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Tsujii Y, Hayashi Y, Ishihara R, Yamaguchi S, Yamamoto M, Inoue T, Nagai K, Ogiyama H, Yamada T, Nakahara M, Kizu T, Kanesaka T, Matsuura N, Ohta T, Nakamatsu D, Yoshii S, Shinzaki S, Nishida T, Iijima H, Takehara T. Diagnostic value of endoscopic ultrasonography for the depth of gastric cancer suspected of submucosal invasion: a multicenter prospective study. Surg Endosc 2022; 37:3018-3028. [PMID: 36536083 DOI: 10.1007/s00464-022-09778-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although the combination of conventional endoscopy (CE) and endoscopic ultrasonography (EUS) is useful for predicting the depth of early gastric cancer (EGC), the diagnostic value of EUS for submucosal (SM) invasive cancer has not been fully investigated. METHODS We conducted a multicenter prospective study from May 2017 to January 2021 to evaluate the validity of a diagnostic strategy combining CE and EUS and to clarify the additional value of EUS for EGC suspected of SM invasion. In each case, the diagnosis was first made using CE, followed by EUS, and finally confirmed using a combination algorithm. RESULTS A total of 180 patients with EGC were enrolled from 10 institutions, of which 175 were analyzed. The histopathological depths were M, SM1, SM2, and ≥ MP in 72, 16, 64, and 23 lesions, respectively. Treatment included 92 endoscopic submucosal dissection cases and 83 surgical cases. The overall diagnostic accuracy classified by M-SM1 or SM2-MP was 58.3% for CE, 75.7% for EUS, and 78.9% for the combination of CE and EUS; the latter two were significantly higher than that of CE alone (P < 0.001). The CE, EUS, and combination accuracy rates in 108 differentiated-type lesions were 51.9%, 77.4%, and 79.6%, respectively; the latter two were significantly higher than CE alone (P < 0.001). A significant additive effect of EUS was observed in CE-SM2 low-confidence lesions but not in CE-M-SM1 lesions or in CE-SM2 high-confidence lesions. Among the nine CE findings, irregular surface, submucosal tumor-like elevation, and non-extension signs were significant independent markers of pSM2-MP. Poorly delineated EUS lesions were misdiagnosed. CONCLUSIONS EUS provides additional value for differentiated-type and CE-SM2 low-confidence EGCs in diagnosing invasion depth. CLINICAL REGISTRATION NUMBER UMIN000025862.
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Affiliation(s)
- Yoshiki Tsujii
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshito Hayashi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | | | - Masashi Yamamoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Takuya Inoue
- Department of Gastroenterology, Osaka General Medical Center, Osaka, Japan
| | - Kengo Nagai
- Department of Gastroenterology, Suita Municipal Hospital, Suita, Japan
| | - Hideharu Ogiyama
- Department of Gastroenterology, Itami City Hospital, Itami, Japan
| | - Takuya Yamada
- Department of Gastroenterology, Osaka Rosai Hospital, Sakai, Japan
| | - Masanori Nakahara
- Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan
| | - Takashi Kizu
- Department of Gastroenterology, Yao Municipal Hospital, Yao, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Ohta
- Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Japan
| | - Dai Nakamatsu
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Shunsuke Yoshii
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shinichiro Shinzaki
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Hideki Iijima
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Wang J, Shan F, Li S, Li Z, Wu Q. Effect of administration of a proton pump inhibitor for ulcerative differentiated early gastric cancer prior to endoscopic submucosal dissection. Dig Endosc 2021; 33:939-947. [PMID: 33184984 DOI: 10.1111/den.13892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Predicting the depth of invasion for early gastric cancer (EGC) with ulcerative findings may prove difficult. The purpose of this study was to evaluate the extent of ulcer healing and clinical effectiveness of proton pump inhibitor (PPI) administration for ulcerative differentiated EGC prior to endoscopic submucosal dissection (ESD). METHODS A total of 214 patients with ulcerative differentiated EGC who were treated by ESD were retrospectively analyzed, among whom 129 had been administered a PPI prior to ESD and 85 patients had not. The degree of ulcer healing following administration of PPI and the clinical outcome were compared between the PPI and non-PPI groups. RESULTS The ulcer healing rate (80.7 vs. 30.6%, P < 0.001) and complete ulcer healing rate (45.0 vs. 16.5%, P < 0.001) differed significantly between the PPI and non-PPI groups, respectively. The ESD procedure time was 86.0 (73) vs. 100.0 (68.0) min (P = 0.044). However, no significant differences were observed in the en bloc resection rate, complete resection rate, or the incidence of adverse events. Based on the multivariate regression analysis, PPI administration [odds ratio (OR) = 4.909, 95% confidence interval (CI) 2.459-9.799, P < 0.001] and mucosal cancer (OR = 9.336, 95% CI 2.693-32.362, P < 0.001) were independent predictive factors for complete ulcer healing. Partial or complete ulcer healing following PPI administration had a better predictive ability than EUS for mucosal invasion (kappa value 0.553 vs. 0.101; Youden index 0.553 vs. 0.132). CONCLUSIONS Partial or complete ulcer healing following PPI administration predicts differentiated EGC that is confined to the mucosa.
