Comparison of endoscopic ultrasonography and conventional endoscopy for prediction of depth of tumor invasion in early gastric cancer

 

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Background and study aims: This study aimed to compare the diagnostic accuracy of endoscopic ultrasonography (EUS) with that of conventional endoscopy for staging depth of invasion (T staging) in early gastric cancer.

Patients and methods: A total of 955 patients with suspected early gastric cancer were prospectively registered. EUS staging was carried out prospectively by a single endoscopist using either miniprobe or radial EUS depending on the endoscopic appearance of the tumor. Conventional endoscopy staging was performed retrospectively by consensus between two endoscopists who were blinded to the EUS staging. Conventional endoscopy staging was conducted on the basis of endoscopic features such as surface nodularity and fold convergence. Patients underwent either surgical (n = 586) or endoscopic resection (n = 369) with curative intent. The staging accuracy of each test was compared with the pathological staging of the resected specimen.

Results: The presence of a T1m tumor was histologically confirmed in 644 cases (67.4 %) and that of a T1sm tumor in 311 cases (32.6 %). The overall accuracy of EUS staging was 67.4 % (644 / 955) and that of conventional endoscopy staging was 73.7 % (704 / 955) (P < 0.001). The accuracy of miniprobe EUS was significantly higher than that of radial EUS (79.5 % vs. 59.6 %, P < 0.001), but did not differ significantly from that of conventional endoscopy (79.0 %).

Conclusions: EUS does not substantially impact on pretreatment T staging of patients with early gastric cancer compared with conventional endoscopy. Therefore, EUS may not be necessary routinely, and conventional endoscopy may be sufficient for determining the optimal therapeutic strategy, especially in relation to endoscopic resection for early gastric cancer.

References

• 1 Sano T, Kobori O, Muto T. Lymph node metastasis from early gastric cancer: endoscopic resection of tumour.  Br J Surg. 1992;  79 241-244
  CrossrefPubMedGoogle Scholar
• 2 Nam S Y, Choi I J, Park K W. et al . Effect of repeated endoscopic screening on the incidence and treatment of gastric cancer in health screenees.  Eur J Gastroenterol Hepatol. 2009;  21 855-860
  CrossrefPubMedGoogle Scholar
• 3 Chung I K, Lee J H, Lee S H. et al . Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study.  Gastrointest Endosc. 2009;  69 1228-1235
  CrossrefPubMedGoogle Scholar
• 4 Isomoto H, Shikuwa S, Yamaguchi N. et al . Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study.  Gut. 2009;  58 331-336
  CrossrefPubMedGoogle Scholar
• 5 Yanai H, Matsumoto Y, Harada T. et al . Endoscopic ultrasonography and endoscopy for staging depth of invasion in early gastric cancer: a pilot study.  Gastrointest Endosc. 1997;  46 212-216
  CrossrefPubMedGoogle Scholar
• 6 Kim J H, Song K S, Youn Y H. et al . Clinicopathologic factors influence accurate endosonographic assessment for early gastric cancer.  Gastrointest Endosc. 2007;  66 901-908
  CrossrefPubMedGoogle Scholar
• 7 Sano T, Okuyama Y, Kobori O. et al . Early gastric cancer. Endoscopic diagnosis of depth of invasion.  Dig Dis Sci. 1990;  35 1340-1344
  CrossrefPubMedGoogle Scholar
• 8 Yanai H, Noguchi T, Mizumachi S. et al . A blind comparison of the effectiveness of endoscopic ultrasonography and endoscopy in staging early gastric cancer.  Gut. 1999;  44 361-365
  CrossrefPubMedGoogle Scholar
• 9 Gotoda T, Yanagisawa A, Sasako M. et al . Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers.  Gastric Cancer. 2000;  3 219-225
  CrossrefPubMedGoogle Scholar
• 10 Hunerbein M, Ulmer C, Handke T, Schlag P M. Endosonography of upper gastrointestinal tract cancer on demand using miniprobes or endoscopic ultrasound.  Surg Endosc. 2003;  17 615-619
  CrossrefPubMedGoogle Scholar
• 11 Thomas T, Gilbert D, Kaye P V. et al . High-resolution endoscopy and endoscopic ultrasound for evaluation of early neoplasia in Barrett’s esophagus.  Surg Endosc. 2010;  24 1110-1116
  CrossrefPubMedGoogle Scholar
• 12 Matsumoto Y, Yanai H, Tokiyama H. et al . Endoscopic ultrasonography for diagnosis of submucosal invasion in early gastric cancer.  J Gastroenterol. 2000;  35 326-331
  CrossrefPubMedGoogle Scholar
• 13 Japanese Gastric Cancer A . Japanese Classification of Gastric Carcinoma – 2nd English Edition.  Gastric Cancer. 1998;  1 10-24
  PubMedGoogle Scholar
• 14 Dwyer A J. Matchmaking and McNemar in the comparison of diagnostic modalities.  Radiology. 1991;  178 328-330
  PubMedGoogle Scholar
• 15 Ohashi S, Segawa K, Okamura S. et al . The utility of endoscopic ultrasonography and endoscopy in the endoscopic mucosal resection of early gastric cancer.  Gut. 1999;  45 599-604
  CrossrefPubMedGoogle Scholar
• 16 Kwee R M, Kwee T C. Imaging in local staging of gastric cancer: a systematic review.  J Clin Oncol. 2007;  25 2107-2116
  CrossrefPubMedGoogle Scholar
• 17 Hizawa K, Iwai K, Esaki M. et al . Is endoscopic ultrasonography indispensable in assessing the appropriateness of endoscopic resection for gastric cancer?.  Endoscopy. 2002;  34 973-978
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Kwee R M, Kwee T C. The accuracy of endoscopic ultrasonography in differentiating mucosal from deeper gastric cancer.  Am J Gastroenterol. 2008;  103 1801-1809
  CrossrefPubMedGoogle Scholar
• 19 Akahoshi K, Chijiwa Y, Hamada S. et al . Pretreatment staging of endoscopically early gastric cancer with a 15 MHz ultrasound catheter probe.  Gastrointest Endosc. 1998;  48 470-476
  CrossrefPubMedGoogle Scholar
• 20 Ahn H S, Lee H J, Yoo M W. et al . Diagnostic accuracy of T and N stages with endoscopy, stomach protocol CT, and endoscopic ultrasonography in early gastric cancer.  J Surg Oncol. 2009;  99 20-27
  CrossrefPubMedGoogle Scholar
• 21 Sano T, Katai H, Sasako M, Maruyama K. The management of early gastric cancer.  Surg Oncol. 2000;  9 17-22
  CrossrefPubMedGoogle Scholar

S. G. KimMD, PhD 

Division of Gastroenterology
Department of Internal Medicine and Liver Research Institute
Seoul National University College of Medicine

Yongun-dong 28, Chongno-gu
Seoul 110-744
South Korea

Fax: +82-2-7436701

Email: harley1333@hanmail.net