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Rofo 2012; 184(8): 706-712
DOI: 10.1055/s-0031-1299371
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© Georg Thieme Verlag KG Stuttgart · New York

Aktualisierte S3-Leitlinie zur Diagnostik und Therapie des Magenkarzinoms: Bedeutung für die Radiologische Diagnostik

S3 Guideline – Diagnosis and Treatment of Gastric Carcinoma: Relevance for Radiologic Imaging
L. Grenacher
1   Abt. Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg
,
M. Schwarz
1   Abt. Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg
,
F. Lordick
3   Medizinische Klinik III, Städt. Klinikum Braunschweig
,
B. Krause
4   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Rostock
,
C. Roecken
5   Institut für Pathologie, Christian-Albrechts-Universität Kiel
,
S. Moenig
6   Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln
,
M. Ebert
7   Medizinische Klinik II, Universitätsklinikum Mannheim
,
C. Jenssen
8   Innere Medizin, Krankenhaus Märkisch Oderland
,
H.-U. Kauczor
1   Abt. Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg
,
M. Moehler
10   I. Med. Klinik und Poliklinik, Universitätsmedizin Mainz
› Author Affiliations
Further Information

Publication History

30 January 2012

01 February 2012

Publication Date:
20 March 2012 (online)

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Zusammenfassung

Die neue Deutsche S3-Leitlinie „Magenkarzinom“ beinhaltet eine Vielzahl an Neuerungen bezüglich Diagnostik und Therapie von Adenokarzinomen des Magens und des ösophagogastralen Überganges. Die Leitlinie wurde intensiv unterstützt durch das Leitlinien-Programm Onkologie, bestehend aus der Deutschen Krebshilfe, der Deutschen Krebsgesellschaft und der AWMF (Dr. M. Follmann). Diese Leitlinie enthält neben evidenzbasierten Therapieempfehlungen herausgearbeitete Qualitätsindikatoren, die der Leitlinien-Implementierung und Evaluation dienen, um eine breite medizinische Versorgung zu verbessern und eine Weiterentwicklung und spätere Anpassung zu erleichtern. Im vorliegenden Artikel möchten wir die Neuerungen bzgl. der radiologischen Diagnostik vorstellen und die neueste Literatur zum Thema diskutieren.

Abstract

The new German S3 guideline regarding stomach cancer includes a variety of innovations with respect to the diagnosis and treatment of adenocarcinoma of the stomach and the esophagogastric junction. The guideline has been strongly supported by the “oncology” guidelines program consisting of the “Deutsche Krebshilfe” and the German Cancer Society and the AWMF (Dr. M. Follmann). This guideline contains evidence-based treatment recommendations and quality indicators for guideline implementation and evaluation in order to improve broad medical care and to facilitate development and subsequent adjustment. The purpose of this article is to introduce the innovations with regard to radiological diagnosis and to discuss the latest literature on the subject.

