (72.7% vs 51.5%, P = 0.041), T3 (86.4% vs 45.8%, P < 0.001) and T4 (87.7% vs 70.2%, P = 0.022) staging of GC.
CONCLUSION DCEUS improved the diagnostic accuracy of preoperative T staging in patients with GC compared with MDCT, and constitutes a promising imaging modality for preoperative evaluation of GC to aid individualized treatment decision-making.
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Affiliation(s)
- Yan-Fen Xu
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Hui-Yun Ma
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Gui-Ling Huang
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Yu-Ting Zhang
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Xue-Yan Wang
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Ming-Jie Wei
- Department of Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Xiao-Qing Pei
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
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Liu S, Zhang M, Yang Y, Cai F, Guo F, Dai Z, Cao F, Zhou D, Liang H, Zhang R, Deng J. Establishment and validation of a risk score model based on EUS: assessment of lymph node metastasis in early gastric cancer. Gastrointest Endosc 2024:S0016-5107(24)03162-6. [PMID: 38692516 DOI: 10.1016/j.gie.2024.04.2903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/10/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND AND AIMS Lymph node metastasis significantly affects the prognosis of early gastric cancer patients. EUS plays a crucial role in the preoperative assessment of early gastric cancer. This study evaluated the efficacy of EUS in identifying lymph node metastasis in early gastric cancer patients and developed a risk score model to aid in choosing the best treatment options. METHODS We retrospectively analyzed the effectiveness of EUS for detecting lymph node metastasis in early gastric cancer patients. A risk score model for predicting lymph node metastasis preoperatively was created using independent risk factors identified through binary logistic regression analysis and subsequently validated. Receiver operating characteristic curves were generated for both the development and validation cohorts. RESULTS The overall accuracy of EUS in identifying lymph node metastasis was 85.3%, although its sensitivity (29.2%) and positive predictive value (38.7%) were relatively low. Patients were categorized based on preoperative risk factors for lymph node metastasis, including tumor size of ≥20 mm, lymph nodes of ≥10 mm, body mass index of ≥24 kg/m2, and lymph node metastasis on CT scans. A 7-point risk score model was developed to assess the likelihood of lymph node metastasis. The areas under the receiver operating characteristic curve for the development and validation sets were 0.842 and 0.837, respectively, with sensitivities of 64% and 79%, respectively. CONCLUSIONS We developed a practical risk score model based on preoperative factors to help EUS predict lymph node metastasis in early gastric cancer patients, guiding the selection of optimal treatment approaches for these patients.
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Affiliation(s)
- Siya Liu
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, P. R. China; Key Laboratory of Cancer Prevention and Therapy, Tianjin, P. R. China; Key Laboratory of Digestive Cancer, Tianjin, P. R. China; Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Mengmeng Zhang
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, P. R. China; Key Laboratory of Cancer Prevention and Therapy, Tianjin, P. R. China; Key Laboratory of Digestive Cancer, Tianjin, P. R. China; Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Yang Yang
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, P. R. China; Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China; Department of Anesthesiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Fenglin Cai
- Department of Biochemistry and Molecular Biology, The Province and Ministry Cosponsored Collaborative Innovation Center for Medical Epigenetics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, P. R. China
| | - Feng Guo
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, P. R. China; Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China; Department of Endoscopy Diagnosis and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Zhenbo Dai
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, P. R. China; Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China; Department of Endoscopy Diagnosis and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Fuliang Cao
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, P. R. China; Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China; Department of Endoscopy Diagnosis and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Dejun Zhou
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, P. R. China; Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China; Department of Endoscopy Diagnosis and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Han Liang
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, P. R. China; Key Laboratory of Cancer Prevention and Therapy, Tianjin, P. R. China; Key Laboratory of Digestive Cancer, Tianjin, P. R. China; Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Rupeng Zhang
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, P. R. China; Key Laboratory of Cancer Prevention and Therapy, Tianjin, P. R. China; Key Laboratory of Digestive Cancer, Tianjin, P. R. China; Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Jingyu Deng
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, P. R. China; Key Laboratory of Cancer Prevention and Therapy, Tianjin, P. R. China; Key Laboratory of Digestive Cancer, Tianjin, P. R. China; Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China.
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Aslanian HR, Muniraj T, Nagar A, Parsons D. Endoscopic Ultrasound in Cancer Staging. Gastrointest Endosc Clin N Am 2024; 34:37-49. [PMID: 37973230 DOI: 10.1016/j.giec.2023.09.009] [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] [Indexed: 11/19/2023]
Abstract
The authors review the role of endoscopic ultrasound (EUS) in the staging of cancers throughout the gastrointestinal tract. EUS offers an advantage over cross-sectional imaging in locoregional tumor staging but is less sensitive in identifying distant metastasis. The addition of FNA increases diagnostic accuracy and provides a tissue diagnosis. EUS combined with cross-sectional imaging is important in accurately staging GI tumors and thereby reducing unnecessary procedures and health care costs.
