Prospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2024; 30(23): 3005-3015
Published online Jun 21, 2024. doi: 10.3748/wjg.v30.i23.3005
Double contrast-enhanced ultrasonography improves diagnostic accuracy of T staging compared with multi-detector computed tomography in gastric cancer patients
Yan-Fen Xu, Hui-Yun Ma, Gui-Ling Huang, Yu-Ting Zhang, Xue-Yan Wang, Ming-Jie Wei, Xiao-Qing Pei
Yan-Fen Xu, Gui-Ling Huang, Yu-Ting Zhang, Xue-Yan Wang, 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
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
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
Co-first authors: Yan-Fen Xu and Hui-Yun Ma.
Author contributions: Xu YF and Ma HY contributed equally to the manuscript; Xu YF, Ma HY, Huang GL, Zhang YT, Wang XY, Wei MJ, and Pei XQ designed the research study; Xu YF, Ma HY, Huang GL, and Zhang YT performed the research; Xu YF and Ma HY analyzed the data and wrote the manuscript; and all authors have read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Sun Yat-sen University Cancer Center (Approval No. B2023-219-03).
Clinical trial registration statement: This study is registered at Chinese Clinical Trial Registry (www.chictr.org.cn). The registration identification number is ChiCTR2400083433.
Informed consent statement: Informed consent was obtained from all the patients.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
Data sharing statement: The datasets generated and/or analysed during the current study are not publicly available due to patient privacy and copyright issues but are available from the corresponding author upon reasonable request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Qing Pei, MD, PhD, Doctor, Professor, 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, No. 651 Dongfeng Road East, Guangzhou 510060, Guangdong Province, China. peixq@sysucc.org.cn
Received: December 30, 2023
Revised: April 24, 2024
Accepted: May 13, 2024
Published online: June 21, 2024
Processing time: 173 Days and 15.6 Hours
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.

Keywords: Double contrast-enhanced ultrasonography; Multi-detector computed tomography; Gastric cancer; T staging

Core Tip: This current prospective study identified double contrast-enhanced ultrasonography (DCEUS) findings in preoperative T staging, developed DCEUS criteria based on the 5-layer gastric wall structure and perfusion characteristics of CEUS, and evaluated the diagnostic performance of DCEUS in gastric cancer (GC) T staging using DCEUS criteria, a method that may overcome limitations by detailing hemodynamic changes of GCs. DCEUS showed superior performance in GC T staging to multi-detector computed tomography and constitutes a promising imaging modality for preoperative evaluation of GC to aid individualized treatment decision-making.