Key words

stomach - gastric cancer - radiologic diagnosis - guideline - review
 

  • Literatur

  • 1 Christian Wittekind HJM. TNM: Klassifikation maligner Tumoren. Wiley-VCH Verlag GmbH & Co; 2010
    Google Scholar
  • 2 Moehler M, Al-Batran SE, Andus T et al. German S3-guideline “Diagnosis and treatment of esophagogastric cancer”. Z Gastroenterol 2011; 49: 461-531
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Peeters MLT, Vlayen J et al. Wetenschappelijke ondersteuning van het College voor Oncologie: een nationale praktijkrichtlijn voor de aanpak van slokdarm – en maagkanker. Brussel: Federaal Kenniscentrum voor de Gezondheidszorg.
    PubMedGoogle Scholar
  • 4 Centre fédéral d’expertise des soins de santé. Available from: 2008 http://kce.fgov.be/sites/default/files/page_documents/d20081027316.pdf
    PubMedGoogle Scholar
  • 5 SIGN. Management of oesophageal and gastric cancer – A national clinical guideline. ; Available from: 2006 http://www.sign.ac.uk/pdf/sign87.pdf
    PubMedGoogle Scholar
  • 6 Oldenburg A, Albrecht T. Baseline and contrast-enhanced ultrasound of the liver in tumor patients. Ultraschall in Med 2008; 29: 488-498
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Kinkel K, Lu Y, Both M et al. Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis. Radiology 2002; 224: 748-756
    CrossrefPubMedGoogle Scholar
  • 8 Piscaglia F, Corradi F, Mancini M et al. Real time contrast enhanced ultrasonography in detection of liver metastases from gastrointestinal cancer. BMC Cancer 2007; 7: 171
    CrossrefPubMedGoogle Scholar
  • 9 Dietrich CF, Kratzer W, Strobe D et al. Assessment of metastatic liver disease in patients with primary extrahepatic tumors by contrast-enhanced sonography versus CT and MRI. World J Gastroenterol 2006; 12: 1699-1705
    CrossrefPubMedGoogle Scholar
  • 10 Albrecht T, Blomley MJ, Burns PN et al. Improved detection of hepatic metastases with pulse-inversion US during the liver-specific phase of SHU 508A: multicenter study. Radiology 2003; 227: 361-370
    CrossrefPubMedGoogle Scholar
  • 11 Cantisani V, Ricci P, Erturk M et al. Detection of hepatic metastases from colorectal cancer: prospective evaluation of gray scale US versus SonoVue(R) low mechanical index real time-enhanced US as compared with multidetector-CT or Gd-BOPTA-MRI. Ultraschall in Med 2010; 31: 500-505
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Claudon M, Cosgrove D, Albrecht T et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) – update 2008. Ultraschall in Med 2008; 29: 28-44
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Dietrich CF. Comments and illustrations regarding the guidelines and good clinical practice recommendations for contrast-enhanced ultrasound (CEUS) – update 2008. Ultraschall in Med 2008; 29: 188-S202
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Dietrich CF. Characterisation of focal liver lesions with contrast enhanced ultrasonography. Eur J Radiol 2004; 51: 9-S17
    CrossrefPubMedGoogle Scholar
  • 15 Seitz K, Strobel D, Bernatik T et al. Contrast-Enhanced Ultrasound (CEUS) for the characterization of focal liver lesions – prospective comparison in clinical practice: CEUS vs. CT (DEGUM multicenter trial). Parts of this manuscript were presented at the Ultrasound Dreilandertreffen 2008, Davos. Ultraschall in Med 2009; 30: 383-389
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Strobel D, Seitz K, Blank W et al. Contrast-enhanced ultrasound for the characterization of focal liver lesions – diagnostic accuracy in clinical practice (DEGUM multicenter trial). Ultraschall in Med 2008; 29: 499-505
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Strobel D, Seitz K, Blank W et al. Tumor-specific vascularization pattern of liver metastasis, hepatocellular carcinoma, hemangioma and focal nodular hyperplasia in the differential diagnosis of 1,349 liver lesions in contrast-enhanced ultrasound (CEUS). Ultraschall in Med 2009; 30: 376-382
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Seitz K, Bernatik T, Strobel D et al. Contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesions in clinical practice (DEGUM Multicenter Trial): CEUS vs. MRI – a prospective comparison in 269 patients. Ultraschall in Med 2010; 31: 492-499
