A blind comparison of the effectiveness of endoscopic ultrasonography and endoscopy in staging early gastric cancer

Abstract

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...

Diagnostic performance of conventional endoscopy in the identification of submucosal invasion by early gastric cancer: the “non-extension sign” as a simple diagnostic marker

“…However, even recent studies have reported widely varying diagnostic accuracies of 67-90 % when determining the depth of invasion using EUS, making it difficult to view the method as sufficiently reliable [9][10][11][12][13][14]. Furthermore, its diagnostic ability is similar to that of CE alone [15][16][17], and a number of studies have stated that EUS is unsuitable as a routine investigation for determining the depth of invasion by EGCs [15]. In recent years, there have been some promising reports regarding the determination of invasion depth using new modalities such as infrared endoscopy [18] and magnifying endoscopy with narrow-band imaging [19], but these are yet to produce consistently reliable results.…”

Depth-predicting score for differentiated early gastric cancer

“…The overall accuracy rates for determining depth of invasion of EGCs were between 63 and 73% by non-objective criteria [11,14,15]. Namieno et al [16] concluded that Tumor size (more than 30 mm) 2 0…”

“…The introduction of high-frequency thin probes has allowed target scanning with high resolution under endoscopic control [8,9]. In spite of some excellent accuracy data [17], there have been no significant differences between EUS and endoscopy in terms of depth accuracy [14].…”

Endoscopic features of early stage gastric adenocarcinoma of fundic gland type (chief cell predominant type): a case report

“…Moreover, EUS sometimes overestimates tumor depth [19] , leading to unnecessary surgery in some cases. Histological analysis of resected specimens provides the most accurate assessment of the tumor depth and lymphatic or venous involvement, which define requirement for surgery.…”