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Affiliation(s)
- Jing Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Fei Shan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Shijie Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Ziyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Qi Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
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Clinical significance of endoscopic ultrasonography in diagnosing invasion depth of early gastric cancer prior to endoscopic submucosal dissection. Gastric Cancer 2021; 24:145-155. [PMID: 32572791 DOI: 10.1007/s10120-020-01100-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Endoscopic ultrasonography is a reliable diagnostic modality for determining indications of endoscopic submucosal dissection for early gastric cancer. We aimed to clarify the clinical significance of endoscopic ultrasonography in the invasion depth diagnosis of early gastric cancer. METHODS We retrospectively assessed 1598 consecutive patients with 2001 early gastric cancers who underwent EUS before ESD or surgery between October 2010 and April 2019 at our institution. Lesions were classified according to endoscopic ultrasonography-determined invasion depth as EUS-M/SM1 (lesions confined to sonographic layers 1 and 2 or lesions with changes in sonographic layer 3; depth, < 1 mm) and EUS-SM2 (lesions with changes in sonographic layer 3; depth, ≥ 1 mm). We evaluated the invasion depth determination accuracy of endoscopic ultrasonography and analyzed the clinicopathological features of misdiagnosed early gastric cancer cases. RESULTS The invasion depth determination accuracy was as follows: EUS-M/SM1: pathological T1a/T1b1 early gastric cancer, 97%; EUS-SM2: pathological T1b2 early gastric cancer, 79%. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 95%, 98%, 69%, 97%, and 79%, respectively. In EUS-M/SM1 early gastric cancer, tumor size of ≥ 15 mm, presence of ulceration, and undifferentiated histological type were significantly associated with endoscopic ultrasonography accuracy. In EUS-SM2 early gastric cancer, tumor size of ≥ 30 mm was significantly associated with endoscopic ultrasonography accuracy. CONCLUSIONS Endoscopic ultrasonography is a useful modality in accurately determining the invasion depth of early gastric cancer before endoscopic submucosal dissection.
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Takamaru H, Yoshinaga S, Takisawa H, Oda I, Katai H, Sekine S, Taniguchi K, Saito Y. Endoscopic Ultrasonography Miniature Probe Performance for Depth Diagnosis of Early Gastric Cancer with Suspected Submucosal Invasion. Gut Liver 2020; 14:581-588. [PMID: 31816675 PMCID: PMC7492497 DOI: 10.5009/gnl19243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 12/18/2022] Open
Abstract
Background/Aims The accurate assessment of the depth of invasion of early gastric cancer (EGC) is critical to determine the most appropriate treatment option. However, it is difficult to distinguish shallow submucosal (SM1) invasion from deeper submucosal (SM2) invasion. We investigated the diagnostic performance of endoscopic ultrasonography (EUS) using a miniature probe for EGC with suspected SM invasion. Methods From April 2008 to June 2018, EGCs with suspected SM invasion were analyzed retrospectively. The EGCs examined by a 20 MHz high-frequency miniature probe was included in our study. Esophago-gastric junction cancers and patients treated by chemotherapy before resection were excluded. The sensitivity and specificity for the detection of SM2 invasion by EUS were compared with those of white light imaging (WLI). Additionally, factors related to depth underestimation or overestimation were investigated using multivariate analysis. Results A total of 278 EGCs in 259 patients were included in the final analysis. The sensitivity and specificity for SM2 or deeper by EUS were 73.7% (87/118) and 74.4% (119/160), respectively. The sensitivity and specificity by WLI were 47.5% (56/118) and 68.1% (109/160), respectively. The sensitivity of EUS was significantly superior to that of conventional endoscopy (p<0.01). Multivariate analysis revealed that an anterior location of the EGC was an independent risk factor for underestimation by EUS (odds ratio, 3.3; 95% confidence interval, 1.1 to 9.8; p=0.03). Conclusions The depth diagnostic performance for EGCs with suspected SM invasion using EUS was satisfactory and superior to that of conventional endoscopy. Additionally, it is important to recognize factors that may lead to misdiagnosis in those lesions.