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Affiliation(s)
- Harry R Aslanian
- Department of Medicine, Section Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA.
| | - Thiruvengadam Muniraj
- Department of Medicine, Section Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Anil Nagar
- Department of Medicine, Section Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - David Parsons
- Department of Medicine, Section Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
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Gao Z, Yu Z, Zhang X, Chen C, Pan Z, Chen X, Lin W, Chen J, Zhuge Q, Shen X. Development of a deep learning model for early gastric cancer diagnosis using preoperative computed tomography images. Front Oncol 2023; 13:1265366. [PMID: 37869090 PMCID: PMC10587601 DOI: 10.3389/fonc.2023.1265366] [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: 07/22/2023] [Accepted: 09/15/2023] [Indexed: 10/24/2023] Open
Abstract
Background Gastric cancer is a highly prevalent and fatal disease. Accurate differentiation between early gastric cancer (EGC) and advanced gastric cancer (AGC) is essential for personalized treatment. Currently, the diagnostic accuracy of computerized tomography (CT) for gastric cancer staging is insufficient to meet clinical requirements. Many studies rely on manual marking of lesion areas, which is not suitable for clinical diagnosis. Methods In this study, we retrospectively collected data from 341 patients with gastric cancer at the First Affiliated Hospital of Wenzhou Medical University. The dataset was randomly divided into a training set (n=273) and a validation set (n=68) using an 8:2 ratio. We developed a two-stage deep learning model that enables fully automated EGC screening based on CT images. In the first stage, an unsupervised domain adaptive segmentation model was employed to automatically segment the stomach on unlabeled portal phase CT images. Subsequently, based on the results of the stomach segmentation model, the image was cropped out of the stomach area and scaled to a uniform size, and then the EGC and AGC classification models were built based on these images. The segmentation accuracy of the model was evaluated using the dice index, while the classification performance was assessed using metrics such as the area under the curve (AUC) of the receiver operating characteristic (ROC), accuracy, sensitivity, specificity, and F1 score. Results The segmentation model achieved an average dice accuracy of 0.94 on the hand-segmented validation set. On the training set, the EGC screening model demonstrated an AUC, accuracy, sensitivity, specificity, and F1 score of 0.98, 0.93, 0.92, 0.92, and 0.93, respectively. On the validation set, these metrics were 0.96, 0.92, 0.90, 0.89, and 0.93, respectively. After three rounds of data regrouping, the model consistently achieved an AUC above 0.9 on both the validation set and the validation set. Conclusion The results of this study demonstrate that the proposed method can effectively screen for EGC in portal venous CT images. Furthermore, the model exhibits stability and holds promise for future clinical applications.
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Affiliation(s)
- Zhihong Gao
- Zhejiang Engineering Research Center of Intelligent Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhuo Yu
- School of Information and Safety Engineering, Zhongnan University of Economics and Law, Wuhan, China
| | - Xiang Zhang
- Wenzhou Data Management and Development Group Co., Ltd., Wenzhou, Zhejiang, China
| | - Chun Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhifang Pan
- Zhejiang Engineering Research Center of Intelligent Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaodong Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weihong Lin
- Zhejiang Engineering Research Center of Intelligent Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jun Chen
- Zhejiang Engineering Research Center of Intelligent Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qichuan Zhuge
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xian Shen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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de Nucci G, Gabbani T, Impellizzeri G, Deiana S, Biancheri P, Ottaviani L, Frazzoni L, Mandelli ED, Soriani P, Vecchi M, Manes G, Manno M. Linear EUS Accuracy in Preoperative Staging of Gastric Cancer: A Retrospective Multicenter Study. Diagnostics (Basel) 2023; 13:diagnostics13111842. [PMID: 37296694 DOI: 10.3390/diagnostics13111842] [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: 04/01/2023] [Revised: 04/25/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Preoperative gastric cancer (GC) staging is the most reliable prognostic factor that affects therapeutic strategies. Contrast-enhanced computed tomography (CECT) and radial endoscopic ultrasound (R-EUS) scans are the most commonly used staging tools for GC. The accuracy of linear EUS (L-EUS) in this setting is still controversial. The aim of this retrospective multicenter study was to evaluate the accuracy of L-EUS and CECT in preoperative GC staging, with regards to depth of tumor invasion (T staging) and nodal involvement (N staging). MATERIALS AND METHODS 191 consecutive patients who underwent surgical resection for GC were retrospectively enrolled. Preoperative staging had been performed using both L-EUS and CECT, and the results were compared to postoperative staging by histopathologic analysis of surgical specimens. RESULTS L-EUS diagnostic accuracy for depth of invasion of the GC was 100%, 60%, 74%, and 80% for T1, T2, T3, and T4, respectively. CECT accuracy for T staging was 78%, 55%, 45%, and 10% for T1, T2, T3, and T4, respectively. L-EUS diagnostic accuracy for N staging of GC was 85%, significantly higher than CECT accuracy (61%). CONCLUSIONS Our data suggest that L-EUS has a higher accuracy than CECT in preoperative T and N staging of GC.
