The detection of gastric and esophageal tumor extension by high‐resolution ultrasound during surgery

High‐resolution ultrasound with 7.5‐MHz instruments was employed to detect tumor extension during 30 gastric and 25 esophageal cancer operations. With 5 echo layers, which corresponded to histologie structures of the stomach wall, operative ultrasound diagnosed intramural tumor spread more accurately than operative palpation. Thirteen of 14 early gastric cancers including 8 nonpalpable cancers were precisely localized by operative ultrasonography. In addition, lateral extension of tumor along the stomach wall was correctly diagnosed by operative ultrasound in 26 of 30 cancers, while palpation was correct in 14 of 30 cancers. For esophageal cancer, extramural local invasion, particularly to vessels, was accurately detected by operative ultrasound. Three of 25 esophageal cancers had histological invasion of the aorta. Preoperative imaging methods showed 1 false‐negative and 2 false‐positive results in determining the aortic invasion. Operative ultrasound had no false results. Lymph nodes that were unrecognized at preoperative studies, nodes that were nonpalpable prior to tissue dissection, and nodes as small as 3 mm in size could be depicted by ultrasonography during gastroesophageal operations. The present results indicate that high‐resolution operative ultrasound may be a valuable technique for the detection of gastric and esophageal cancer extension during surgery. Résumé L'échographie per‐opératoire avec des instruments d'une puissance de 7.5 MHz a été employée pour rechercher l'extension de 30 cancers gastriques et 25 cancers oesophagiens. En mettant en évidence 5 couches échographiques qui correspondent aux structures histologiques de l'estomac, l'échographie opératoire permet mieux que la palpation d'apprécier avec précision l'extension du cancer. Treize des 14 cancers précoces comprenant 8 cancers inpalpables furent localisés avec précision par l'échographie per‐opératoire. De plus l'extension latérale de la tumeur le long de la paroi gastrique fut correctement diagnostiquée dans 26 des 30 cancers alors qu'elle ne fut reconnue par la palpation que dans 14 de ces 30 tumeurs. En ce qui concerne le cancer oesophagien, l'échographie per‐opératoire permit d'apprécier avec précision l'extension locale extramurale du processus tumoral, en particulier l'extension aux vaisseaux. Trois des 25 cancers oesophagiens avaient histologiquement envahi l'aorte. Les méthodes d'imagerie pré‐opératoire appréciant l'envahissement de l'aorte étaient à l'origine de resultat