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Affiliation(s)
- Hiroyuki Takamaru
- Divisions of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
| | | | - Hajime Takisawa
- Divisions of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
| | - Ichiro Oda
- Divisions of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
| | - Hitoshi Katai
- Divisions of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shigeki Sekine
- Divisions of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Yutaka Saito
- Divisions of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
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Clinicopathological Features of Advanced Gastric Cancers which Were Misjudged and Subjected to Endoscopic Submucosal Dissection. Gastroenterol Res Pract 2020; 2020:6525098. [PMID: 32190041 PMCID: PMC7071798 DOI: 10.1155/2020/6525098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/08/2020] [Indexed: 11/21/2022] Open
Abstract
Background and Aims Endoscopic submucosal dissection (ESD) is widely performed for early gastric cancer (EGC). We have sometimes encountered gastric cancer lesions for which ESD was performed and at which pathologically advanced cancer was found. In this study, we performed clinicopathological examination of lesions whose endoscopic diagnosis and pathology differed substantially. Methods ESD was performed for 2,194 gastric cancer lesions (1,753 cases) in our institute from April 2005 through March 2015. The vertical margin was positive or status unknown in 51 lesions (2.3%); among these, muscularis propria (MP) or deeper infiltration was identified in 6 lesions from specimens obtained during subsequent surgery. In 1 lesion with MP invasion, the vertical margin was negative. We evaluated the clinicopathological features of these 7 lesions and retrospectively reviewed endoscopic indicators of submucosal invasion for EGC on white light imaging (WLI), narrow-band imaging magnifying endoscopy (NBI-ME), and endoscopic ultrasonography (EUS) performed previously. Results Average age was 73.2 ± 7.2 years, and all cases were men. The 7 lesions diagnosed as advanced cancer were 0.32% of 2,194 lesions and were all located in the U region (fundus). On retrospective review of endoscopic findings, 2 of 7 lesions on WBI, 3 of 6 lesions on NBI-ME, and 2 of 5 lesions on EUS met the criteria for indicating submucosal invasion of EGC. No lesions had findings on all 3 modalities. Conclusion In rare cases, advanced gastric cancer could not be accurately diagnosed by endoscopy using various modalities. Each case had special characteristics making identification of deep infiltration difficult.
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Lan Z, Hu H, Mandip R, Zhu W, Guo W, Wen J, Xie F, Qiao W, Venkata A, Huang Y, Liu S, Li Y. Linear-array endoscopic ultrasound improves the accuracy of preoperative submucosal invasion prediction in suspected early gastric cancer compared with radial endoscopic ultrasound: A prospective cohort study. J Gastroenterol Hepatol 2020; 35:118-123. [PMID: 31379013 DOI: 10.1111/jgh.14819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/26/2019] [Accepted: 08/01/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIM There is a lack of literature comparing linear endoscopic ultrasound (EUS) and radial EUS for the prediction of the depth of invasion in early gastric cancer (EGC). The aim of this study is to evaluate the accuracy of linear EUS for the diagnosis of submucosal (SM) invasion and compare linear EUS with radial EUS in suspected EGC patients. METHODS Seventy-two consecutive patients with suspected EGC who underwent a preoperative assessment using linear EUS or radial EUS were prospectively enrolled. The depth of invasion was categorized into mucosal to SM (< T1b) and SM or deeper (≥ T1b), and the EUS-determined diagnosis was compared with postoperative histopathological findings. RESULTS Thirty-nine patients underwent radial EUS, and 33 patients underwent linear EUS examination. The baseline characteristics between the groups were well balanced. The diagnostic accuracy was much higher for patients who underwent linear EUS compared with radial EUS (90.9% vs 69.2%, P = 0.024). The sensitivity was 92.3% (95% confidence interval [CI] 66.7-98.6%) for linear EUS and 90.9% (95% CI 62.3-98.4%) for radial EUS. The specificity was 90.0% (95% CI 69.9-97.2%) in the linear EUS group, while the specificity was 60.7% (95% CI 42.4-76.4%) in the radial EUS group. Univariate analysis showed that EUS type (odds ratio 0.225, 95% CI 0.057-0.884, P = 0.033) was an associated risk factor of incorrect T1b staging in EGC patients. The area under the receiver operating curve was 0.912 and 0.758 for linear and radial EUS, respectively. CONCLUSION Linear EUS was more accurate for determining SM invasion and therapeutic strategy in suspected EGC patients compared with radial EUS.