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Affiliation(s)
- Germana de Nucci
- Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense, 20094 Garbagnate Milanese, Italy
| | - Tommaso Gabbani
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, 41012 Carpi, Italy
| | - Giovanna Impellizzeri
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, 41012 Carpi, Italy
| | - Simona Deiana
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, 41012 Carpi, Italy
| | - Paolo Biancheri
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, 41012 Carpi, Italy
| | - Laura Ottaviani
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, 41012 Carpi, Italy
| | - Leonardo Frazzoni
- Gastroenterology Unit, Surgical and Medical Sciences Department, Sant'Orsola Malpighi Hospital, 40138 Bologna, Italy
| | - Enzo Domenico Mandelli
- Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense, 20094 Garbagnate Milanese, Italy
| | - Paola Soriani
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, 41012 Carpi, Italy
| | - Maurizio Vecchi
- Gastroenterology Unit, Major Policlinic Hospital, 20122 Milan, Italy
| | - Gianpiero Manes
- Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense, 20094 Garbagnate Milanese, Italy
| | - Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, 41012 Carpi, Italy
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Giandola T, Maino C, Marrapodi G, Ratti M, Ragusi M, Bigiogera V, Talei Franzesi C, Corso R, Ippolito D. Imaging in Gastric Cancer: Current Practice and Future Perspectives. Diagnostics (Basel) 2023; 13:diagnostics13071276. [PMID: 37046494 PMCID: PMC10093088 DOI: 10.3390/diagnostics13071276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/19/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Gastric cancer represents one of the most common oncological causes of death worldwide. In order to treat patients in the best possible way, the staging of gastric cancer should be accurate. In this regard, endoscopy ultrasound (EUS) has been considered the reference standard for tumor (T) and nodal (N) statuses in recent decades. However, thanks to technological improvements, computed tomography (CT) has gained an important role, not only in the assessment of distant metastases (M status) but also in T and N staging. In addition, magnetic resonance imaging (MRI) can contribute to the detection and staging of primary gastric tumors thanks to its excellent soft tissue contrast and multiple imaging sequences without radiation-related risks. In addition, MRI can help with the detection of liver metastases, especially small lesions. Finally, positron emission tomography (PET) is still considered a useful diagnostic tool for the staging of gastric cancer patients, with a focus on nodal metastases and peritoneal carcinomatosis. In addition, it may play a role in the treatment of gastric cancer in the coming years thanks to the introduction of new labeling peptides. This review aims to summarize the most common advantages and pitfalls of EUS, CT, MRI and PET in the TNM staging of gastric cancer patients.
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Wadhwa V, Patel N, Grover D, Ali FS, Thosani N. Interventional gastroenterology in oncology. CA Cancer J Clin 2022; 73:286-319. [PMID: 36495087 DOI: 10.3322/caac.21766] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 12/14/2022] Open
Abstract
Cancer is one of the foremost health problems worldwide and is among the leading causes of death in the United States. Gastrointestinal tract cancers account for almost one third of the cancer-related mortality globally, making it one of the deadliest groups of cancers. Early diagnosis and prompt management are key to preventing cancer-related morbidity and mortality. With advancements in technology and endoscopic techniques, endoscopy has become the core in diagnosis and management of gastrointestinal tract cancers. In this extensive review, the authors discuss the role endoscopy plays in early detection, diagnosis, and management of esophageal, gastric, colorectal, pancreatic, ampullary, biliary tract, and small intestinal cancers.
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Affiliation(s)
- Vaibhav Wadhwa
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Nicole Patel
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Dheera Grover
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Faisal S Ali
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Nirav Thosani
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
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Detection and Characterization of Gastric Cancer Using Cascade Deep Learning Model in Endoscopic Images. Diagnostics (Basel) 2022; 12:diagnostics12081996. [PMID: 36010346 PMCID: PMC9406996 DOI: 10.3390/diagnostics12081996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/31/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022] Open
Abstract
Endoscopy is widely applied in the examination of gastric cancer. However, extensive knowledge and experience are required, owing to the need to examine the lesion while manipulating the endoscope. Various diagnostic support techniques have been reported for this examination. In our previous study, segmentation of invasive areas of gastric cancer was performed directly from endoscopic images and the detection sensitivity per case was 0.98. This method has challenges of false positives and computational costs because segmentation was applied to all healthy images that were captured during the examination. In this study, we propose a cascaded deep learning model to perform categorization of endoscopic images and identification of the invasive region to solve the above challenges. Endoscopic images are first classified as normal, showing early gastric cancer and showing advanced gastric cancer using a convolutional neural network. Segmentation on the extent of gastric cancer invasion is performed for the images classified as showing cancer using two separate U-Net models. In an experiment, 1208 endoscopic images collected from healthy subjects, 533 images collected from patients with early stage gastric cancer, and 637 images from patients with advanced gastric cancer were used for evaluation. The sensitivity and specificity of the proposed approach in the detection of gastric cancer via image classification were 97.0% and 99.4%, respectively. Furthermore, both detection sensitivity and specificity reached 100% in a case-based evaluation. The extent of invasion was also identified at an acceptable level, suggesting that the proposed method may be considered useful for the classification of endoscopic images and identification of the extent of cancer invasion.
