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A specific role of endoscopic ultrasonography for therapeutic decision-making in patients with gastric cardia cancer

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Abstract

Background

The role of endoscopic ultrasonography (EUS) in gastric cardia cancer should be further evaluated because the accuracy of EUS depends on tumor location. We aimed to identify a specific role of EUS for therapeutic decision-making in patients with gastric cardia cancer.

Methods

Initial EUS examinations for treatment-naïve gastric cancer that were followed by endoscopic resection or surgery were included in the study. Lesions were classified as cardiac and non-cardiac cancer according to tumor location. The diagnostic performance of EUS in predicting invasion depth was compared between the two groups.

Results

The overall accuracy of EUS in predicting invasion depth did not differ between the cardiac and non-cardiac cancer groups (44.4 vs. 52.3 %, P = 0.259). The underestimation rate was higher in the cardiac cancer group than in the non-cardiac cancer group (37.0 vs. 18.5 %, P = 0.001). When the depth of invasion was predicted to be deeper than the mucosa (submucosal or deeper) by EUS, the positive predictive value was 82.1 [95 % confidence interval (CI), 66.5–92.5 %] and 62.9 % (95 % CI, 60.5–66.9 %) in the cardiac and non-cardiac cancer groups, respectively (P = 0.015). In multivariable analysis, tumor location in the cardia was found to be an independent factor for the underestimation of invasion depth [odds ratio (95 % CI) = 2.242 (1.156–4.349)].

Conclusions

The underestimation rate in predicting invasion depth was significantly higher for cardiac cancers than for non-cardiac cancers. Therefore, selection of the treatment method for gastric cardia cancer via EUS should be done carefully.

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Authors and Affiliations

  1. Department of Internal Medicine, Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea

    Chan Hyuk Park

  2. Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Jun Chul Park, Hyunsoo Chung, Sung Kwan Shin, Sang Kil Lee & Yong Chan Lee

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  1. Chan Hyuk Park
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  2. Jun Chul Park
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Correspondence to Jun Chul Park.

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Disclosures

Chan Hyuk Park, Jun Chul Park, Hyunsoo Chung, Sung Kwan Shin, Sang Kil Lee, and Yong Chan Lee have no conflicts of interest or financial ties to disclose.

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Park, C.H., Park, J.C., Chung, H. et al. A specific role of endoscopic ultrasonography for therapeutic decision-making in patients with gastric cardia cancer. Surg Endosc 30, 4193–4199 (2016). https://doi.org/10.1007/s00464-015-4728-2

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  • DOI: https://doi.org/10.1007/s00464-015-4728-2

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