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Affiliation(s)
- Zhixian Lan
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Haiyan Hu
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rai Mandip
- Department of Medicine, Division of Gastroenterology, Queen's University, Kingston, Ontario, Canada
| | - Wei Zhu
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wen Guo
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Wen
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fang Xie
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weiguang Qiao
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Akshintala Venkata
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ying Huang
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Side Liu
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yue Li
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Factors Affecting the Accuracy of Endoscopic Ultrasonography in the Diagnosis of Early Gastric Cancer Invasion Depth: A Meta-analysis. Gastroenterol Res Pract 2019; 2019:8241381. [PMID: 31933632 PMCID: PMC6942824 DOI: 10.1155/2019/8241381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/02/2019] [Accepted: 11/25/2019] [Indexed: 12/15/2022] Open
Abstract
Background Endoscopic ultrasonography (EUS) is the first imaging modality for investigating the depth of invasion in early gastric cancer (EGC). However, there is presently no consensus on the accuracy of EUS in diagnosing the invasion depth of EGC. Aim This study is aimed at systematically evaluating the accuracy of EUS in diagnosing the invasion depth of EGC and its affecting factors. Methods The literatures were identified by searching PubMed, SpringerLink, Cochrane Library, Web of Science, Nature, and Karger knowledge databases. Two researchers extracted the data from the literature and reconstructed these in 2 × 2 tables. The Meta-DiSc software was used to evaluate the overall sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic advantage ratio, and 95% confidence interval (CI). The SROC was drawn, and the area under the curve (AUC) was calculated to evaluate the diagnostic value. Results A total of 17 articles were selected, which included 4525 cases of lesions. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic dominance ratio, and 95% CI of EUS for diagnosing EGC was 0.87 (95% CI: 0.86-0.88), 0.67 (95% CI: 0.65-0.70), 2.90 (95% CI: 2.25-3.75), 0.17 (95% CI: 0.13-0.23), and 18.25 (95% CI: 12.61-26.39), respectively. The overall overstaging rate of mucosa/submucosa 1 (M/SM1) and SM by EUS was 13.31% and 32.8%, respectively, while the overall understaging rate of SM was 29.7%. The total misdiagnosis rates for EUS were as follows: 30.4% for lesions ≥ 2 cm and 20.9% for lesions < 2 cm, 27.7% for ulcerative lesions and 21.4% for nonulcerative lesions, and 22% for differentiated lesions and 26.9% for undifferentiated lesions. Conclusion EUS has a moderate diagnostic value for the depth of invasion of EGC. The shape, size, and differentiation of lesions might be the main factors that affect the accuracy of EUS in diagnosing EGC.
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Kim TY, Yi NH, Hwang JW, Kim JH, Kim GH, Kang MS. Morphologic pattern analysis of submucosal deformities identified by endoscopic ultrasonography for predicting the depth of invasion in early gastric cancer. Surg Endosc 2018; 33:2169-2180. [PMID: 30334157 DOI: 10.1007/s00464-018-6496-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aims of this study are to evaluate the usefulness of submucosal deformity pattern analysis with endoscopic ultrasonography (EUS) for predicting the depth of invasion in early gastric cancer (EGC) and the treatment results of endoscopic submucosal dissection (ESD). METHODS The endoscopic and EUS parameters of 345 patients with endoscopically suspected EGC who underwent endoscopic or surgical resection between July 2012 and May 2017 were retrospectively reviewed. All patients were classified into three categories as follows according to the morphologic type of submucosal deformity identified by EUS: (1) no submucosal deformity, (2) wedge-shaped deformity, and (3) arch-shaped deformity. The presence of an arch-shaped submucosal deformity on EUS and an active endoscopic ulcer or surrounding mucosal fold convergence/clubbing on conventional endoscopy were defined as suggestive of deep submucosal cancer invasion (SCI). RESULTS Upper location (p = 0.034) and the presence of an arch-shaped submucosal deformity on EUS (p < 0.001) were significant predictors of deep submucosal invasion, with the presence of an arch-shaped submucosal deformity showing the highest predictive value (odds ratio of 26.27). The overall diagnostic accuracy of EUS for predicting deep SCI was 83.5%, with a sensitivity of 84.0% and a specificity of 83.3%, which were significantly higher than those of conventional endoscopy. A larger lesion size and the presence of an arch-shaped submucosal deformity were significant factors associated with noncurative resection after ESD. CONCLUSIONS Submucosal deformity pattern analysis with EUS can provide more accurate information than conventional endoscopy for predicting deep SCI. The presence of an arch-shaped submucosal deformity on EUS was an effective predictor of deep SCI and noncurative resection.
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Affiliation(s)
- Tae Young Kim
- Department of Gastroenterology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokjiro, Busanjin-Gu, Busan, 47392, South Korea
| | - Nam Hee Yi
- Department of Gastroenterology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokjiro, Busanjin-Gu, Busan, 47392, South Korea
| | - Jin Won Hwang
- Department of Gastroenterology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokjiro, Busanjin-Gu, Busan, 47392, South Korea
| | - Ji Hyun Kim
- Department of Gastroenterology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokjiro, Busanjin-Gu, Busan, 47392, South Korea.