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Yan Y, Ma Z, Ji X, Liu J, Ji K, Li S, Wu Q. A potential decision-making algorithm based on endoscopic ultrasound for staging early gastric cancer: a retrospective study. BMC Cancer 2022; 22:761. [PMID: 35831843 PMCID: PMC9281103 DOI: 10.1186/s12885-022-09870-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical staging of gastric cancer (GC) before treatment is essential. Endoscopic ultrasound (EUS) is a recommended staging tool, but its efficacy remains controversial. Our previous prospective study evaluated the potential value of EUS for T staging and presented discrepancies. In this study, we aimed to evaluate the efficacy of EUS in T staging by comparing it with pathological staging. We analyze the factors that can potentially affect accuracy to identify suitable subgroups for EUS staging. METHODS Data from a total of 1763 consecutive patients with GC from January 2015 to December 2017 were analyzed. Results from EUS and pathological T staging were compared. The factors that might affect EUS's accuracy were analyzed. RESULTS The sensitivity, specificity, positive predictive value, and negative predictive value of EUS in patients with early GC were 62.08%, 96.13%, 90.94%, and 80.21%, respectively. The accuracy rates of uT1, uT2-uT4, and uT3-uT4 were 90.94%, 79.02%, and 78.39%, respectively. In multivariate analysis, underestimation was more likely to be observed in patients with tumors located in the middle or upper third of the stomach. Overestimation was more likely to be observed in patients with tumors located in the lower third or those without ulcer. Other factors affecting accuracy included ulcer, differentiation, larger size and undergoing surgery. CONCLUSION Our findings highlight the role of EUS in determining the T staging of GC. Overestimation and underestimation in T-staging were significantly associated with the tumor location in early GC, and a decision-making algorithm was proposed for clinical practice in early cancers based on these findings.
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Affiliation(s)
- Yan Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital & Institute, #52 Fucheng Road Haidian District, Beijing, China
| | - Zhonghua Ma
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital & Institute, #52 Fucheng Road Haidian District, Beijing, China
| | - Xin Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiawei Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ke Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shijie Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital & Institute, #52 Fucheng Road Haidian District, Beijing, China
| | - Qi Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital & Institute, #52 Fucheng Road Haidian District, Beijing, China.
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11
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Sacerdoțianu VM, Ungureanu BS, Iordache S, Cazacu SM, Pirici D, Liliac IM, Burtea DE, Șurlin V, Stroescu C, Gheonea DI, Săftoiu A. Gastric Cancer Angiogenesis Assessment by Dynamic Contrast Harmonic Imaging Endoscopic Ultrasound (CHI-EUS) and Immunohistochemical Analysis-A Feasibility Study. J Pers Med 2022; 12:jpm12071020. [PMID: 35887515 PMCID: PMC9324362 DOI: 10.3390/jpm12071020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 11/16/2022] Open
Abstract
Tumor vascular perfusion pattern in gastric cancer (GC) may be an important prognostic factor with therapeutic implications. Non-invasive methods such as dynamic contrast harmonic imaging endoscopic ultrasound (CHI-EUS) may provide details about tumor perfusion and could also lay out another perspective for angiogenesis assessment. Methods: We included 34 patients with GC, adenocarcinoma, with CHI-EUS examinations that were performed before any treatment decision. We analyzed eighty video sequences with a dedicated software for quantitative analysis of the vascular patterns of specific regions of interest (ROI). As a result, time-intensity curve (TIC) along with other derived parameters were automatically generated: peak enhancement (PE), rise time (RT), time to peak (TTP), wash-in perfusion index (WiPI), ROI area, and others. We performed CD105 and CD31 immunostaining to calculate the vascular diameter (vd) and the microvascular density (MVD), and the results were compared with CHI-EUS parameters. Results: High statistical correlations (p < 0.05) were observed between TIC analysis parameters MVD and vd CD31. Strong correlations were also found between tumor grade and 7 CHI-EUS parameters, p < 0.005. Conclusions: GC angiogenesis assessment by CHI-EUS is feasible and may be considered for future studies based on TIC analysis.
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Affiliation(s)
- Victor Mihai Sacerdoțianu
- Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (S.I.); (S.M.C.); (D.E.B.); (D.I.G.); (A.S.)
| | - Bogdan Silviu Ungureanu
- Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (S.I.); (S.M.C.); (D.E.B.); (D.I.G.); (A.S.)
