Background/Aims-Endoscopic ultrasonography is expected to be useful for invasion depth staging of early gastric cancer. A prospective blind study of the staging characteristics of endoscopy and endoscopic ultrasonography for early gastric cancer was performed. Methods-Findings of endoscopy and endoscopic ultrasonography using a 20 MHz thin ultrasound probe were independently reviewed and the results of 52 early gastric cancer lesions analysed. Results-The overall accuracy rates in invasion depth staging of early gastric cancer were 63% for endoscopy and 71% for endoscopic ultrasonography. No statistically significant diVerences were observed in overall accuracy. Endoscopic ultrasonography tended to overstage, and lesions that were classified as mucosal cancer by endoscopic ultrasonography were very likely (95%) to be limited to the mucosa on histological examination. All 16 lesions staged as mucosal cancer independently but coincidentally by both methods were histologically limited to the mucosa. Conclusions-Endoscopic ultrasonography is expected to compensate for the understaging of lesions with submucosal invasion that are endoscopically staged as mucosal cancer. (Gut 1999;44:361-365) Keywords: early gastric cancer; endoscopic ultrasonography; endoscopyThe first use of the ultrasonic endoscope was reported in 1980, and the use of endoscopic ultrasonography (EUS) has become widespread for examination of the biliary tract, gall bladder, pancreas, and gastrointestinal tract. [1][2][3][4][5] In the field of stomach diseases, the importance of tumour staging of gastric cancer has been increasing with the development of the endoscopic resection technique.6-8 EUS has been expected to be useful for invasion depth staging of early gastric cancer.9-13 Although EUS using the appropriate instrument (7.5-12.5 MHz) is useful for advanced gastric cancer, optical control of such a large instrument for small lesions is not easy and the resolution is insuYcient for the precise observation of superficial lesions. The recent introduction of high frequency thin endoscopic ultrasound probes has enabled us to perform target scanning with high resolution of even very small gastric cancer lesions under endoscopic control. [14][15][16] Conventional endoscopy has been the most useful diagnostic modality for early gastric cancer.17 18 Unfortunately, there are only a few reports on the relation between the tumour invasion depth staging characteristics of endoscopy and EUS. Therefore the true role of EUS in early gastric cancer depth staging is still unclear. To obtain fundamental data to answer such questions, we previously performed a retrospective non-blinded pilot study of the staging characteristics of endoscopy and EUS in 108 early gastric cancer lesions. 19 The overall accuracy rates for staging depth of invasion for endoscopy and EUS were 72.2 and 64.8% respectively. Staging characteristics with regard to understaging and overstaging of the two methods were significantly diVerent. EUS showed a higher overstaging rate. Le...
Endoscopic ultrasonography (EUS) is considered to be useful for deciding the treatment course for early gastric cancer. To determine reliable indications suggesting submucosal tumor invasion, we retrospectively analyzed EUS images of the hyperechoic third layer, which corresponds to the submucosa. The subjects enrolled in this study were 75 patients, with 78 gastric cancers (diagnosed as mucosal cancer without ulcerous changes on endoscopy and as histologically differentiated adenocarcinoma on biopsy), who were also examined by EUS. We retrospectively classified EUS features of the third layer (submucosa) into five groups: (1) irregular narrowing, (2) budding sign, (3) multiple echo-free spots, (4) unclear, and (5) no changes. In endoscopically diagnosed gastric mucosal cancer, 16 of the 78 lesions were associated with histologic submucosal invasion. EUS features that were associated with a high incidence of histological submucosal tumor invasion were irregular narrowing (submucosal invasion, 60.0%) and the budding sign (85.7%), and 90.9% of lesions with either of these features had submucosal invasion of tumors when tumorous changes in the third layer exceeded 1 mm in depth. Endosonographic irregular narrowing and a budding sign of more than 1 mm in depth in the third layer are useful for the diagnosis of submucosal invasion in gastric cancers that are diagnosed as mucosal cancers without ulcerous change on endoscopy.
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