Endoscopic Ultrasonography in the Assessment of Invasive Gastric Cancer

Abstract

Endoscopic ultrasonographic (EUS) images of 174 cases of gastric cancer were examined to assess the depth of tumor invasion. Comparison was made between the depth of the changes shown in the multi-layered image produced by ultrasonography and the actual depth of invasion. Cases showing ultrasonographic changes extending deeper than the actual tumor were found to have fibrosis associated with peptic ulceration within the tumor focus. In such cases the echo images chiefly depicted the form and nature of the fibrosis, and the images were so characteristic that they could be classified into patterns. In the other cases the depth of tumor invasion could be almost precisely determined by detecting to which layer the changes shown by EUS extended.

Endoscopic Ultrasonography: Current Indications and Applications

“…The results for staging are similar to those for the esophagus, with T stage accuracy ranging from 67 to 92% and N stage accuracy from 50 to 88% in the larger series [44][45][46][47], When these series were combined, the average T stage and N stage accuracy was 78 and 73%, respectively, and compared favorably to CT scanning for preoperative staging -about 50% overall [47][48][49], The actual N stage of patients with gastric adenocarcinoma turns out to have a significant influence on accuracy of EUS. For those with N0 tumors, EUS is cor rect in over 90%, however, the rate falls to about 65 and 52% for N| and N2 tumors, respectively, in one recent series [44], In addi tion to vertical and regional spread, EUS may provide useful information regarding the hor izontal involvement of the stomach, to assist in determining the proper line of resection.…”

A Classification System of Echogenicity for Gastrointestinal Neoplasms

“…Although echogenicity reflects sonohistopathological structure, an important part of differential diagnosis, there has been no adequate method for objective assessment of the echogenicity of gastrointestinal neoplasms. Previous reports on gastrointestinal diseases have applied the terms ‘hypoechoic’, ‘hyperechoic’ determined by mere operator’s subjective impressions without clear reason [1,2,3,4,5,6,7,8,9, 13]. Interpretation of echogenicity in terms of ultrasound intensity (dB) does not have an absolute meaning because echogenicity in the range of interest is inevitably affected by the sound pathway.…”

“…Endoscopic ultrasonography (EUS) has been reported to be an effective modality in the assessment of gastrointestinal neoplasms, enabling us to evaluate the extension and depth of tumor invasion, original layer of submucosal tumor (SMT), homogeneity of internal parenchymal echo, and echogenicity of lesions [1,2,3,4,5,6,7,8,9,10,11,12,13]. Because echogenicity reflects histopathological structure, its evaluation is important to the differential diagnoses of neoplastic lesions.…”

Retroperitoneal neurilemoma diagnosed by endosonographically guided fine needle aspiration

“…EUS is a useful imaging technique for demonstrating lesions of the gastrointestinal tract and in adjacent organs, but it cannot reliably distinguish between benign and malignant solid lesions. 3 Significant progress was made with the use of EUS-guided FNA, which has proven to be a safe method capable of providing sufficient specimens to make a diagnosis and to stage the lesion. 4,5 Color Doppler examination makes it possible to avoid vessels during FNA.…”