A 58-year-old Indian man presents with progressive dysphagia, early satiety, and weight loss of 8 kg over 3 months. Upper GI endoscopy reveals a large ulcerated lesion in the gastric antrum with rolled edges. Biopsy from the lesion shows adenocarcinoma. What is the most appropriate investigation to determine the depth of tumor invasion and locoregional lymph node involvement before staging?
A. Positron emission tomography (PET)-CT
B. Contrast-enhanced CT chest and abdomen
C. Endoscopic ultrasound (EUS) with fine-needle aspiration
D. Diagnostic laparoscopy
Explanation
Investigation of Choice for Locoregional Staging in Gastric Carcinoma
Why Endoscopic Ultrasound (EUS) is Optimal
Key Point
EUS is the gold standard for assessing T-stage (depth of tumor invasion) and N-stage (regional lymph node involvement) in gastric cancer. It provides superior resolution of the gastric wall layers and perigastric lymph nodes compared to cross-sectional imaging.
High-YieldNEET PG
EUS can:
Differentiate between T1a (mucosa), T1b (submucosa), T2 (muscularis propria), T3 (subserosa), and T4 (serosa/adjacent structures)
Identify regional lymph nodes (N1, N2) with >90% accuracy for nodes >3 mm
Guide fine-needle aspiration (FNA) for cytological confirmation of involved nodes
Poor resolution for T-stage and small regional nodes (<1 cm)
PET-CT
Identifies distant metastases and FDG-avid nodes
Low sensitivity for small primary tumors and T-staging
Diagnostic laparoscopy
Detects peritoneal/liver metastases missed on imaging
Invasive; not first-line for locoregional staging
Clinical Pearl
In this patient with histologically confirmed adenocarcinoma, EUS should be performed before CT staging to guide treatment decisions (surgery vs. neoadjuvant chemotherapy).
Mnemonic — EUS in Gastric Cancer (T-N-E):
T = Tumor depth (T-stage)
N = Node involvement (N-stage)
E = Endoscopic approach (no radiation, real-time assessment)
Warning
EUS is operator-dependent and may be limited by gastric stenosis or inability to pass the scope; in such cases, CT or MRI becomes the alternative.
Practice similar questions
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.
