The New American Joint Committee on Cancer T staging system for stomach: increased complexity without clear improvement in predictive accuracy for endoscopic ultrasound
Abstract Background The efficacy of endoscopic ultrasound (EUS) for determining the T category of gastric cancer is variable. The aim of this study was to evaluate the superiority of EUS by using the 6th edition American Joint Committee on Cancer (AJCC) staging system for stomach cancer compared to...
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BMC
2021-06-01
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| Series: | BMC Gastroenterology |
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| Online Access: | https://doi.org/10.1186/s12876-020-01558-8 |
| _version_ | 1819088894442864640 |
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| author | Chaoqun Han Tao Xu Qin Zhang Jun Liu Zhen Ding Xiaohua Hou |
| author_facet | Chaoqun Han Tao Xu Qin Zhang Jun Liu Zhen Ding Xiaohua Hou |
| author_sort | Chaoqun Han |
| collection | DOAJ |
| description | Abstract Background The efficacy of endoscopic ultrasound (EUS) for determining the T category of gastric cancer is variable. The aim of this study was to evaluate the superiority of EUS by using the 6th edition American Joint Committee on Cancer (AJCC) staging system for stomach cancer compared to the new 7th/8th edition. Methods A retrospective analysis of clinical and EUS imaging features of 348 gastric carcinoma patients who underwent radical resection were retrospectively analyzed. Differences between the 6th and 7th/8th edition T staging systems for preoperative EUS evaluation were compared. Results The accuracy of EUS T staging was 72.4% for the 7th/8th edition and 78.4% for the 6th edition. T3 stage accuracy was significantly worse when the T3 group status was changed. The tumor location, echoendoscope type, and histological type were associated with inaccuracy. We further analyzed the EUS image features for each tumor T stage and found that an indistinctly visible muscularis propria (MP) or with obvious thickening was considered an indicator of lesions involved in the MP with a sensitivity of 81.3%; an MP completely disappeared and accompanied with a serosal layer intact may be a marker that the lesion invaded to the subserosa. We also found that irregularities in the outer edge of the gastric wall were markers of gastric serosal layer penetration with a positive predictive value of 92.2%. Conclusions The increased complexity of the 7th/8th edition T staging system is accompanied by worsening of the predictive accuracy for EUS as compared to the 6th edition. Furthermore, the tumor location, echoendoscope type, histological type, and EUS image features for each tumor T stage should warrant attention. |
| first_indexed | 2024-12-21T21:59:17Z |
| format | Article |
| id | doaj.art-7238a9ed87c842459a25a04eea9cd027 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-21T21:59:17Z |
| publishDate | 2021-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-7238a9ed87c842459a25a04eea9cd0272022-12-21T18:48:53ZengBMCBMC Gastroenterology1471-230X2021-06-012111910.1186/s12876-020-01558-8The New American Joint Committee on Cancer T staging system for stomach: increased complexity without clear improvement in predictive accuracy for endoscopic ultrasoundChaoqun Han0Tao Xu1Qin Zhang2Jun Liu3Zhen Ding4Xiaohua Hou5Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDivision of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDivision of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDivision of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDivision of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyAbstract Background The efficacy of endoscopic ultrasound (EUS) for determining the T category of gastric cancer is variable. The aim of this study was to evaluate the superiority of EUS by using the 6th edition American Joint Committee on Cancer (AJCC) staging system for stomach cancer compared to the new 7th/8th edition. Methods A retrospective analysis of clinical and EUS imaging features of 348 gastric carcinoma patients who underwent radical resection were retrospectively analyzed. Differences between the 6th and 7th/8th edition T staging systems for preoperative EUS evaluation were compared. Results The accuracy of EUS T staging was 72.4% for the 7th/8th edition and 78.4% for the 6th edition. T3 stage accuracy was significantly worse when the T3 group status was changed. The tumor location, echoendoscope type, and histological type were associated with inaccuracy. We further analyzed the EUS image features for each tumor T stage and found that an indistinctly visible muscularis propria (MP) or with obvious thickening was considered an indicator of lesions involved in the MP with a sensitivity of 81.3%; an MP completely disappeared and accompanied with a serosal layer intact may be a marker that the lesion invaded to the subserosa. We also found that irregularities in the outer edge of the gastric wall were markers of gastric serosal layer penetration with a positive predictive value of 92.2%. Conclusions The increased complexity of the 7th/8th edition T staging system is accompanied by worsening of the predictive accuracy for EUS as compared to the 6th edition. Furthermore, the tumor location, echoendoscope type, histological type, and EUS image features for each tumor T stage should warrant attention.https://doi.org/10.1186/s12876-020-01558-8Endoscopic ultrasoundGastric cancerAmerican Joint Committee on CancerStagingAccuracy |
| spellingShingle | Chaoqun Han Tao Xu Qin Zhang Jun Liu Zhen Ding Xiaohua Hou The New American Joint Committee on Cancer T staging system for stomach: increased complexity without clear improvement in predictive accuracy for endoscopic ultrasound BMC Gastroenterology Endoscopic ultrasound Gastric cancer American Joint Committee on Cancer Staging Accuracy |
| title | The New American Joint Committee on Cancer T staging system for stomach: increased complexity without clear improvement in predictive accuracy for endoscopic ultrasound |
| title_full | The New American Joint Committee on Cancer T staging system for stomach: increased complexity without clear improvement in predictive accuracy for endoscopic ultrasound |
| title_fullStr | The New American Joint Committee on Cancer T staging system for stomach: increased complexity without clear improvement in predictive accuracy for endoscopic ultrasound |
| title_full_unstemmed | The New American Joint Committee on Cancer T staging system for stomach: increased complexity without clear improvement in predictive accuracy for endoscopic ultrasound |
| title_short | The New American Joint Committee on Cancer T staging system for stomach: increased complexity without clear improvement in predictive accuracy for endoscopic ultrasound |
| title_sort | new american joint committee on cancer t staging system for stomach increased complexity without clear improvement in predictive accuracy for endoscopic ultrasound |
| topic | Endoscopic ultrasound Gastric cancer American Joint Committee on Cancer Staging Accuracy |
| url | https://doi.org/10.1186/s12876-020-01558-8 |
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