Endoscopic ultrasound (EUS) in staging and follow-up of patients with malt lymphoma treated conservatively

Abstract

EUS appears to be a sensitive procedure for initial staging and assessment of treatment response and long-term follow up in patients with gastric lymphoma. The importance of EUS lies in abbility to detect relapse early, too.

Role of the Endoscopic Ultrasonography in the Management of Gastric Lymphomas: Our Experience and Review of Literature

“…Interestingly, Varas et al defined, in a subset of 24 patients, an accuracy of EUS in defining T factor of 91%, whereas the usage of miniprobes has given an accuracy of 88% and this mismatch was higher in evaluating the N factor confirming the high clinical impact of EUS (Varas et al, 2006). As a general rule, EUS has entered in the clinical practice of staging evaluation (Di Raimondo et al, 2007;Pavlović et al 2005) and has been indicated as an ''obligatory part of the staging procedure'' (Fischbach, 2010). Thus, in the 2010 ESMO guidelines (Zucca & Dreayler, 2010), EUS has been indicated as the most appropriate technique in defining the locoregional staging.…”

“…Before the introduction of HPeradication therapy, the presence of an early stage disease represented the major indicator of response to surgery, while in HP-eradication era it designates the response to the HPtherapy itself. Nevertheless, the most important factor in risk assessment remains the loco regional staging and EUS preserves a great importance due to the fact that it is able to indicate, with accuracy superior to other techniques, the precise loco-regional stage of disease and consequently the required treatment (Pavlović et al 2005). Indeed, PGL of MALT type, when confined to mucosa and sub-mucosa layers responds to HP eradication therapy without any need of chemotherapy, meanwhile DLBCL are usually treated as general disease with chemo-immuno-therapy, even if recent case reports indicated the regression of locally staged DLBCL after HP eradication (Montalban et al, 2001, Tari et al, 2009.…”

“…During 2003, two other reports stated that EUS is a reliable tool in determining the response evaluation and the early detection of disease reappearance, thus avoiding the performance of invasive procedures (Hoepffner et al, 2003;Yeh et al, 2003). In addition, the Serbian group found a stringent correlation between EUS and histology in patients treated both with HP-eradicating therapy and/or chemotherapy ± radiotherapy (Pavlović et al 2005). Table 5.…”

“…However, the importance of EUS in assessing the response to treatment and the follow-up is controversial. During the last decade, some reports indicated the importance of EUS in evaluating the response to treatment and also in long-term follow-up of gastric lymphomas with limited disease (Yeh et al, 2003), whereas other recent reports indicated the importance of EUS also in the follow-up of local-advanced MALT lymphoma (Pavlović et al, 2005). That notwithstanding, the latest ESMO clinical guidelines for diagnosis, treatment and follow-up…”

Endoscopic ultrasonography in gastric lymphomas: appraisal on reliability in long‐term follow‐up

“…However, the importance of EUS in follow‐up evaluation is controversial . During the last decade, some reports have indicated the importance of EUS in evaluating the response to treatment and long‐term follow‐up of gastric lymphomas with limited disease and in patients with local‐advanced MALT lymphoma . However, other studies have not confirmed these results and have indicated that the achievement of a complete response by EUS takes much more time than the demonstration of a complete response by endoscopic biopsy .…”