Gastric cancer staging
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Gastric Cancer Staging: Current Approaches and Diagnostic Tools
Introduction to Gastric Cancer Staging
Gastric cancer staging is a critical process in determining the appropriate treatment strategy and predicting patient outcomes. Accurate staging helps in assessing the extent of the disease, which is essential for planning surgical interventions and other therapies. This article synthesizes the latest research on various staging methods and their effectiveness in gastric cancer.
Imaging Techniques for Gastric Cancer Staging
Computed Tomography (CT) and Endoscopic Ultrasound (EUS)
CT and EUS are commonly used imaging modalities for staging gastric cancer. EUS is particularly effective in local (T) staging, with studies showing it has a diagnostic accuracy ranging from 65% to 92.1% for overall T staging. EUS is superior to multidetector CT (MDCT) in preoperative T1 and N staging, although MDCT is more specific for M staging. However, both methods should be used cautiously for N staging due to insufficient data.
Magnetic Resonance Imaging (MRI)
MRI is another promising tool for local staging, with sensitivity and specificity for assessing serosal involvement comparable to EUS and MDCT. However, fewer studies are available on MRI, making EUS the first-choice imaging modality for preoperative T staging.
Staging Laparoscopy (SL)
Staging laparoscopy is a valuable diagnostic tool, especially for detecting peritoneal metastases. It has shown high accuracy, with an overall sensitivity of 84.6% and specificity of 100%. SL is particularly recommended for patients with locally advanced disease signs, as it provides accurate information about peritoneal dissemination and can be performed safely.
Lymph Node Dissection and Assessment
For curative-intent resection in advanced non-metastatic gastric cancer, a D2 lymph node dissection (LND) is preferred. Adequate staging requires the assessment of at least 16 lymph nodes. This approach ensures a more accurate staging and better patient outcomes.
Multidisciplinary Approach and Surgical Techniques
All patients should be discussed at a multidisciplinary team meeting, and a staging CT of the chest and abdomen should always be performed. Diagnostic laparoscopy is recommended for patients at risk for stage IV disease. Laparoscopic resections should meet the same standards as open resections, and patients should be referred to higher volume centers for better management of potential complications.
New Proposals for TNM Classification
The International Gastric Cancer Association (IGCA) has proposed a new stage grouping for the TNM classification, which better stratifies patient survival, especially among stage III subgroups. This new grouping is based on a large, worldwide data collection and aims to provide more accurate prognostic information.
Conclusion
Accurate staging of gastric cancer is essential for effective treatment planning and improving patient outcomes. EUS remains the preferred method for local staging, while staging laparoscopy is crucial for detecting peritoneal metastases. A multidisciplinary approach and adherence to recommended surgical techniques, including adequate lymph node assessment, are vital for optimal patient care. The proposed new TNM classification by the IGCA offers a promising improvement in staging accuracy and patient stratification.
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