위암의 병기판정에 있어서 위에 물을 채운후 시행하는 복부초음파검사의 의의

Abstract

The accurate prediction of the stage is essential in the treatment of gastric cancer. Recently endoscopic ultrasonography(EUS) is introduced and that was known to be very effective in the assessment of depth of invasion in gastric cancer. Although the endoscopic ultrasono- graphy can be successfully employed for the selective evaluation of regional wall changes, a systematic study of the entire stomach and upper abdominal structures such as liver is not possible. The recent advances of ultrasonographic equipments made it possible to visualize precisely and the transabdominal ultrasound of stomach after fluid ingestion made it also pos- sible to visualize all layers of gastric wall with high degree of image resolution without any difficulty. To assess the accuracy of transabdominal ultrasound of fluid-filled stomach for staging of stomach cancer, we performed ultrasonographic examinations in sixty-two patients with gas- tric cancer immediately after 600cc water ingestion prior to surgery and the image findings were compared with histologic or surgical findings. The overall accuracy for the depth of invasion was 75.8%. The depth of invasion was overes- timated in 5 cases(8.1%) and underestimated in 10 cases(16.1%). The diagnostic accuracy for the depth of invasion increased with the progression of T stages(Tl, T2, T3 and T4: 33.3%, 68. 8%, 83.3% and 90.0%, respectively). The diagnostic accuracy for the depth of invasion in 39 pa- tients with ulceration was 69.2% and 10 patients without ulceration 80/. There was no statis- tical differences in the accuracy for the depth of invasion according to the location and direc- tion of the lesion. Lymph node metastasis was correctly diagnosed in 42 of 62 cases(67.7%). According to N stage, the accuracy in NO is 94.7%, Nl 58.3% and NZ 52.6%. Distant metastasis was correctly diagnosed in 59 of 62 cases(95.2%). In 3 cases a false-negative diagnosis was made who had tiny tumor nodules at the surface of right hepatic dome or mesentery. The ac- curacy for the overall stage was 55.1%. In conclusion, transabdominal ultrasonography of fluid-filled stomach is considered to be very simple and useful method in the staging of gastric cancer such as endoscopic ultrasono- graphy.