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Clinical efficacy of endoscopic ultrasonography for decision of treatment strategy of gastric cancer

  • Jung Kim
  • Sang Gyun Kim
  • Hyunsoo Chung
  • Joo Hyun Lim
  • Ji Min Choi
  • Jae Yong Park
  • Hyo-Joon Yang
  • Seung Jun Han
  • Sooyeon Oh
  • Min Seong Kim
  • Hyun Ju Kim
  • Hyoungju Hong
  • Hee Jong Lee
  • Jue Lie Kim
  • Eunwoo Lee
  • Hyun Chae Jung
Article
  • 162 Downloads

Abstract

Background

Accurate preoperative tumor staging of gastric cancer is indispensable with expansion of indications for laparoscopic surgery and endoscopic resection. It is important to distinguish mucosal cancer (T1a) in smaller lesion and differentiate early gastric cancer (EGC) in larger lesion considering endoscopic resection indication and laparoscopic surgery indication. We evaluated the clinical outcomes of endoscopic ultrasonography (EUS) for the decision of treatment strategy of gastric cancer compared with pathological staging.

Methods

The patients who underwent EUS and surgical or endoscopic resection for gastric cancer were retrospectively reviewed between September 2005 and February 2016. The depth of tumor invasion (T staging) by EUS was compared with the pathological staging after endoscopic or surgical resection.

Results

A total of 6084 patients were finally analyzed. The accuracy rates for T1a and EGC were 75.0 and 89.4%, respectively. The overall accuracy of T staging by EUS was 66.3% when divided by T1a, T1b, and over T2. The accuracy of EUS prior to endoscopic resection was 75.1% in absolute indication and 73.1% in expanded criteria, respectively. The accuracy rates for T1a with lesion ≤ 2 cm in miniprobe EUS and EGC with lesion > 2 cm in conventional EUS were 84.6 and 83.2%, respectively. In multivariate analysis, presence of ulcer, large tumor size, and radial EUS were associated with overestimation, and small tumor size and miniprobe were associated with underestimation in T staging.

Conclusions

EUS showed the high accuracy of 84.6% for T1a in lesion ≤ 2 cm in miniprobe EUS and 83.2% for EGC in lesion > 2 cm in conventional EUS, respectively. EUS can be a complementary diagnostic method to determine endoscopic or surgical treatment modality.

Keywords

Endoscopic ultrasonography Gastric cancer Tumor staging 

Notes

Acknowledgements

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2017R1D1A1B03036304).

Compliance with ethical standards

Disclosures

Jung Kim, Sang Gyun Kim, Hyunsoo Chung, Joo Hyun Lim, Ji Min Choi, Jae Yong Park, Hyo-Joon Yang, Seung Jun Han, Sooyeon Oh, Min Seong Kim, Hyun Ju Kim, Hyoungju Hong, Hee Jong Lee, Jue Lie Kim, Eunwoo Lee, and Hyun Chae Jung have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jung Kim
    • 1
  • Sang Gyun Kim
    • 1
  • Hyunsoo Chung
    • 1
  • Joo Hyun Lim
    • 2
  • Ji Min Choi
    • 2
  • Jae Yong Park
    • 3
  • Hyo-Joon Yang
    • 4
  • Seung Jun Han
    • 1
  • Sooyeon Oh
    • 1
  • Min Seong Kim
    • 1
  • Hyun Ju Kim
    • 1
  • Hyoungju Hong
    • 1
  • Hee Jong Lee
    • 1
  • Jue Lie Kim
    • 1
  • Eunwoo Lee
    • 1
  • Hyun Chae Jung
    • 1
  1. 1.Department of Internal Medicine and Liver Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam CenterSeoul National University HospitalSeoulRepublic of Korea
  3. 3.Department of Internal MedicineChung-Ang University HospitalSeoulRepublic of Korea
  4. 4.Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulRepublic of Korea

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