- Correspondence: ; Tel.: +40-723-178-763
| | - Sevastiţa Iordache
- Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (S.I.); (S.M.C.); (D.E.B.); (D.I.G.); (A.S.)
| | - Sergiu Marian Cazacu
- Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (S.I.); (S.M.C.); (D.E.B.); (D.I.G.); (A.S.)
| | - Daniel Pirici
- Histology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.P.); (I.M.L.)
| | - Ilona Mihaela Liliac
- Histology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (D.P.); (I.M.L.)
| | - Daniela Elena Burtea
- Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (S.I.); (S.M.C.); (D.E.B.); (D.I.G.); (A.S.)
| | - Valeriu Șurlin
- Surgical Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Cezar Stroescu
- Surgical Department II, St. Mary Hospital Bucharest, 011172 București, Romania;
| | - Dan Ionuț Gheonea
- Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (S.I.); (S.M.C.); (D.E.B.); (D.I.G.); (A.S.)
| | - Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (S.I.); (S.M.C.); (D.E.B.); (D.I.G.); (A.S.)
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12
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Kim S, Lee CM, Lee D, Kim JH, Park S, Park SH. Can We Reboot the Role of Intraperitoneal Chemotherapy in the Treatment for Gastric Cancer with Peritoneal Carcinomatosis?: A Retrospective Cohort Study Regarding Minimally Invasive Surgery Conjoined with Intraperitoneal plus Systemic Chemotherapy. Cancers (Basel) 2022; 14:cancers14092334. [PMID: 35565463 PMCID: PMC9103395 DOI: 10.3390/cancers14092334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Peritoneal carcinomatosis (PC) is the most common form of metastasis in gastric cancer (GC) and is related with a poor prognosis. Several treatment modalities including systemic chemotherapy and intraperitoneal chemotherapy have been studied and adopted in treatment of GC patients with PC. Nevertheless, few studies have reported the comparison of the oncologic outcomes between minimally invasive surgery (MIS) with intraperitoneal (IP) chemotherapy and conventional chemotherapy for GC with PC. Methods: We retrospectively reviewed the clinical records of 74 patients who had been diagnosed as GC with PC via either intra-abdominal exploration or abdominopelvic computed tomography between January 2011 and April 2021. After performing propensity score-matching for this retrospective data, we compared the outcomes of 26 patients who underwent MIS followed by IP combined systemic chemotherapy (MIS-IP group) and 26 patients who underwent systemic chemotherapy only (SC-only group). Results: The 2-year progression free survival rate of the MIS-IP group was significantly higher than the SC-only groups (36.4% and 10.5%, respectively; p = 0.010). In multivariate analysis to detect relevant factors on PFS, IP chemotherapy (HR 0.213; p < 0.001), Eastern Cooperative Oncology Group performance status (HR 3.689; p = 0.002), and the amount of ascites (p = 0.011) were significant prognostic factors. Conclusions: This study demonstrated the therapeutic potential of MIS conjoined IP plus systemic chemotherapy for GC patients with PC. MIS conjoined by IP plus systemic chemotherapy can be adopted as a treatment option to reboot the role of IP chemotherapy in GC patients with PC.
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Affiliation(s)
- Sungho Kim
- Department of Surgery, Korea University College of Medicine, Seoul 02841, Korea; (S.K.); (J.-H.K.); (S.P.); (S.-H.P.)
- Department of Surgery, Korea University Ansan Hospital, Ansan 15355, Korea;
| | - Chang-Min Lee
- Department of Surgery, Korea University College of Medicine, Seoul 02841, Korea; (S.K.); (J.-H.K.); (S.P.); (S.-H.P.)
- Department of Surgery, Korea University Ansan Hospital, Ansan 15355, Korea;
- Correspondence: ; Tel.: +82-31-412-4936; Fax: +82-31-413-4829
| | - Danbi Lee
- Department of Surgery, Korea University Ansan Hospital, Ansan 15355, Korea;
| | - Jong-Han Kim
- Department of Surgery, Korea University College of Medicine, Seoul 02841, Korea; (S.K.); (J.-H.K.); (S.P.); (S.-H.P.)
- Department of Surgery, Korea University Guro Hospital, Seoul 08308, Korea
| | - Sungsoo Park
- Department of Surgery, Korea University College of Medicine, Seoul 02841, Korea; (S.K.); (J.-H.K.); (S.P.); (S.-H.P.)
- Department of Surgery, Korea University Anam Hospital, Seoul 02841, Korea
| | - Seong-Heum Park
- Department of Surgery, Korea University College of Medicine, Seoul 02841, Korea; (S.K.); (J.-H.K.); (S.P.); (S.-H.P.)
