Endoscopic Ultrasonography in the Local Staging of Primary Gastric Lymphoma

Abstract

Endoscopic ultrasonography (EUS) and endoscopy were prospectively performed and compared to the histopathologic findings of the resection specimens in 24 patients with primary gastric lymphoma (PGL). On EUS, three types of PGL could be differentiated, a superficial type (n = 10), an infiltrating type (n = 12) and a tumorous type (n = 2). In the correct assessment of surface extension of the tumors, endoscopy and EUS agreed in 37.5% of cases and EUS showed more extensive disease than endoscopy in 58% of cases. However, in comparison to the resection specimens, EUS still underestimated the tumor surface extension in 37.5% of cases; this was mainly in low grade malignant PGL. The depth of tumor infiltration was correctly determined on EUS compared to the resection specimens in 91.5% of cases. Sensitivity, specificity and accuracy of diagnosing lymph node metastases were 100%, 80% and 83%, respectively. We conclude that EUS is a useful pre-therapeutic staging tool for primary gastric lymphoma but there remain some problems in determining the longitudinal and circular tumor spread in order to accurately guide the extent of gastric resection.

Combination therapy with rituximab and intravenous or oral fludarabine in the first‐line, systemic treatment of patients with extranodal marginal zone B‐cell lymphoma of the mucosa‐associated lymphoid tissue type

“…In patients who had lymphoma restricted to the stomach, upper endoscopy and upper ultrasound endoscopy were performed. 33 Additional radiologic studies were performed according to the primary anatomic site of disease, such as magnetic resonance imaging of the salivary glands or orbit.…”

Endoscopic ultrasound: an overview of its role in current clinical practice

“…For established gastric cancer, EUS is superior to CT in assessing locoregional stage 20 , although three dimensional multidetector row CT techniques have improved accuracy 21 . In patients with gastric lymphoma, EUS is particularly accurate in assessing T stage 22 . EUS‐FNA is valuable for lymph node sampling and biopsying the gastric wall when the EUS appearance is abnormal but mucosal biopsies are non‐diagnostic.…”

Predictive factors for regression of gastric MALT lymphoma after anti-Helicobacter pylori treatment

“…The depth of infiltration was evaluated as previously described. 14 Lymph nodes detected around the duodenum and stomach were considered as infiltrated by lymphoma at EUS if they were spherical, hypoechogenic, and 1 cm or more in diameter. The echo endoscopists were blinded as to the detailed results of histology, and the pathologists were blinded to the results of EUS staging.…”

“…Its value for such detection was also demonstrated in our previous study. 14 Discrepancies between diVerent response rates may be due not only to nodal involvement but also to the depth of wall invasion. Eidt et al demonstrated that the probability of lymph node infiltration increased when it was correlated with the depth of gastric wall infiltration.…”