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, South Korea
| | - Mi Seon Kang
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
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Hsu WH, Kuo CH, Wu MC, Su YC, Chen CY, Wang JY, Shih HY, Lu CY, Wu DC, Yu FJ. Application of miniprobe sonography in the local staging of earlier stage upper gastrointestinal epithelial neoplasm: A four-year experience in a single center. ADVANCES IN DIGESTIVE MEDICINE 2018. [DOI: 10.1002/aid2.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Chao-Hung Kuo
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Meng-Chieh Wu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Yu-Chung Su
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Chiao-Yun Chen
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Jaw-Yuan Wang
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Hsiang-Yao Shih
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Chien-Yu Lu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
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Park SH, Choi KD, Jung K, Park Y, Lee S, Gong EJ, Na HK, Ahn JY, Jung KW, Lee JH, Kim DH, Song HJ, Lee GH, Jung HY. Gastric Cancer Caused by Adenoma: Predictive Factors Associated with Lesions Other Than the Expanded Indications. Gut Liver 2018; 12:246-254. [PMID: 29409304 PMCID: PMC5945255 DOI: 10.5009/gnl17162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/02/2017] [Accepted: 09/30/2017] [Indexed: 12/17/2022] Open
Abstract
Background/Aims We aimed to investigate whether the current indications for curative endoscopic resection (ER) of gastric cancer (GC) can be applied to GC caused by adenoma. Additionally, we attempted to identify factors predictive of lesions subsequently found in addition to the expanded indications for ER. Methods We retrospectively analyzed 342 patients diagnosed with GC caused by adenoma who underwent ER at a single tertiary center between February 2011 and December 2014. The gross whole tumor size was measured using the endoscopically resected specimen. The microscopic whole tumor size was measured using mapping paper. The estimated cancer size was calculated using the microscopic whole tumor size and the square root of the carcinoma component. Results A gross whole tumor size ≥3 cm, carcinoma component ≥35%, and gross ulceration were predictive of lesions other than the expanded indications for ER. The overall rate of lymph node metastasis was 0.3% (1/327), which only occurred in one patient with a lesion other than the expanded indications (4.5%, 1/22). Conclusions The current indications for curative ER in GC can be applied to GC caused by adenoma. In cases suspected of having lesions other than the expanded indications, patients should be cautiously selected for ER to reduce the risk of an inappropriate procedure.
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Affiliation(s)
- Seong Hwan Park
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoungwon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Yangsoon Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sunpyo Lee
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jeong Gong
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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11
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Sato K, Saito H, Yashima K, Isomoto H, Hirooka Y. Transabdominal Ultrasonography for Assessing the Depth of Tumor Invasion in Gastric Cancer. Yonago Acta Med 2017; 60:154-161. [PMID: 28959125 PMCID: PMC5611469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/12/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Although endoscopy and endoscopic ultrasonography are generally used to diagnose the depth of gastric tumor invasion, endoscopy is invasive and frequently results in patient discomfort. Transabdominal ultrasonography (TUS) is noninvasive and may be useful in determining this depth. We investigated the usefulness of TUS in determining the depth of tumor invasion in patients with gastric cancer. METHODS This retrospective study included 190 patients with gastric cancer and 200 lesions who underwent curative resection at the Department of Gastrointestinal Surgery of Tottori University Hospital from July 2007 to July 2015. The results of conventional diagnostic imaging and TUS were compared with those of pathological analysis obtained after surgery. Furthermore, the ruptured form of the third layer on TUS imaging was reviewed and investigated to differentiate between the SM2 and MP lesions. RESULTS The accuracy of TUS was similar to that of conventional diagnostic imaging for all depths of tumor invasion. Eight lesions could not be assessed by TUS, including four that could not be identified and four in which TUS was unable to diagnose the depth. In cases where the ruptured form of the third layer could be determined in MP lesions, the forms were observed toward the inside of the gastric lumen. CONCLUSION The results of this study suggested that the accuracy of TUS was equivalent to that of conventional diagnostic imaging in determining the depth of tumor invasion. TUS assessment criteria may be useful to classify this depth. Furthermore, the ruptured form of the third layer is believed to be important in distinguishing between early and advanced gastric cancer.