- Department of Surgery, Korea University Anam Hospital, Seoul 02841, Korea
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13
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The Need for Oral Hygiene Care and Periodontal Status among Hospitalized Gastric Cancer Patients. J Pers Med 2022; 12:jpm12050684. [PMID: 35629110 PMCID: PMC9147473 DOI: 10.3390/jpm12050684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/14/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022] Open
Abstract
Poor oral hygiene leads to the accumulation of dental plaque, thus contributing to the initiation of periodontal disease (PD). Local infections can lead to systemic inflammatory responses, which are essential mediators for the evolution of systemic conditions or cancer tumorigenesis. Often, patients hospitalized with life-threatening and incapacitating disorders such as gastric cancer (GC) might lose interest in keeping their mouth healthy. This study evaluates oral hygiene, periodontal status, and the need for oral care and medical personnel to assist in achieving it in patients hospitalized with GC. This study was carried out on 25 patients with a diagnosis of GC, divided into two groups (GP—14 patients from the Gastroenterology Department, and SP—11 patients from the 1st Department of Surgery). Patients were examined on the day of admission (T0), the day of the medical procedure of endoscopy or surgery (T1), and the day of discharge (T2), recording the number of absent teeth, dental plaque (PI), bleeding on probing (BOP), probing depths (PPD), frequency of toothbrushing, and if the oral hygiene had been self-performed or assisted. Data were subjected to statistical analysis. Our results showed that, in both the GP and the SP group, there were strong and statistically significant correlations between PI and BOP measured on the last day of hospitalization and the period of hospitalization after the medical procedure. Longer hospital stays and the presence of surgery were risk factors for changing toothbrushing frequency. Results also highlight the need for a dentist to diagnose and eventually treat periodontal disease before and after hospitalization, and for a trained nurse who should help take care of the patient’s oral hygiene during hospitalization.
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14
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Zhang X, Yao J, Zhang Y, Huang X, Wang W, Huang H. Updated Evaluation of the Diagnostic Performance of Double Contrast-Enhanced Ultrasonography in the Preoperative T Staging of Gastric Cancer: A Meta-Analysis and Systematic Review. Front Oncol 2022; 12:844390. [PMID: 35356215 PMCID: PMC8959463 DOI: 10.3389/fonc.2022.844390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/08/2022] [Indexed: 01/30/2023] Open
Abstract
Objective This study aimed to systematically evaluate the diagnostic performance of double contrast-enhanced ultrasonography (DCEUS) in the preoperative T staging of gastric cancer (GC). Methods Literature searches for eligible studies were performed using MEDLINE, EMBASE, and Cochrane Library. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the summary receiver operating characteristic curve of DCEUS in the diagnosis of each T stage tumor were calculated. Meta-analyses were performed to obtain the pooled effects of risk ratio (RR) with 95% confidence interval (CI) in the comparison of DCEUS with CT/endoscopic ultrasound (EUS). Results A total of 8 studies including 1,232 patients were identified for inclusion in this meta-analysis. The pooled sensitivity and specificity were 0.78 (95% CI = 0.64–0.88) and 0.98 (95% CI = 0.96–0.99) for T1, 0.81 (95% CI = 0.76–0.86) and 0.96 (95% CI = 0.91–0.98) for T2, 0.88 (95% CI = 0.84–0.91) and 0.85 (95% CI = 0.79–0.90) for T3, and 0.81 (95% CI = 0.69–0.89) and 0.96 (95% CI = 0.93–0.97) for T4. Moreover, DCEUS demonstrated significant superiority to CT in diagnosing T1 (RR = 1.57, 95% CI = 1.20–2.05, p = 0.001) and T2 (RR = 1.41, 95% CI = 1.16–1.71, p = 0.001) and to EUS in diagnosing T3 (RR = 1.24, 95% CI = 1.08–1.42, p = 0.003) and T4 (RR = 1.40, 95% CI = 1.09–1.79, p = 0.008). However, it showed a lower diagnostic accuracy than EUS in T1 tumors (RR = 0.77, 95% CI = 0.62–0.94, p = 0.013). Conclusions DCEUS is a feasible complementary diagnostic tool for clinical T staging of GC. However, it is still far from a definitive conclusion for DCEUS to be proposed for use in routine clinical practice.
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Affiliation(s)
- Xin Zhang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jun Yao
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yu Zhang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xin Huang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Weijun Wang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Hejing Huang
- Department of Ultrasound, Second Affiliated Hospital of Naval Medical University, Shanghai, China
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15
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Chen S, Yu Y, Li T, Ruan W, Wang J, Peng Q, Yu Y, Cao T, Xue W, Liu X, Chen Z, Yu J, Fan JB. A novel DNA methylation signature associated with lymph node metastasis status in early gastric cancer. Clin Epigenetics 2022; 14:18. [PMID: 35115040 PMCID: PMC8811982 DOI: 10.1186/s13148-021-01219-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background Lymph node metastasis (LNM) is an important factor for both treatment and prognosis of early gastric cancer (EGC). Current methods are insufficient to evaluate LNM in EGC due to suboptimal accuracy. Herein, we aim to identify methylation signatures for LNM of EGC, facilitate precision diagnosis, and guide treatment modalities. Methods For marker discovery, genome-wide methylation sequencing was performed in a cohort (marker discovery) using 47 fresh frozen (FF) tissue samples. The identified signatures were subsequently characterized for model development using formalin-fixed paraffin-embedded (FFPE) samples by qPCR assay in a second cohort (model development cohort, n = 302, training set: n = 151, test set: n = 151). The performance of the established model was further validated using FFPE samples in a third cohorts (validation cohort, n = 130) and compared with image-based diagnostics, conventional clinicopathology-based model (conventional model), and current standard workups. Results Fifty LNM-specific methylation signatures were identified de novo and technically validated. A derived 3-marker methylation model for LNM diagnosis was established that achieved an AUC of 0.87 and 0.88, corresponding to the specificity of 80.9% and 85.7%, sensitivity of 80.6% and 78.1%, and accuracy of 80.8% and 83.8% in the test set of model development cohort and validation cohort, respectively. Notably, this methylation model outperformed computed tomography (CT)-based imaging with a superior AUC (0.88 vs. 0.57, p < 0.0001) and individual clinicopathological features in the validation cohort. The model integrated with clinicopathological features demonstrated further enhanced AUCs of 0.89 in the same cohort. The 3-marker methylation model and integrated model reduced 39.4% and 41.5% overtreatment as compared to standard workups, respectively. Conclusions A novel 3-marker methylation model was established and validated that shows diagnostic potential to identify LNM in EGC patients and thus reduce unnecessary gastrectomy in EGC. Supplementary Information The online version contains supplementary material available at 10.1186/s13148-021-01219-x.
