Yuya Sato1, Junki Mizusawa2, Hiroshi Katayama2, Kenichi Nakamura2, Takeo Fukagawa3, Hitoshi Katai3, Shusuke Haruta4, Makoto Yamada5, Masakazu Takagi6, Shigeyuki Tamura7, Tsunehiro Yoshimura8, Masanori Tokunaga9, Takaki Yoshikawa3, Narikazu Boku10, Takeshi Sano11, Mitsuru Sasako12, Masanori Terashima13. 1. JCOG Data Center/ Operations Office, National Cancer Center, Japan. Electronic address: yusatoh.srg1@tmd.ac.jp. 2. JCOG Data Center/ Operations Office, National Cancer Center, Japan. 3. Gastric Surgery Division, National Cancer Center Hospital, Japan. 4. Department of Gastroenterological Surgery, Toranomon Hospital, Japan. 5. Department of Surgery, Gifu Municipal Hospital, Japan. 6. Department of Gastroenterological Surgery, Shizuoka General Hospital, Japan. 7. Department of Surgery, Kansai Rosai Hospital, Japan. 8. Department of Digestive Surgery, Tenri Hospital, Japan. 9. Department of Gastric Surgery, Tokyo Medical and Dental University, Japan. 10. Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Japan. 11. Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan. 12. Department of Surgery, Yodogawa Chrisitan Hospital, Japan. 13. Department of Gastric Surgery, Shizuoka Cancer Center, Japan.
Abstract
BACKGROUND: Neoadjuvant chemotherapy (NAC) is increasingly used for resectable locally advanced gastric cancer (LAGC). JCOG1302A investigated the diagnostic criteria of LAGC patients with cT3-4/N1-3 to minimize contamination of pathological stage I as a candidate for NAC. In JCOG1302A, 77.2% of cT3-4 tumors diagnosed via a combination of endoscopy and computed tomography (CT) were pT3-4. However, the role of endoscopic ultrasonography (EUS) and additional diagnostic procedures/modalities remains unclear. Here, we investigated whether EUS, thin-slice CT, and foaming agent (FA) in CT contribute to accurate diagnosis of AGC invasion depth. METHODS: Using JCOG1302A study data, we compared positive predictive value (PPV), negative predictive value (NPV), and kappa index (KI) between conventional and additional diagnostic procedures to identify pT3-4: conventional endoscopy (CE) with versus without EUS, 1-mm versus 5-mm CT slice, and CT with versus without FA. RESULTS: We analyzed 1232 patients' data. PPV, NPV, and KI were 79.2%/73.7%, 59.2%/58.8%, and 0.38/0.39 (CE alone/CE with EUS), 77.8%/75.5%, 62.9%/71.2%, and 0.38/0.39 (5-mm CT/1-mm CT), and 78.6%/75.1%, 60.9%/69.7%, and 0.38/0.40 (CT without FA/CT with FA), respectively. Overall, there were no remarkable differences in any comparison. More specifically, PPV and KI were slightly higher with CE alone rather than CE with EUS. Although NPV was higher for 1-mm CT and CT with FA, PPV was rather higher for 5-mm CT and CT without FA. CONCLUSION: Additional diagnostic procedures/modalities, like EUS, 1-mm slice CT, or FA in CT may not improve the diagnostic accuracy of invasion depth in resectable LAGC.
BACKGROUND: Neoadjuvant chemotherapy (NAC) is increasingly used for resectable locally advanced gastric cancer (LAGC). JCOG1302A investigated the diagnostic criteria of LAGC patients with cT3-4/N1-3 to minimize contamination of pathological stage I as a candidate for NAC. In JCOG1302A, 77.2% of cT3-4 tumors diagnosed via a combination of endoscopy and computed tomography (CT) were pT3-4. However, the role of endoscopic ultrasonography (EUS) and additional diagnostic procedures/modalities remains unclear. Here, we investigated whether EUS, thin-slice CT, and foaming agent (FA) in CT contribute to accurate diagnosis of AGC invasion depth. METHODS: Using JCOG1302A study data, we compared positive predictive value (PPV), negative predictive value (NPV), and kappa index (KI) between conventional and additional diagnostic procedures to identify pT3-4: conventional endoscopy (CE) with versus without EUS, 1-mm versus 5-mm CT slice, and CT with versus without FA. RESULTS: We analyzed 1232 patients' data. PPV, NPV, and KI were 79.2%/73.7%, 59.2%/58.8%, and 0.38/0.39 (CE alone/CE with EUS), 77.8%/75.5%, 62.9%/71.2%, and 0.38/0.39 (5-mm CT/1-mm CT), and 78.6%/75.1%, 60.9%/69.7%, and 0.38/0.40 (CT without FA/CT with FA), respectively. Overall, there were no remarkable differences in any comparison. More specifically, PPV and KI were slightly higher with CE alone rather than CE with EUS. Although NPV was higher for 1-mm CT and CT with FA, PPV was rather higher for 5-mm CT and CT without FA. CONCLUSION: Additional diagnostic procedures/modalities, like EUS, 1-mm slice CT, or FA in CT may not improve the diagnostic accuracy of invasion depth in resectable LAGC.