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Affiliation(s)
- Kengo Sato
- Department of Pathobiological Science and Technology, School of Health Sciences, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Hiroaki Saito
- †Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Kazuo Yashima
- ‡Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Hajime Isomoto
- ‡Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yasuaki Hirooka
- Department of Pathobiological Science and Technology, School of Health Sciences, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
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12
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Diagnostic performance of conventional endoscopy in the identification of submucosal invasion by early gastric cancer: the "non-extension sign" as a simple diagnostic marker. Gastric Cancer 2017; 20:304-313. [PMID: 27165641 DOI: 10.1007/s10120-016-0612-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/23/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM The ability to differentiate between mucosal (M) or microinvasive submucosal (SM1: depth of less than 500 µm) and invasive submucosal (SM2: depth of 500 µm or more) cancer is paramount when choosing the method of treatment for early gastric cancer (EGC). The "non-extension sign" relates to a localized increase in thickness and rigidity due to massive submucosal invasion by a cancer. The present study sought to assess the ability of conventional endoscopy (CE) to correctly identify SM2 cancer using only the non-extension sign. METHODS This is a retrospective study based on a prospectively collected database. EGCs had been diagnosed according to invasion depth as M-SM1 or SM2. In terms of the endoscopic diagnostic criterion, lesions positive for the non-extension sign were classified as SM2 cancers, while those negative for the non-extension sign were classified as M-SM1 cancers. Histopathological findings were used as the gold standard. RESULTS We examined a total of 863 lesions from 704 patients, comprising 104 true-positive, 733 true-negative, 9 false-positive, and 17 false-negative lesions. This yielded a sensitivity of 92.0 % (95 % confidence interval (CI), 87.0-97.0 %), a specificity of 97.7 % (95 % CI, 96.7-98.8 %), a positive predictive value of 85.9 % (95 % CI, 79.7-92.1 %), a negative predictive value of 98.8 % (95 % CI, 98.0-99.6 %), and a diagnostic accuracy of 96.9 % (95 % CI, 95.8-98.1 %). CONCLUSION The non-extension sign may be useful for accurately determining the suitability of minimally invasive endoscopic treatment. Nevertheless, considering the limitations of retrospective analysis, a further prospective study is warranted to confirm the diagnostic reliability of the non-extension sign.
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13
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Watari J, Ueyama S, Tomita T, Ikehara H, Hori K, Hara K, Yamasaki T, Okugawa T, Kondo T, Kono T, Tozawa K, Oshima T, Fukui H, Miwa H. What types of early gastric cancer are indicated for endoscopic ultrasonography staging of invasion depth? World J Gastrointest Endosc 2016; 8:558-567. [PMID: 27621768 PMCID: PMC4997788 DOI: 10.4253/wjge.v8.i16.558] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/02/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To clarify the diagnostic efficacy and limitations of endoscopic ultrasonography (EUS) and the characteristics of early gastric cancers (EGCs) that are indications for EUS-based assessment of cancer invasion depth.
METHODS We retrospectively investigated the cases of 153 EGC patients who underwent conventional endoscopy (CE) and EUS (20 MHz) before treatment.
RESULTS We found that 13.7% were “inconclusive” cases with low-quality EUS images, including all nine of the cases with protruded (0-I)-type EGCs. There was no significant difference in the diagnostic accuracy between CE and EUS. Two significant independent risk factors for misdiagnosis by EUS were identified-ulcer scarring [UL(+); odds ratio (OR) = 4.49, P = 0.003] and non-indication criteria for endoscopic resection (ER) (OR = 3.02, P = 0.03). In the subgroup analysis, 23.1% of the differentiated-type cancers exhibiting SM massive invasion (SM2) invasion (submucosal invasion ≥ 500 μm) by CE were correctly diagnosed by EUS, and 23.1% of the undifferentiated-type EGCs meeting the expanded-indication criteria for ER were correctly diagnosed by EUS.
CONCLUSION There is no need to perform EUS for UL(+) EGCs or 0-I-type EGCs, but EUS may enhance the pretreatment staging of differentiated-type EGCs with SM2 invasion without UL or undifferentiated-type EGCs revealed by CE as meeting the expanded-indication criteria for ER.
