Presentations World Congress of Gastroenterology

Staging of Gastric Cancer with Laparoscopic Ultrasound (LUS)

J. Durup, MB.Mortensen, T.Pless, HO Nielsen, C. Hovendal. Dept of Surgical Gastroenterology, Odense University Hospital, Denmark

Background: Accurate TNM staging and assessment of resectability is important to design the correct therapy for patients with Gastric Cancer (GC).

LUS is not routinely used for this purpose, but is well known to add important information concerning metastases. But what is the precise information we gain from the laparoscopic ultrasound examination?

The purpose of this study was to evaluate LUS concerning TNM stage and assessment of resectability in a consecutive group of patients with GC.

Material: Eighty-three patients were admitted with GC in a two-year period. 40 patients were excluded. All patients went through abdominal ultrasound, CT scan, Endoscopic ultrasound, and blinded; Laparoscopic Ultrasound. The final answer for LUS was achieved by histopathological examination of the resected specimen or biopsies, or by the answer from explorative laparotomy.

Results:

Accuracy in T staging with LUS, Laparoscopy (LAP) and LAP+LUS: 0.81, 0.17 and 0.81.

Accuracy in N-staging with, LUS, LAP and LAP+LUS: 0.67, 0.00 and 0.67.

Accuracy in M-staging with LUS, LAP and LAP+LUS: 0.88, 0.95 and 0.98.

Accuracy in TNM-staging with LUS, LAP and LAP+LUS: 0.59, 0.29 and 0.64.

Accuracy in assessment of resectability with LUS, LAP and LAP+LUS was 0.80, 0.75 and 0.86 respectively

Conclusion: Laparoscopy without Laparoscopic Ultrasound is inaccurate in T and N staging of gastric cancer, but an accurate T, N and M staging and assessment of resectability can be achieved by adding LUS to laparoscopy.

Laparoscopic Ultrasound (LUS) guided biopsy in patients with upper GI cancer.

J. Durup, MB.Mortensen, T.Pless, HO Nielsen, C. Hovendal. Dept of Surgical Gastroenterology, Odense University Hospital, Denmark.

LUS has become an important modality in staging of upper GI cancer. However, cytological or histological confirmation is often necessary before a correct treatment decision can be made. Real time LUS guided biopsy is now possible, and preliminary results using this technique is reported.

Equipment: A new laparoscopic ultrasound probe with a built-in biopsy guidance facility was used (B-K Medical 8566). The ultrasound probe is equipped with a curved array transducer and has a detachable biopsy device with a needle guide. Needles for aspiration cytology (22G) and for tru-cut biopsies (19G) are available.

Material: Twenty patients with upper GI tract tumors were biopted. Forty-four biopsies were performed. Tru-cut biopsies were performed in 41 cases and fine-needle aspiration in 3 cases.

Results: In 90% of the cases the needle monitoring and penetration into the target tissue were good or acceptable. The material obtained by LUS guided biopsy was sufficient for analysis in 13 patients (65%) and insufficient in seven (35%). In 19/20 patients (95%) pathology and /or surgery confirmed that the lesion which were biopted in fact were the expected target. Complications were seen in three cases; all of them being minor and without any clinical importance. The procedure lasted 16.3 minutes (range 10-20 minutes)

Conclusion: Real time laparoscopic ultrasound guided biopsy has become possible using a dedicated biopsy system. Larger studies are needed to evaluate the clinical impact of this new technique.