Preliminary Diagnosis: Gastric Cancer
I. What imaging technique is first-line for this diagnosis
- Upper GI series is the first-line imaging study. However, it is important to note that esophagogastroduodenoscopy (EGD) is the most sensitive and specific diagnostic method in patients suspected of having gastric carcinoma.
II. Describe the advantages and disadvantages of this technique for diagnosis of gastric cancer.
Advantages
- Less invasive than EGD
- No need for conscious sedation
- Often the first test performed for patients with reflux or other upper GI symptoms
- Less expensive than EGD
Disadvantages
- Less sensitive and less specific than EGD
- Ionizing radiation
- Upper GI findings are usually not diagnostic and differential considerations of gastric masses include lymphoma, metastasis, gastrointestinal stromal tumor (GIST), peptic ulcer, or Ménétrier disease
III. What are the contraindications for the first-line imaging technique?
- Patient must be mobile enough to change body position on the fluoroscopy table
IV. What alternative imaging techniques are available?
- CT abdomen with oral and intravenous contrast (staging modality of choice)
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of gastric cancer.
CT abdomen with oral and intravenous contrast
Advantages
- Can evaluate for extragastric extension and metastatic disease for staging purposes
Disadvantages
- Less sensitive than EGD and upper GI series for small mucosal lesions
- Usually not diagnostic, and further evaluation with endoscopy and biopsy are often necessary
- Ionizing radiation
VI. What are the contraindications for the alternative imaging techniques?
- Pregnant patients should not undergo CT examination
- Administration of IV contrast can cause worsening renal function (contrast nephropathy) in patients with renal insufficiency. Contrast dose should be reduced or withheld in these patients.
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