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Affiliation(s)
- Shang Chen
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Yanqi Yu
- Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Tao Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Weimei Ruan
- AnchorDx Medical Co., Ltd, Unit 502, No. 8, 3rd Luoxuan Road, International Bio-Island, Guangzhou, 510300, China
| | - Jun Wang
- AnchorDx Medical Co., Ltd, Unit 502, No. 8, 3rd Luoxuan Road, International Bio-Island, Guangzhou, 510300, China
| | - Quanzhou Peng
- Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China.,Department of Pathology, Shenzhen People's Hospital, Shennan Dong Lu, Luohu District, Shenzhen, 518002, China
| | - Yingdian Yu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Tianfeng Cao
- Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Wenyuan Xue
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Xin Liu
- AnchorDx, Inc., 46305 Landing Pkwy, Fremont, CA, 94538, USA
| | - Zhiwei Chen
- AnchorDx Medical Co., Ltd, Unit 502, No. 8, 3rd Luoxuan Road, International Bio-Island, Guangzhou, 510300, China.,AnchorDx, Inc., 46305 Landing Pkwy, Fremont, CA, 94538, USA
| | - Jiang Yu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Jian-Bing Fan
- Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China. .,AnchorDx Medical Co., Ltd, Unit 502, No. 8, 3rd Luoxuan Road, International Bio-Island, Guangzhou, 510300, China.
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16
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Sacerdotianu VM, Ungureanu BS, Iordache S, Turcu-Stiolica A, Facciorusso A, Crinò SF, Saftoiu A. Diagnostic Value of Endoscopic Ultrasound after Neoadjuvant Chemotherapy for Gastric Cancer Restaging: A Meta-Analysis of Diagnostic Test. Diagnostics (Basel) 2022; 12:diagnostics12010100. [PMID: 35054266 PMCID: PMC8775115 DOI: 10.3390/diagnostics12010100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/18/2021] [Accepted: 12/29/2021] [Indexed: 12/04/2022] Open
Abstract
This study aimed to evaluate the diagnostic value of endoscopic ultrasound (EUS) after neoadjuvant therapy (NT) for gastric cancer restaging by meta-analysis. We conducted a systematic search of studies published on PubMed and Web of Science up to 30th August 2021. Assessing the risk of bias in the included studies was done with the QUADAS-2 tool. We used R and Review Manager 5.4.1 for calculations and statistical analysis. To evaluate the diagnostic value of EUS after NT for gastric cancer restaging, we performed a meta-analysis on six studies, with a total of 283 patients, including true-positive, true-negative, false-positive, and false-negative results for T1-T4, N0. EUS as a diagnostic test for GC patients after chemotherapy has a relatively low DOR for the T2 (3.96) and T4 stages (4.79) and a relatively high partial AUC for the T2 (0.85) and T4 (0.71) stages. Our results reveal that the pooled sensitivity for T stages after chemotherapy is rather low (29–56%), except for the T3 stage (71%). A potential limitation of our study was the small number of included studies, but no significant heterogeneity was found between them. Our meta-analysis concludes that EUS is not recommended or is still under debate for GC restaging after NT.
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Affiliation(s)
- Victor Mihai Sacerdotianu
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (B.S.U.); (A.S.)
| | - Bogdan Silviu Ungureanu
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (B.S.U.); (A.S.)
| | - Sevastita Iordache
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (B.S.U.); (A.S.)
- Correspondence: (S.I.); (A.T.-S.)
| | - Adina Turcu-Stiolica
- Pharmacoeconomics Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: (S.I.); (A.T.-S.)
| | - Antonio Facciorusso
- Pancreas Center, Gastroenterology Unit, Department of Medicine, University of Verona, 37134 Verona, Italy; (A.F.); (S.F.C.)
- Department of Medical and Surgical Sciences, Section of Gastroenterology, Ospedali Riuniti di Foggia, 71122 Foggia, Italy
| | - Stefano Francesco Crinò
- Pancreas Center, Gastroenterology Unit, Department of Medicine, University of Verona, 37134 Verona, Italy; (A.F.); (S.F.C.)
| | - Adrian Saftoiu
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.M.S.); (B.S.U.); (A.S.)
