Imaging in Gastric Cancer: Current Practice and Future Perspectives

Gastric cancer represents one of the most common oncological causes of death worldwide. In order to treat patients in the best possible way, the staging of gastric cancer should be accurate. In this regard, endoscopy ultrasound (EUS) has been considered the reference standard for tumor (T) and nodal (N) statuses in recent decades. However, thanks to technological improvements, computed tomography (CT) has gained an important role, not only in the assessment of distant metastases (M status) but also in T and N staging. In addition, magnetic resonance imaging (MRI) can contribute to the detection and staging of primary gastric tumors thanks to its excellent soft tissue contrast and multiple imaging sequences without radiation-related risks. In addition, MRI can help with the detection of liver metastases, especially small lesions. Finally, positron emission tomography (PET) is still considered a useful diagnostic tool for the staging of gastric cancer patients, with a focus on nodal metastases and peritoneal carcinomatosis. In addition, it may play a role in the treatment of gastric cancer in the coming years thanks to the introduction of new labeling peptides. This review aims to summarize the most common advantages and pitfalls of EUS, CT, MRI and PET in the TNM staging of gastric cancer patients.

Automated summary

Gastric cancer is a common cause of death worldwide. Accurate staging is crucial for optimal treatment, and endoscopy ultrasound (EUS) has been the reference standard for tumor and nodal statuses. However, computed tomography (CT) and magnetic resonance imaging (MRI) have gained importance in assessing distant metastases and primary gastric tumors. Positron emission tomography (PET) is also useful for nodal metastases and may play a future role in treatment. This review summarizes the advantages and pitfalls of these imaging techniques in TNM staging of gastric cancer patients.