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14
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Kim JM, Sohn JH, Cho MY, Kim WH, Chang HK, Jung ES, Kook MC, Jin SY, Chae YS, Park YS, Kang MS, Kim H, Lee JH, Park DY, Kim KM, Kim H, Kim YW, Hwang SS, Seol SY, Jung HY, Lee NR, Park SH, You JH. Pre- and post-ESD discrepancies in clinicopathologic criteria in early gastric cancer: the NECA-Korea ESD for Early Gastric Cancer Prospective Study (N-Keep). Gastric Cancer 2016; 19:1104-1113. [PMID: 26621523 PMCID: PMC5033989 DOI: 10.1007/s10120-015-0570-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/05/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Discrepancies in the clinicopathologic parameters pre- and post-endoscopic submucosal dissection (ESD) sometimes necessitate additional surgical resection. The aim of this study was to assess such discrepancies in clinicopathologic parameters before and after ESD in the context of reducing the risk of failure of curative ESD. METHODS Data on 712 early gastric cancer patients were prospectively collected from 12 university hospitals nationwide. The inclusion criteria were differentiated carcinoma <3 cm in size, no ulceration, submucosal invasion <500 μm, and no metastasis. Clinicopathologic factors were compared retrospectively. RESULTS The discrepancy rate was 20.1 % (148/737) and the most common cause of discrepancy was tumor size (64 cases, 8.7 %). Ulceration, undifferentiated histology, and SM2 invasion were found in 34 (4.6 %), 18 (2.4 %), and 51 cases (6.9 %), respectively. Lymphovascular invasion (LVI) was observed in 34 cases (4.6 %). Cases with lesions exceeding 3 cm in size showed more frequent submucosal invasion, an elevated gross morphology, and upper and middle locations (p < 0.05). In the cases with ulceration, depth of invasion (DOI) was deeper than in the cases without ulceration (p = 0.005). Differentiation was correlated with DOI and LVI (p = 0.021 and 0.007). DOI was correlated with tumor size, ulceration, differentiation, LVI, gross type, and location. There were statistically significant differences between mucosal cancer cases and submucosal cancer cases in tumor size, differentiation, ulceration, LVI, and location. CONCLUSIONS The overall discrepancy rate was 20.1 %. To reduce this rate, it is necessary to evaluate the DOI very cautiously, because it is correlated with other parameters. In particular, careful checking for SM-invasive cancer is required due to the high incidence of LVI irrespective of the depth of submucosal invasion.
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Affiliation(s)
- Joon Mee Kim
- grid.202119.90000000123648385Department of Pathology, Inha University School of Medicine, Incheon, Korea
| | - Jin Hee Sohn
- grid.264381.a000000012181989XDepartment of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108, Pyung-Dong, Jongro-Ku, Seoul, 110-102 Korea
| | - Mee-Yon Cho
- grid.464718.80000000406473124Yonsei University Wonju Christian Hospital, Wonju, Korea
| | - Woo Ho Kim
- grid.31501.360000000404705905Seoul National University College of Medicine, Seoul, Korea
| | - Hee Kyung Chang
- grid.411144.50000000405329454Kosin University College of Medicine, Busan, Korea
| | - Eun Sun Jung
- grid.411947.e0000000404704224College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | | | - So-Young Jin
- grid.412678.e0000000406341623Soonchunhyang University Hospital, Seoul, Korea
| | - Yang Seok Chae
- grid.222754.40000000108402678Korea University College of Medicine, Seoul, Korea
| | - Young Soo Park
- grid.267370.70000 0004 0533 4667University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea
| | - Mi Seon Kang
- grid.411625.50000000406471102Inje University Busan Paik Hospital, Busan, Korea
| | - Hyunki Kim
- grid.15444.300000000404705454Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hyuk Lee
- grid.411602.00000 0004 0647 9534Chonnam National University Hwasun Hospital, Hwasun-Gun, Korea
| | - Do Youn Park
- grid.262229.f0000000107198572Pusan National University College of Medicine, Busan, Korea
| | - Kyoung Mee Kim
- grid.414964.a0000000106405613Sungkyunkwan University Samsung Medical Center, Seoul, Korea
| | - Hoguen Kim
- grid.15444.300000000404705454Yonsei University College of Medicine, Seoul, Korea
| | - Youn Wha Kim
- grid.289247.20000000121717818Kyunghee University College of Medicine, Seoul, Korea
| | - Seung-Sik Hwang
- grid.202119.90000000123648385Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sang Yong Seol
- grid.411625.50000000406471102Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Hwoon-Yong Jung
- grid.413967.e0000000108422126Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea
| | - Na Rae Lee
- grid.453731.7000000044691449XNational Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Seung-Hee Park
- grid.453731.7000000044691449XNational Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Ji Hye You
- grid.453731.7000000044691449XNational Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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15
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Pei Q, Wang L, Pan J, Ling T, Lv Y, Zou X. Endoscopic ultrasonography for staging depth of invasion in early gastric cancer: A meta-analysis. J Gastroenterol Hepatol 2015; 30:1566-73. [PMID: 26094975 DOI: 10.1111/jgh.13014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 03/29/2015] [Accepted: 05/30/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM Endoscopic ultrasonography (EUS) is a widely used imaging modality for detecting the depth of early gastric cancer (EGC) invasion. However, the studies pertaining to EUS for staging early gastric cancer have reported widely varied sensitivities and specificities. This study was conducted to estimate the overall diagnostic accuracy of EUS for staging the depth in EGCs. METHODS The literatures were identified by searching in PubMed, Embase, and Web of Knowledge databases. Two reviewers independently extracted the information from the literatures for constructing 2 × 2 table. A random-effect model or a fixed-effect model was used to estimate the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. A summary receiver operating characteristic curve also was constructed. Meta-regression and subgroup analysis were used to explore the sources of heterogeneity. RESULTS The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of EUS for M staging were 76% (95% confidence interval [CI], 74-78%), 72% (95% CI, 69-75%), 3.67 (95% CI, 2.48-5.44), and 0.31 (95% CI, 0.24-0.40), respectively. For SM staging, these results were 62% (95% CI, 59-66%), 78% (95% CI, 76-80%), 2.99 (95% CI, 2.26-3.96), and 0.43 (95% CI, 0.32-0.57), respectively. For M/SM1 staging, they were 90% (95% CI, 88-92%), 67% (95% CI, 61-72%), 3.14 (95% CI, 2.08-4.73), and 0.12 (95% CI, 0.07-0.22), respectively. The area under the curve for mucosal, submucosal, and mucosal/minimal submucosal invasion staging were 0.85, 0.82, and 0.81, respectively. CONCLUSIONS Endoscopic ultrasonography only has a relatively low accuracy for staging the depth of invasion in EGCs. Accordingly, EUS may be not indispensable in the staging of EGCs.
