Journal of Occupational
Health and Epidemiology
Rafsanjan university Of medical sciences
Volume 15, Issue 1 (Winter 2026)
J Occup Health Epidemiol 2026, 15(1): 32-39 |
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Pouramiri M K, Shafiei M, Doost Mohammadi F, Amirbeigi A. Diagnostic Accuracy and Staging Concordance between Endoscopic Ultrasound and Laparoscopy in Gastric Cancer: A Diagnostic Test Evaluation Study from Southeast Iran. J Occup Health Epidemiol 2026; 15 (1) :32-39
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URL: http://johe.rums.ac.ir/article-1-1066-en.html
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1- MD, General Surgery Specialist, Dept. of Surgery, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
2- Assistant Prof., Dept. of General Surgery, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
3- Ph.D. in Epidemiology, Clinical Research Development Unit, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran.
4- Assistant Prof., Dept. of Surgery, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran & Assistant Prof., Clinical Research Development Unit, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran. ,Ali_amirbeigi@yahoo.com
2- Assistant Prof., Dept. of General Surgery, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
3- Ph.D. in Epidemiology, Clinical Research Development Unit, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran.
4- Assistant Prof., Dept. of Surgery, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran & Assistant Prof., Clinical Research Development Unit, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran. ,
Article history
Received: 2025/06/7
Accepted: 2025/08/26
ePublished: 2025/03/30
Accepted: 2025/08/26
ePublished: 2025/03/30
Subject:
Epidemiology
Abstract: (14 Views)
Background: Accurate staging is critical for optimal management of gastric cancer. This study ascertained the diagnostic accuracy as well as agreement between endoscopic ultrasound (EUS) and staging laparoscopy in patients with locally advanced gastric cancer in southeastern Iran.
Materials & Methods: In this diagnostic test evaluation study, 83 patients with histologically confirmed gastric adenocarcinoma underwent both EUS and staging laparoscopy between October 2023 and June 2024 at two tertiary centers in Kerman, Iran. Laparoscopy, capable of detecting occult peritoneal metastases, was considered the reference standard. EUS performance was appraised through sensitivity, specificity, predictive values, and area under the ROC curve. Concordance between modalities was determined using Cohen’s kappa. Subgroup analyses captured tumor size, location, and Helicobacter pylori infection status.
Results: The mean patient age was 64.99 years; 61.4% were male. EUS staged 47.3% as stage II and 52.7% as stage III, while laparoscopy identified 42.2% as stage II, 56.6% as stage III, and 1.2% as stage IV. Agreement for overall staging (Stage II vs. III/IV) was 94% (kappa = 0.88; 95% CI: 0.77–0.98). EUS indicated 91.7% sensitivity, 100% specificity, 100% PPV, and 89.7% NPV. Agreement was strongest in patients with tumors ≥5 cm (kappa = 0.91), distal/mid-gastric tumors (kappa = 0.90), and H. pylori-positive cases (kappa = 0.95).
Conclusions: While EUS and laparoscopy revealed excellent concordance, laparoscopy detected additional metastases in 6% of cases. A selective combined approach may ameliorate staging accuracy in resource-limited settings.
Materials & Methods: In this diagnostic test evaluation study, 83 patients with histologically confirmed gastric adenocarcinoma underwent both EUS and staging laparoscopy between October 2023 and June 2024 at two tertiary centers in Kerman, Iran. Laparoscopy, capable of detecting occult peritoneal metastases, was considered the reference standard. EUS performance was appraised through sensitivity, specificity, predictive values, and area under the ROC curve. Concordance between modalities was determined using Cohen’s kappa. Subgroup analyses captured tumor size, location, and Helicobacter pylori infection status.
Results: The mean patient age was 64.99 years; 61.4% were male. EUS staged 47.3% as stage II and 52.7% as stage III, while laparoscopy identified 42.2% as stage II, 56.6% as stage III, and 1.2% as stage IV. Agreement for overall staging (Stage II vs. III/IV) was 94% (kappa = 0.88; 95% CI: 0.77–0.98). EUS indicated 91.7% sensitivity, 100% specificity, 100% PPV, and 89.7% NPV. Agreement was strongest in patients with tumors ≥5 cm (kappa = 0.91), distal/mid-gastric tumors (kappa = 0.90), and H. pylori-positive cases (kappa = 0.95).
Conclusions: While EUS and laparoscopy revealed excellent concordance, laparoscopy detected additional metastases in 6% of cases. A selective combined approach may ameliorate staging accuracy in resource-limited settings.
Keywords: Stomach Neoplasms [MeSH], Endosonography [MeSH], Laparoscopy [MeSH], Diagnosis [MeSH], Peritoneum [MeSH], Neoplasm Metastasis [MeSH]
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