Abstract
Background
Endoscopic resection as curative treatment of early gastric cancer (EGC) requires accurate staging for depth of invasion (T) before therapy. This study aimed to compare T staging of EGC using a miniprobe with that of conventional endoscopy (CE).
Methods
A total of 388 patients with suspected of EGC by CE were prospectively enrolled in the study. After miniprobe staging by an experienced endosonographer, CE staging was performed by another endoscopist who was blinded to the miniprobe assessment. Patients underwent either endoscopic resection (n = 325) or surgery (=63) according to staging results. Results of each method were compared with the histology of the resected specimen. Clinicopathological factors affecting accuracy of each test were also evaluated.
Results
Overall accuracy of miniprobe and CE staging was 78.9% (306/388) and 81.4% (316/388), respectively (p = 0.052). Sensitivity for T1m was more than 95% (miniprobe 98.7%, CE 97.7%), whereas sensitivity for T1sm was lower at 6.6% for miniprobe and 23.7% for CE (p = 0.002). Among nine lesions identically considered submucosal invasion by both methods, three were T1sm cancer. Diagnostic accuracy of the miniprobe was lower than that of CE with respect to lesions located in the lower third of the stomach, differentiated histology, or massive submucosal invasion.
Conclusions
Overall accuracy of the miniprobe and CE for T staging in EGC was approximately 80% with no significant difference. Accurate prediction of both techniques for submucosal invasion was poor, even by using a combination of the two methods. The use of the miniprobe may not increase the positive predictive value for T staging over the use of CE alone.
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References
Sano T, Kobori O, Muto T (1992) Lymph node metastasis from early gastric cancer: endoscopic resection of tumour. Br J Surg 79:241–244
Nam SY, Choi IJ, Park KW, Kim CG, Lee JY, Kook MC, Lee JS, Park SR, Lee JH, Ryu KW, Kim YW (2009) Effect of repeated endoscopic screening on the incidence and treatment of gastric cancer in health screenees. Eur J Gastroenterol Hepatol 21:855–860
Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, Hwangbo Y, Keum BR, Park JJ, Chun HJ, Kim HJ, Kim JJ, Ji SR, Seol SY (2009) Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc 69:1228–1235
Hunerbein M, Ulmer C, Handke T, Schlag PM (2003) Endosonography of upper gastrointestinal tract cancer on demand using miniprobes or endoscopic ultrasound. Surg Endosc 17:615–619
Menzel J, Hoepffner N, Nottberg H, Schulz C, Senninger N, Domschke W (1999) Preoperative staging of esophageal carcinoma: miniprobe sonography versus conventional endoscopic ultrasound in a prospective histopathologically verified study. Endoscopy 31:291–297
Yanai H, Tada M, Karita M, Okita K (1996) Diagnostic utility of 20-megahertz linear endoscopic ultrasonography in early gastric cancer. Gastrointest Endosc 44:29–33
Ishigami S, Yoshinaka H, Sakamoto F, Natsugoe S, Tokuda K, Nakajo A, Matsumoto M, Okumura H, Hokita S, Aikou T (2004) Preoperative assessment of the depth of early gastric cancer invasion by transabdominal ultrasound sonography (TUS): a comparison with endoscopic ultrasound sonography (EUS). Hepatogastroenterology 51:1202–1205
Kwee RM, Kwee TC (2008) The accuracy of endoscopic ultrasonography in differentiating mucosal from deeper gastric cancer. Am J Gastroenterol 103:1801–1809
Sano T, Okuyama Y, Kobori O, Shimizu T, Morioka Y (1990) Early gastric cancer. Endoscopic diagnosis of depth of invasion. Dig Dis Sci 35:1340–1344
