Clinical characteristics and transabdominal ultrasound features that associated with T3-T4 staging in gastric cancer: A retrospective study

Min-Ying Zhong; Guo-Liang Jian; Jie-Yi Ye; Qin-Xue Liu; Wei-Jun Huang; Chao-Jiong Zhen

doi:10.4240/wjgs.v17.i6.105073

Clinical characteristics and transabdominal ultrasound features that associated with T3-T4 staging in gastric cancer: A retrospective study

World J Gastrointest Surg. 2025 Jun 27;17(6):105073. doi: 10.4240/wjgs.v17.i6.105073.

Authors

Min-Ying Zhong¹, Guo-Liang Jian¹, Jie-Yi Ye¹, Qin-Xue Liu¹, Wei-Jun Huang², Chao-Jiong Zhen¹

Affiliations

¹ Department of Ultrasound, First People's Hospital of Foshan, Foshan 528000, Guangdong Province, China.
² Department of Ultrasound, First People's Hospital of Foshan, Foshan 528000, Guangdong Province, China. hwjun1716@163.com.

Abstract

Background: Transabdominal ultrasound after the oral administration of an echoic cellulose-based gastric ultrasound contrast agent has recently been suggested to be effective in T staging of gastric cancer (GC).

Aim: To explore the clinical characteristics and transabdominal features associated with T3-T4 staging of GC.

Methods: In total, 113 patients who underwent transabdominal ultrasonography and had confirmed GC based on surgical pathology were included. Variables including clinical characteristics [age, body mass index, gender, clinical features, pathological type, histologic type, Lauren type, carcinoembryonic antigen (CEA), and CA19-9] and transabdominal ultrasound features (thickness and length of lesion, presence of angle sign, presence of ulcer, and lesion location) were recorded. Univariate and multivariable logistic regression analyses were performed to identify the factors associated with T3-T4 staging.

Results: Ninety-two patients were T3-T4 staging and 21 were T1-T2 staging. Univariate analysis revealed that the thickness of gastric lesions (1.6 ± 0.6 cm vs 1.0 ± 0.4 cm, P < 0.001), length of gastric lesions (5.7 ± 2.2 cm vs 2.9 ± 1.0 cm, P < 0.001), presence of angle sign (92.4% vs 19.0%, P < 0.001), elevated CEA (36.9% vs 0%, P < 0.001) and elevated CA19-9 (27.2% vs 14.3%, P = 0.034) were statistically significant between the two groups. Multivariable logistic regression analysis revealed that the length of gastric lesions [odds ratio (OR) = 2.373, 95% confidence interval (95%CI): 1.281-4.396, P = 0.006] and presence of angle sign (OR = 31.083, 95%CI: 4.449-217.164, P < 0.001) were independent factors associated with T3-T4 staging. A receiver operating characteristic curve was plotted, and the area under the curve was 0.950 (95% CI: 0.906-0.994, P < 0.001).

Conclusion: Transabdominal ultrasound features, including an angle sign and lesion length, help identify T3-T4 staging.

Keywords: Angle sign; Cellulose-based ultrasound contrast agent; Stomach neoplasms; Tumor staging; Ultrasonography.