Is endoscopic ultrasound clinically useful for follow-up of gastric lymphoma?

Raimondo, Francesco Di; Caruso, L; Bonanno, Giambattista; Naso, P.; Chiarenza, Annalisa; Fiumara, Paolo; Bari, Alessia; Palumbo, Giuseppe A.; Russo, Antonino; Giustolisi, Rosario

doi:10.1093/annonc/mdl378

Cited by 31 publications

(22 citation statements)

References 26 publications

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“…Overall, accuracy for determining nodal status is considered to be 56-90% [13,[26][27][28]. In use for post-treatment monitoring, EUS may appear positive long after biopsies are negative [29].…”

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confidence: 99%

Lymph nodes and gastric cancer

Coburn

2009

Journal of Surgical Oncology

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Worldwide, gastric cancer is one of the top three leading causes of cancer mortality, but incidence and presentation vary geographically. Currently, surgery is the only possible cure. Nodal status is an important prognostic indicator for gastric cancer, and despite results of randomized controlled trials, debate continues over the importance of aggressive lymphadenectomy.J. Surg. Oncol. 2009;99:199-206. ß 2009 Wiley-Liss, Inc. KEY WORDS: gastric neoplasm; lymph nodes; surgery Despite a decrease in incidence in recent decades, gastric cancer is still one of the most common causes of cancer death worldwide [1]. In areas without screening for gastric cancer, it presents late, and has a high frequency of nodal involvement [1]. Surgery is the only effective intervention for cure or long-term survival. Nodal status is an important prognostic indicator for gastric cancer, and debate continues over the importance of aggressive lymphadenectomy for gastric cancer.Historically, gastric lymph node (LN) metastases were detected as distant disease due to advanced presentation, with resultant poor prognosis. Sister Mary Joseph, surgical assistant to Dr. William Mayo, first described the relationship between advanced intra-abdominal malignancy and an umbilical nodule, now known as the Sister Mary Joseph's nodule [2], while Virchow's node (supra-clavicular) [3] and an Irish node (axillary) are used to describe other distant metastatic LN disease for gastric cancer. The idea of an extended lymphadenectomy for gastric cancer was first advanced by Mikulicz in 1889, who stated that the distal pancreas should be removed if necessary [4,5]. ASSESSING LYMPH NODE INVOLVEMENT IN GASTRIC CANCERStudies estimate that LNs will be involved with tumors for 3-5% of cases of gastric adenocarcinoma limited to the mucosa; 11-25% of cases for those limited to the sub-mucosa; 50% for T2; and 83% for T3 tumors [6,7]. Nodal status is one of the most important independent predictors of patient survival [8,9]. For example, for 288 T4 gastric cancers, the 1 and 3-year survivals were 76% and 21.9% for node negative cases, versus 40% and 10% for node positive cases, respectively [10].Pre-operative examinations to study the extent of the cancer may include esophagogastro-duodenoscopy (EGD), radiological imaging, and laparoscopy. A computed tomography (CT) scan of the abdomen and pelvis is the most widely recommended method for pre-operative staging of gastric cancer [11,12]. The sensitivity and specificity of CT scan for determining nodal involvement ranges from 50 to 95% and 40 to 99%, respectively; typically, specificity is higher than sensitivity for nodal involvement, but this is not consistent between studies [13][14][15]. Importantly, the ability of the CT scan to detect nodal involvement is determined primarily by the size of the nodes. In a recent study of 23 patients with equivocal findings of para-aortic LN involvement on CT scan (0.7-1 cm or nodes >1 cm with a fatty marrow) treated with an aggressive LN dissection, including paraaortic LN diss...

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confidence: 99%

Lymph nodes and gastric cancer

Coburn

2009

Journal of Surgical Oncology

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“…However, in other reports that correlation was much lower ranging from 33% and 54% [30,31] . Therefore, at present, EUS cannot be recommended for MALT lymphoma surveillance after treatment, and biopsies remain the only reliable proof of residual disease.…”

Section: Gastrointestinal Lymphomasmentioning

confidence: 67%

Role of endoscopic ultrasonography with and without fine needle aspiration cytology in the diagnosis and staging of lymphoma

Alvarez-Buylla

García²,

Sánchez

et al. 2012

J Hemat Malig

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Diagnosis of lymphoma is frequently challenging. The complexity of the sub-classification of lymphomas along with the necessity of a high quality sample leads to costly and invasive procedures in order to achieve the correct diagnosis. Endoscopic ultrasound is a valuable tool for the diagnosis and staging of gastrointestinal neoplasms as well as those that involve structures in the vicinity of the digestive tract. Whereas most gastrointestinal lymphomas are diagnosed and sub-classified using endoscopic biopsies, those involving deep-seated organs or lymph nodes might be targeted by minimal invasive procedures as endoscopic ultrasound-guided fine needle aspiration cytology. Endoscopic ultrasound is also an accurate tool for the local staging of gastrointestinal lymphomas and prediction of the response to Helicobacter pylori eradication. This review summarizes the indications and evidence of endoscopic ultrasonography with or without fine needle aspiration cytology in the diagnosis and staging of lymphoma.

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“…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.…”

Section: Endoscopic Ultrasound In Staging Of Diseasementioning

confidence: 99%