Diagnostic performance of contrast-enhanced transabdominal ultrasound with gastric filling in preoperative T-staging of advanced gastric cancer: a retrospective study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Accurate preoperative assessment of local invasion remains important in gastric cancer, particularly in distinguishing T3/T4 disease that may alter operative planning and perioperative treatment. This study evaluated the diagnostic performance of transabdominal contrast-enhanced ultrasound (CEUS) with gastric filling for preoperative T staging in surgically treated advanced gastric cancer. Methods: This retrospective single-center diagnostic accuracy study included consecutive patients who underwent CEUS with gastric filling (CEUS-GF) within 2 weeks before gastrectomy between January 2023 and December 2025 and had postoperative pathologic T2-T4 disease. Two blinded sonographers independently assigned clinical T (cT) stage; discrepant cases were adjudicated for the final imaging classification. Exact agreement, Cohen's κ, stage-specific performance, binary discrimination, receiver operating characteristic (ROC) analysis, and subgroup accuracy were assessed against postoperative pathology as the reference standard. Results: In this cohort of 180 patients, exact agreement between final CEUS stage and pathology was 84.4%, with substantial agreement after grouping T4a and T4b as T4 (κ=0.781); initial inter-reader agreement was κ=0.822. For identifying pathologic T4 disease, sensitivity was 95.8%, specificity was 94.4%, positive predictive value was 92.0%, negative predictive value was 97.1%, and accuracy was 95.0%. Stage-specific accuracy was 90.0% for T2, 87.2% for T3, and 95.0% for grouped T4 disease. The area under the ROC curve (AUC) was 0.876 for discrimination of pathologic T stage (pT) 3-or-higher disease from pT2 and 0.966 for discrimination of pT4 from non-T4 disease. Exact T4a/T4b subclassification accuracy was 91.7%. In descriptive subgroup analyses, accuracy was numerically highest for gastric body lesions (91.8%). Conclusions: In this surgically treated single-center T2-T4 cohort, CEUS-GF showed good agreement with pathology and high discrimination for pathologic T4 disease. CEUS-GF may be a useful adjunct for assessing suspected serosal or extragastric extension before surgery; prospective multicenter paired-comparison studies are needed to define its incremental value beyond computed tomography (CT)/endoscopic ultrasound (EUS).
Institution: Shengli Oilfield Central Hospital
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7224106595