Selection Of Surgical Approach Of Carcinoma Of The Cardia Using Transabdominal Ultrasound

Background and aimCarcinoma of the cardia is familiar tumor of the elimentary canal,and its etiology and pathology are not known,and it has some symptoms such as worse and worse dysphagia,pains behind sternum.What we saw mainly are ulcered and moderately-poorly differentiated focus.Carcinoma of the cardia used to be diagnosed by cytology,BCR,endoscopy,and to some extent,CT,MRI play their role too.Cytology has better agreement rate,but it needs multiple operations,and gives more pains to patients.BCR can show focus directly and its clear location,but it is difficult to know its nature.Endoscopy could see focus directly and obtains pathologic result by biopsy.CT,MRI is important on diagnoses of metastasis and invasion of carcinoma of the cardia.Gerenally,the above ways could judge nature and locationg of carcinoma of the cardia,but we do not kown its stage,because they could not tell structure of the elimentary canal wall and have low rate of judging metastasis of lymph nodes.Now US is only means that could show structure of the elimentary canal,and distinguish the three-or-five-layered clear structure ,so US could judge invason depth of carcinoma of the cardia,accordingly tell its stage.This study continuously focuses on wall invasion depth and esophagus length of carcinoma of the cardia using US,and discuss its agreement rate of the stage of carcinoma of the cardia before operation and its role in surgical treatment ,so it may provide surgeon with valuable data .Currently this study was reported rarely in the world.Materials and methodsTransabdominal ultrasound was carried out prospectively in forty inpatients with carcinoma of the cardia who underwent subsequent surgical resection in the first affiliated hospital of anhui medical university during September 2003 and January 2005,and particular attention was paid to the length and depth of esophageal invasion and metastasis of lymph nodes.After operation ,the resected specimen will be observed close,and then make it into slice so as to the reality of length and depth of esophageal invasion and metastasis of lymph nodes.Analysing pathologic matter and observed matter synthetically,at last accurate findings of carcinoma of the cardia was obtained,and was compared between US and histopathology.Statistics software was applied to analyse our data. ResultsForty cases' preoperative ultrasonographic results wre compared with their postoperative histopathologic results.With a margin of error of about 0.8 cm,histopathologically confirmed invasion of the esophagus was correctly predicted by US in twenty-eight of thirty-six patients.An absence of esophagus invasion was correctly predicted in four of additional four.The accuracy of US in predicted invasion of the esophagus was 80.0%(32/40). transabdominal ultrasound had 7 l%of sensitivity and 78% of specifity in affirming invasion of adventitia,and both of them are better.There was relativity between the depth of the wall of the esophagus and invasion of adventitia.Sensitivity of transabdominal was 58%,specificity 91% in judging metastasis of sixteen groups of lymph nodes round stomach,so we think transabdominal US possessed ideal specificity in diagnosing metastasis of lymph nodes. Conclusions1> Transabdominal US could diagnose the length of invsion ofesophagus,and give surgeon valuable data to help them to select asurgical approach.