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17
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Accuracy of Endoscopic Ultrasonography for Gastric Cancer Staging. CURRENT HEALTH SCIENCES JOURNAL 2022; 48:88-94. [PMID: 35911933 PMCID: PMC9289590 DOI: 10.12865/chsj.48.01.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/12/2022] [Indexed: 12/13/2022]
Abstract
Gastric cancer remains a health problem, with treatment indications varying with the TNM stage. We aimed in this study to highlight the role of EUS in GC patients and also to calculate the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of EUS for T and N staging in our group of patients with this disease. In this study, we included 41 GC patients, and individual values for every T stage accuracy, sensitivity, specificity, PPV, NPV, correct staging, understaging, and overstaging were calculated. EUS overall accuracy for T staging was 58.53%, with the highest sensitivity reached for the T4 stage, 95.83%. For N+vs. N-staging, EUS accuracy was 68.29%, with a sensitivity of 75% and a specificity of 44.44%. The positive and negative predicted values for the presence or absence of nodal disease were 82.75%, respectively 33.33%. In conclusion, this study confirmed the importance of EUS for the assessment of GC T and N stage and highlighted the role of this tool in the detection of liver micrometastasis unrevealed by other imaging techniques like abdominal ultrasound or MSCT.
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18
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Degiuli M, Reddavid R, Tomatis M, Ponti A, Morino M, Sasako M. D2 dissection improves disease-specific survival in advanced gastric cancer patients: 15-year follow-up results of the Italian Gastric Cancer Study Group D1 versus D2 randomised controlled trial. Eur J Cancer 2021; 150:10-22. [PMID: 33887514 DOI: 10.1016/j.ejca.2021.03.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The extended lymphadenectomy (D2) was recently introduced in several guidelines as the optimal treatment for gastric cancer, based only on the 15-year follow-up results of the Dutch randomised trial, while the British Medical Research Council (MRC) study failed to demonstrate a survival benefit over the more limited D1 dissection. The Italian Gastric Cancer Study Group randomised controlled trial (RCT) was also undertaken to compare D1 versus D2 gastrectomy, and a tendency to improve survival in patients with advanced resectable disease (pT > 1N+) was documented despite negative results in the entire patient population. Now we present the 15-year follow-up results of survival and gastric cancer-related mortality. METHODS Between June 1998 and December 2006, eligible patients with gastric cancer who signed the informed consent were randomised at 5 centres to either D1 or D2 gastrectomy. Intraoperative randomisation was implemented centrally by phone call. Primary outcome was overall survival (OS); secondary end-points were disease-specific survival, postoperative morbidity and mortality. Analyses were by intention to treat. Strict quality control measures for surgery, lymph node removal, pathology and patient follow-up were implemented and monitored. Registration number: ISRCTN11154654 (http://www.controlled-trials.com). FINDINGS A total of 267 eligible patients were assigned to either D1 (133 patients) or D2 (134) procedure. Median follow-up time was 16.76 years. Analyses were done both in overall patient population and in pT > 1N+. One hundred patients (38.5) were alive without recurrence. OS and disease-specific survival (DSS) were very high in both arms. In overall population, they were not different between D1 and D2 arm (51.3% vs. 46.8% and 65% vs. 67% respectively, p = 0.31 and p = 0.94). DSS was significantly higher after D2 in pT > 1N+ patients (29.4% vs. 51.4%, p = 0.035). OS and DSS were better after D1 in patients older than 70 years (p = 0.003 and p = 0.006). DSS was higher after D1 also in early stages (p = 0.01). INTERPRETATION After 15-year follow up, despite no relevant difference in overall population, DSS and gastric cancer-related mortality of patients with advanced disease and lymph node metastases are improved by D2 procedure. Further data available from this trial suggest that D1 procedure should be preferably used in older patients and in early disease. As accurate detection of advanced diseases can be currently provided by adequate preoperative workup in referral centres, D2 procedure should be recommended in these cases. FUNDING Piedmont Regional fund for Finalized Healthy Research Project, Application 2003 for data collection.
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Affiliation(s)
- M Degiuli
- University of Turin, Department of Oncology, San Luigi University Hospital, Surgical Oncology and Digestive Surgery Unit, Regione Gonzole 10, Orbassano, Turin, 10043, Italy.
| | - R Reddavid
- University of Turin, Department of Oncology, San Luigi University Hospital, Surgical Oncology and Digestive Surgery Unit, Regione Gonzole 10, Orbassano, Turin, 10043, Italy
| | - M Tomatis
- University of Turin, Department of Oncology, San Luigi University Hospital, Surgical Oncology and Digestive Surgery Unit, Regione Gonzole 10, Orbassano, Turin, 10043, Italy
| | - A Ponti
- CPO Piemonte, AOU Città Della Salute e della Scienza, Torino, Italy
| | - M Morino
- University of Turin, Department of Surgical Sciences, Turin, Italy
| | - M Sasako
- Department of Surgery, Yodogawa Christian Hospital, Yodogawa, Japan
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