Prospective comparison of laparoscopy, ultrasonography and computed tomography in the staging of gastric cancer.

A total of 103 consecutive patients with gastric adenocarcinoma was assessed for intra-abdominal spread of malignancy using ultrasonography, computed tomography (CT) and laparoscopy under general anaesthesia. Histologically proven metastases were to the liver in 27 patients, lymph nodes in 49 and directly to peritoneum in 13. All modalities showed a high specificity (92-100 per cent) for each type of metastasis. Laparoscopy was more sensitive in detecting hepatic, nodal and peritoneal metastases; the relative performance of laparoscopy was best with regard to hepatic metastases. Ultrasonography and CT were particularly poor at detecting nodal and peritoneal metastases. There was no significant morbidity and no mortality associated with laparoscopy, which was more accurate in preoperative staging of gastric cancer than ultrasonography or CT.