Article Text

Download PDFPDF
Accuracy of endoscopic ultrasonography in diagnosing ascites and predicting peritoneal metastases in gastric cancer patients
  1. Y T Lee1,
  2. E K W Ng2,
  3. L C T Hung1,
  4. S C S Chung2,
  5. J Y L Ching1,
  6. W Y Chan3,
  7. W C Chu4,
  8. J J Sung1
  1. 1Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China
  2. 2Department of Surgery, Prince of Wales Hospital, Hong Kong, China
  3. 3Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Hong Kong, China
  4. 4Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Hong Kong, China
  1. Correspondence to:
    Dr Y T Lee
    Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong, China;


Background: Preoperative diagnosis of peritoneal metastases (PM) is difficult in patients with gastric cancer (GC).

Aims: To assess the accuracy of endoscopic ultrasonography (EUS) in diagnosing ascites and its predictability for the presence of PM in GC patients.

Subjects: Consecutive patients with newly diagnosed GC from 1998 to 2004 were studied.

Methods: All patients underwent EUS, ultrasound (US), and computed tomography (CT) scan for preoperative staging and the presence of ascites. The results were compared with operative findings. The diagnosis of PM was confirmed by histopathology or peritoneal fluid cytology.

Results: A total of 301 patients were recruited and in 250 patients the presence of ascites (n = 93) and PM (n = 71) were confirmed. EUS was more sensitive (87.1%) than combined US and CT scan examinations (16.1%) and operative findings (laparoscopy or laparotomy) (40.9%) in diagnosing ascites. Sensitivity, specificity, positive and negative predictive values, and accuracy for predicting the presence of PM were 73%, 84%, 64%, 89%, and 81% by EUS; 18%, 99%, 87%, 75%, and 76% by combining US and CT scan; and 77%, 94%, 83%, 91%, and 89% by operative findings, respectively. In multivariate logistic regression analysis, EUS detected ascites was the only significant independent predictor for the presence of PM (p<0.001; odds ratio 4.7 (95% confidence interval 2.0–11.2)).

Conclusion: EUS is a sensitive method for diagnosing ascites which is an important predictive factor for the presence of PM in GC patients.

  • EUS, endoscopic ultrasonography
  • CT, computed tomography
  • US, ultrasound
  • GC, gastric cancer
  • PM, peritoneal metastases
  • PET, positron emission tomography
  • PPV, positive predictive value
  • NPV, negative predictive value
  • OR, odds ratio
  • endoscopic ultrasonography
  • gastric cancer
  • ascites
  • peritoneal metastases

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Published online first 13 June 2005

  • Conflict of interest: None declared.

  • Preliminary results of this paper were presented at the 12th International Symposium on Endoscopic Ultrasonography, 11-13 February 2000, Monte-Carlo, Monaco and the abstract was published in Endoscopy2000;:, and at Digestive Disease Week, 20-23 May 2001, Atlanta and the abstract was published in Gastrointest Endosc2001;:.

Linked Articles