Double contrast-enhanced ultrasonography improves diagnostic accuracy of T staging compared with multi-detector computed tomography in gastric cancer patients

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.

Value of transrectal ultrasonography for tumor node metastasis restaging in patients with locally advanced rectal cancer after neoadjuvant chemoradiotherapy

Objective:To explore the value of transrectal ultrasonography(TRUS)for tumor node metastasis(TNM)restaging for patients with locally advanced rectal cancer after neoadjuvant chemoradiotherapy(neo-CRT).Methods:One hundred and forty-nine patients with locally advanced rectal cancer(cT3-4 or cN+)who underwent TRUS after neo-CRT were retrospectively reviewed.TRUS restaging was compared with the results of post-operative pathological TNM findings.Results:After neo-CRT,the accuracy of TRUS for diagnosing T-staging was 30.9%,with 60.4%(90/149)of cases overestimated.The sensitivity of TRUS for T-staging(T0 vs T1 vs T2 vs T3 vs T4)were 16.3%,0%,12.5%,42.6%and 75.0%,respectively.The accuracy of TRUS for diagnosing N-staging after neo-CRT was 81.2%,with the sensitivities of N0 and N+were 93.3%and 31.0%,respectively.After neo-CRT,27.5%(41/149)of patients achieved pathologically complete response(pCR).The sensitivity,specificity,positive predictive value and negative predictive values of TRUS for pCR were 17.1%,99.1%,87.5%and 75.9%,respectively.Conclusions:TRUS can be applied for restaging T4 and N0,and has potential for screening out patients with pCR in those with locally advanced rectal cancer after neo-CRT,although some stages are overestimated for T-staging and its sensitivity for predicting pCR is low.