Table 4_Preoperative staging of gastric cancer: a prospective comparison of gastric filling ultrasonography and enhanced CT with implications for surgical decision-making.docx

McNemar's test was used for paired comparisons, DeLong test for AUC comparisons, and Kappa statistics for agreement assessment. Univariate logistic regression identified factors affecting ultrasound accuracy.</p>Results<p>For T-staging, overall accuracy was 72.7% (295/406) for ultrasound vs. 63.5% (258/406) for CT (P < 0.001). Ultrasound significantly outperformed CT in T1 (81.5% vs. 56.3%, P = 0.009) and T2 (81.1% vs. 67.9%, P < 0.001) stages.

For N-staging, accuracy was 82.0% (333/406) for ultrasound vs. 60.1% (244/406) for CT (P < 0.001). Kappa agreement with pathology was substantial for ultrasound T-staging (κ = 0.625) and N-staging (κ = 0.748), compared with moderate agreement for CT (κ = 0.508 and 0.395, respectively). In multivariate analysis, vascular infiltration was the only independent factor associated with ultrasound T-staging accuracy.</p>Conclusions<p>Gastric filling ultrasonography demonstrates superior accuracy over gastric-enhanced CT for preoperative T1/T2 and N-staging, with substantial agreement with pathological findings.

This non-invasive and radiation-free examination method can serve as an effective complement to CT, and is particularly suitable for gastric cancer at the T1 and T2 stages. We have proposed a complementary imaging protocol to assist in surgical decision-making, which is expected to enable clinicians to make more accurate preoperative staging assessments for patients with gastric cancer.</p>Registration<p>It was registered in the ClinicalTrials.gov (NCT05596864).</p>