Yanai H, Noguchi T, Mizumachi S, Tokiyama H, Nakamura H, Tada M, Okita K (1999) A blind comparison of the effectiveness of endoscopic ultrasonography and endoscopy in staging early gastric cancer. Gut 44:361–365
Yanai H, Matsumoto Y, Harada T, Nishiaki M, Tokiyama H, Shigemitsu T, Tada M, Okita K (1997) Endoscopic ultrasonography and endoscopy for staging depth of invasion in early gastric cancer: a pilot study. Gastrointest Endosc 46:212–216
Kang HY, Kim SG, Kim JS, Jung HC, Song IS (2010) Clinical outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Surg Endosc 24:509–516
Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225
Lambert R (2005) Endoscopic classification review group. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 37:570–578
Association Japanese Gastric Cancer (1998) Japanese classification of gastric carcinoma––2nd english edition. Gastric Cancer 1:10–24
Mori M, Adachi Y, Kakeji Y, Korenaga D, Sugimachi K, Motooka M, Ooiwa T (1992) Superficial flat-type early carcinoma of the stomach. Cancer 69:306–313
Dwyer AJ (1991) Matchmaking and McNemar in the comparison of diagnostic modalities. Radiology 178:328–330
Kwee RM, Kwee TC (2007) Imaging in local staging of gastric cancer: a systematic review. J Clin Oncol 25:2107–2116
Kim JH, Song KS, Youn YH, Lee YC, Cheon JH, Song SY, Chung JB (2007) Clinicopathologic factors influence accurate endosonographic assessment for early gastric cancer. Gastrointest Endosc 66:901–908
Hizawa K, Iwai K, Esaki M, Matsumoto T, Suekane H, Iida M (2002) Is endoscopic ultrasonography indispensable in assessing the appropriateness of endoscopic resection for gastric cancer? Endoscopy 34:973–978
Sabet E, Okai T, Minamoto T, Mai M, Sawabu N (2002) Three-dimensional endoscopic ultrasonography for the assessment of early gastric carcinoma invasion: could it provide diagnostic innovations? Dig Endosc 14:53–60
Hunerbein M, Handke T, Ulmer C, Schlag PM (2004) Impact of miniprobe ultrasonography on planning of minimally invasive surgery for gastric and colonic tumors. Surg Endosc 18:601–605
Ohashi S, Segawa K, Okamura S, Mitake M, Urano H, Shimodaira M, Takeda T, Kanamori S, Naito T, Takeda K, Itoh B, Goto H, Niwa Y, Hayakawa T (1999) The utility of endoscopic ultrasonography and endoscopy in the endoscopic mucosal resection of early gastric cancer. Gut 45:599–604
Akashi K, Yanai H, Nishikawa J, Satake M, Fukagawa Y, Okamoto T, Sakaida I (2006) Ulcerous change decreases the accuracy of endoscopic ultrasonography diagnosis for the invasive depth of early gastric cancer. Int J Gastrointest Cancer 37:133–138
Gotoda T (2005) A large endoscopic resection by endoscopic submucosal dissection procedure for early gastric cancer. Clin Gastroenterol Hepatol 3:S71–S73
Ahn HS, Lee HJ, Yoo MW, Kim SG, Im JP, Kim SH, Kim WH, Lee KU, Yang HK (2009) Diagnostic accuracy of T and N stages with endoscopy, stomach protocol CT, and endoscopic ultrasonography in early gastric cancer. J Surg Oncol 99:20–27
Akahoshi K, Chijiwa Y, Hamada S, Sasaki I, Nawata H, Kabemura T, Yasuda D, Okabe H (1998) Pretreatment staging of endoscopically early gastric cancer with a 15 MHz ultrasound catheter probe. Gastrointest Endosc 48:470–476
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Jeongmin Choi, Sang Gyun Kim, Jong Pil Im, Joo Sung Kim, Hyun Chae Jung, and In Sung Song have no conflicts of interest or financial ties to disclose.
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Choi, J., Kim, S.G., Im, J.P. et al. Is endoscopic ultrasonography indispensable in patients with early gastric cancer prior to endoscopic resection?. Surg Endosc 24, 3177–3185 (2010). https://doi.org/10.1007/s00464-010-1112-0
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DOI: https://doi.org/10.1007/s00464-010-1112-0