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Schreurs LM, Verhoef CC, van der Jagt EJ et al. Current relevance of cervical ultrasonography in staging cancer of the esophagus and gastroesophageal junction. Eur J Radiol 2008; 67: 105-111
    CrossrefPubMedGoogle Scholar
  • 20 Van Overhagen H, Lameris JS, Berger MY et al. Improved assessment of supraclavicular and abdominal metastases in oesophageal and gastro-oesophageal junction carcinoma with the combination of ultrasound and computed tomography. Br J Radiol 1993; 66: 203-208
    CrossrefPubMedGoogle Scholar
  • 21 van Vliet EP, van der Lugt A, Kuipers EJ et al. Ultrasound, computed tomography, or the combination for the detection of supraclavicular lymph nodes in patients with esophageal or gastric cardia cancer: a comparative study. J Surg Oncol 2007; 96: 200-206
    CrossrefPubMedGoogle Scholar
  • 22 Omloo JM, van Heijl M, Smits NJ et al. Additional value of external ultrasonography of the neck after CT and PET scanning in the preoperative assessment of patients with esophageal cancer. Dig Surg 2009; 26: 43-49
    CrossrefPubMedGoogle Scholar
  • 23 van Overhagen H, Lameris JS, Berger MY et al. Supraclavicular lymph node metastases in carcinoma of the esophagus and gastroesophageal junction: assessment with CT, US, and US-guided fine-needle aspiration biopsy. Radiology 1991; 179: 155-158
    CrossrefPubMedGoogle Scholar
  • 24 van Overhagen H, Lameris JS, Berger MY et al. Assessment of distant metastases with ultrasound-guided fine-needle aspiration biopsy and cytologic study in carcinoma of the esophagus and gastroesophageal junction. Gastrointest Radiol 1992; 17: 305-310
    CrossrefPubMedGoogle Scholar
  • 25 Kwee RM, Kwee TC. Imaging in local staging of gastric cancer: a systematic review. J Clin Oncol 2007; 25: 2107-2116
    CrossrefPubMedGoogle Scholar
  • 26 Puli SR, Batapati Krishna Reddy J, Bechtold ML et al. How good is endoscopic ultrasound for TNM staging of gastric cancers? A meta-analysis and systematic review. World J Gastroenterol 2008; 14: 4011-4019
    CrossrefPubMedGoogle Scholar
  • 27 Hassan H, Vilmann P, Sharma V. Impact of EUS-guided FNA on management of gastric carcinoma. Gastrointest Endosc 2010; 71: 500-504
    CrossrefPubMedGoogle Scholar
  • 28 DeWitt J, LeBlanc J, McHenry L et al. Endoscopic ultrasound-guided fine-needle aspiration of ascites. Clin Gastroenterol Hepatol 2007; 5: 609-615
    CrossrefPubMedGoogle Scholar
  • 29 Lee YT, Ng EK, Hung LC et al. Accuracy of endoscopic ultrasonography in diagnosing ascites and predicting peritoneal metastases in gastric cancer patients. Gut 2005; 54: 1541-1545
    CrossrefPubMedGoogle Scholar
  • 30 Nguyen PT, Chang KJ. EUS in the detection of ascites and EUS-guided paracentesis. Gastrointest Endosc 2001; 54: 336-339
    CrossrefPubMedGoogle Scholar
  • 31 Chen CH, Yang CC, Yeh YH. Preoperative staging of gastric cancer by endoscopic ultrasound: the prognostic usefulness of ascites detected by endoscopic ultrasound. J Clin Gastroenterol 2002; 35: 321-327
    CrossrefPubMedGoogle Scholar
  • 32 Sultan J, Robinson S, Hayes N et al. Endoscopic ultrasonography-detected low-volume ascites as a predictor of inoperability for oesophagogastric cancer. Br J Surg 2008; 95: 1127-1130
    CrossrefPubMedGoogle Scholar
  • 33 Hollerbach S, Willert J, Topalidis T et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy of liver lesions: histological and cytological assessment. Endoscopy 2003; 35: 743-749
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 McGrath K, Brody D, Luketich J et al. Detection of unsuspected left hepatic lobe metastases during EUS staging of cancer of the esophagus and cardia. Am J Gastroenterol 2006; 101: 1742-1746
    CrossrefPubMedGoogle Scholar
  • 35 Fritscher-Ravens A, Sriram PV, Bobrowski C et al. Mediastinal lymphadenopathy in patients with or without previous malignancy: EUS-FNA-based differential cytodiagnosis in 153 patients. Am J Gastroenterol 2000; 95: 2278-2284
    CrossrefPubMedGoogle Scholar