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Affiliation(s)
- Qingshan Pei
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Lei Wang
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, China
| | - Jianmei Pan
- Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
| | - Tingsheng Ling
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, China
| | - Ying Lv
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, China
| | - Xiaoping Zou
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, China
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16
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Yoshinaga S, Hilmi IN, Kwek BEA, Hara K, Goda K. Current status of endoscopic ultrasound for the upper gastrointestinal tract in Asia. Dig Endosc 2015; 27 Suppl 1:2-10. [PMID: 25537645 DOI: 10.1111/den.12422] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/22/2014] [Indexed: 12/12/2022]
Abstract
We summarize the current status of endoscopic ultrasound (EUS) for the upper gastrointestinal (GI) tract solely in Asia, focusing on the staging of superficial cancers and the diagnosis of submucosal tumors (SMT), by analysis of questionnaire responses and a literature review. EUS for assessing the depth of superficial cancers of the upper GI tract is useful; however, evidence is lacking to support that EUS is superior to other modalities. The current status of EUS varies across different Asian countries, and standardization of the methods used both during the procedure and for depth subclassification is necessary to evaluate the diagnostic accuracy. Although EUS alone is limited in the diagnosis of SMT, EUS-guided fine-needle aspiration is an effective and safe diagnostic tool. Although there is a role for EUS, there are still many limitations both technically and in terms of accessibility.
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17
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Asakawa Y, Ohtaka M, Maekawa S, Fukasawa M, Nakayama Y, Yamaguchi T, Inoue T, Uetake T, Sakamoto M, Sato T, Kawaguchi Y, Fujii H, Mochizuki K, Hada M, Oyama T, Yasumura T, Omata K, Nishiyama A, Naito K, Hata H, Haba Y, Miyata K, Saitoh H, Yamadera Y, Miura K, Kawaoi A, Abe T, Tsunoda H, Honda Y, Kurosaki M, Enomoto N. Stratifying the risk of lymph node metastasis in undifferentiated-type early gastric cancer. World J Gastroenterol 2015; 21:2683-2692. [PMID: 25759537 PMCID: PMC4351219 DOI: 10.3748/wjg.v21.i9.2683] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/22/2014] [Accepted: 10/15/2014] [Indexed: 02/07/2023] Open
Abstract
AIM: To study how lymph node metastasis (LNM) risk is stratified in undifferentiated-type early gastric cancer (undiff-EGC) dependent on combinations of risk factors.
METHODS: Five hundred and sixty-seven cases with undiff-EGC undergoing gastrectomy with lymphadenectomy were examined retrospectively. Using clinicopathological factors of patient age, location, size, an endoscopic macroscopic tumor form, ulceration, depth, histology, lymphatic involvement (LI) and venous involvement (VI), LNM risk was examined and stratified by conventional statistical analysis and data-mining analysis.
RESULTS: LNM was positive in 44 of 567 cases (7.8%). Univariate analysis revealed > 2 cm, protrusion, submucosal (sm), mixed type, LI and VI as significant prognostic factors and > 2 cm and LI-positive were independent factors by multivariate analysis. In preoperatively evaluable factors excluding LVI, sm and > 2 cm were independent factors. According to the depth and size, cases were categorized into the low-risk group [m and ≤ 2 cm, 0% (LNM incidence)], the moderate-risk group (m and > 2 cm, 5.6%; and sm and ≤ 2 cm, 6.0%), and the high-risk group (sm and > 2 cm, 19.3%). On the other hand, LNM occurred in 1.4% in all LI-negative cases, greatly lower than 28.2% in all LI-positive cases, and LNM incidence was low in LI-negative cases even in the moderate- and high-risk groups.
CONCLUSION: LNM-related factors in undiff-EGC were depth and size preoperatively while those were LI and size postoperatively. Among these factors, LI was the most significantly correlated factor.
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