ARTIGO PRIMEIRO

Accuracy of Surgical Diagnosis in Detecting Early Gastric Cancer and Lymph Node Metastasis
and Its Role in Determining Limited Surgery

Vol. 209, No. 3, September 2009 Jeong et al. Journal of the American College of Surgeons

ABSTRACT

BACKGROUND: The aim of this study was to evaluate the accuracy of surgical diagnosis of early gastric cancer (EGC) and lymph node metastasis, and elucidate its role in determining limited surgery for EGC.
STUDY DESIGN: We reviewed 369 patients undergoing gastrectomy for primary gastric carcinoma. Surgical diagnosis was evaluated by determining its sensitivity, specificity, and accuracy, and was compared with preoperative examinations.
RESULTS: Sensitivity, specificity, and accuracy of intraoperative diagnosis for EGC were 74.5%, 95.7%, and 83.7%, respectively. The predictive value for EGC by intraoperative diagnosis was 95.7%.
Surgical diagnosis of EGC showed higher specificity and predictive value than preoperative
examinations did, which significantly reduced the risk of underestimating advanced gastric
cancer (AGC) to EGC. The sensitivity, specificity, and accuracy for lymph node metastasis by
surgical diagnosis were 73.2%, 78.1%, and 76.4%, respectively. In 70 patients with a discrepancy
in the diagnosis of EGC between pre- and intraoperative diagnoses, surgical diagnosis was
correct in 63 (90%) patients, but preoperative examination was correct in only 7 (10%)
patients.
CONCLUSIONS: Surgical diagnosis shows better accuracy than preoperative examinations do in detecting EGC and lymph node metastasis. Our results suggest that the decision to perform limited surgery based on surgical diagnosis might reduce the risk of undertreatment of AGCtoEGCbetter than preoperative examinations.

Os autores realizaram um estudo retrospectivo quanto à qualidade do diagnóstico intra-operatório do câncer gástrico em relação à seu estágio de desenvolvimento(principalmente entre câncer gástrico precoce - EGC no artigo e câncer gástrico avançado - AGC). É muito interessante o estudo individual feito apenas com aqueles casos em que houve discrepância entre os exames pré-operatórios e avaliação intra-operatóio, pois nestes casos o diagnóstico intra-operatório mostrou-se indubitavelmente superior à avaliação pré-op, mesmo utlizando USG endoscópico e
reconstrução do estômago por tomografia.
O artigo enfatiza que nos casos em que se detectou um tumor menos avançado do que mostravam os exames pré-op, foram realizadas cirurgias menos agressivas, com vantagens para a qualidade de vida do paciente. Considero isto primordial, pois estamos considerando pacientes com uma sobrevida prolongada e chances reais de cura.