  • 36 Mortensen MB, Pless T, Durup J et al. Clinical impact of endoscopic ultrasound-guided fine needle aspiration biopsy in patients with upper gastrointestinal tract malignancies. A prospective study. Endoscopy 2001; 33: 478-483
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Chen VK, Eloubeidi MA. Endoscopic ultrasound-guided fine needle aspiration is superior to lymph node echofeatures: a prospective evaluation of mediastinal and peri-intestinal lymphadenopathy. Am J Gastroenterol 2004; 99: 628-633
    CrossrefPubMedGoogle Scholar
  • 38 Davies AR, Deans DA, Penman I et al. The multidisciplinary team meeting improves staging accuracy and treatment selection for gastro-esophageal cancer. Dis Esophagus 2006; 19: 496-503
    CrossrefPubMedGoogle Scholar
  • 39 Ganpathi IS, So JB, Ho KY. Endoscopic ultrasonography for gastric cancer: does it influence treatment?. Surg Endosc 2006; 20: 559-562
    CrossrefPubMedGoogle Scholar
  • 40 Meining A, Dittler HJ, Wolf A et al. You get what you expect? A critical appraisal of imaging methodology in endosonographic cancer staging. Gut 2002; 50: 599-603
    CrossrefPubMedGoogle Scholar
  • 41 Barbour AP, Rizk NP, Gerdes H et al. Endoscopic ultrasound predicts outcomes for patients with adenocarcinoma of the gastroesophageal junction. J Am Coll Surg 2007; 205: 593-601
    CrossrefPubMedGoogle Scholar
  • 42 Bentrem D, Gerdes H, Tang L et al. Clinical correlation of endoscopic ultrasonography with pathologic stage and outcome in patients undergoing curative resection for gastric cancer. Ann Surg Oncol 2007; 14: 1853-1859
    CrossrefPubMedGoogle Scholar
  • 43 Power DG, Schattner MA, Gerdes H et al. Endoscopic ultrasound can improve the selection for laparoscopy in patients with localized gastric cancer. J Am Coll Surg 2009; 208: 173-178
    CrossrefPubMedGoogle Scholar
  • 44 van Vliet EP, Eijkemans MJ, Poley JW et al. Staging of esophageal carcinoma in a low-volume EUS center compared with reported results from high-volume centers. Gastrointest Endosc 2006; 63: 938-947
    CrossrefPubMedGoogle Scholar
  • 45 Anzidei M, Napoli A, Zaccagna F et al. Diagnostic performance of 64-MDCT and 1.5-T MRI with high-resolution sequences in the T staging of gastric cancer: a comparative analysis with histopathology. Radiol Med 2009; 114: 1065-1079
    CrossrefPubMedGoogle Scholar
  • 46 Hammerstingl R, Huppertz A, Breuer J et al. Diagnostic efficacy of gadoxetic acid (Primovist-)enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 2008; 18: 457-467
    CrossrefPubMedGoogle Scholar
  • 47 Ha TK, Choi YY, Song SY et al. F18-fluorodeoxyglucose-positron emission tomography and computed tomography is not accurate in preoperative staging of gastric cancer. J Korean Surg Soc 2011; 81: 104-110
    CrossrefPubMedGoogle Scholar
  • 48 Seevaratnam R, Cardoso R, McGregor C et al. How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis. Gastric Cancer 2011; DOI: 10.1007/s10120-011-0069-6.
    PubMedGoogle Scholar
  • 49 Wang KK, Wongkeesong M, Buttar NS. American Gastroenterological Association technical review on the role of the gastroenterologist in the management of esophageal carcinoma. Gastroenterology 2005; 128: 1471-1505
    CrossrefPubMedGoogle Scholar
  • 50 Mesenas S, Vu C, McStay M et al. A large series, resection controlled study to assess the value of radial EUS in restaging gastroesophageal cancer following neoadjuvant chemotherapy. Dis Esophagus 2008; 21: 37-42
    PubMedGoogle Scholar
  • 51 Park SR, Lee JS, Kim CG et al. Endoscopic ultrasound and computed tomography in restaging and predicting prognosis after neoadjuvant chemotherapy in patients with locally advanced gastric cancer. Cancer 2008; 112: 2368-2376
    CrossrefPubMedGoogle Scholar
  • 52 Patel PR, Mansfield PF, Crane CH et al. Clinical stage after preoperative chemoradiation is a better predictor of patient outcome than the baseline stage for localized gastric cancer. Cancer 2007; 110: 989-995
    CrossrefPubMedGoogle Scholar
  • 53 Mocellin S, Marchet A, Nitti D. EUS for the staging of gastric cancer: a meta analysis. Gastrointest Endosc 2011; 73: 1122-1134
    CrossrefPubMedGoogle Scholar