Examination of Endoscopic Ultrasonographic Diagnosis for the Depth of Early Gastric Cancer

Kazu Hamada, Tohru Itoh, Ken Kawaura, Hidekazu Kitakata, Hiroaki Kuno, Junji Kamai, Rika Kobayasi, Sadahumi Azukisawa, Taishi Ishisaka, Yuta Igarashi, Kumie Kodera, Tazuo Okuno, Takuro Morita, Taroh Himeno, Hiroshi Yano, Toshihiro Higashikawa, Osamu Iritani, Kunimitsu Iwai, Shigeto Morimoto, Masashi Okuro


Background: Endoscopic ultrasonography (EUS) is one of the helpful tools to diagnose depth of early gastric cancer (EGC). In this study, we examined efficiencies of EUS for EGC such as overall accuracy, risk factors of over/under-staging, and accuracies of each invasive distance.

Methods: A total of 403 EGC lesions that could be investigated by EUS during pre-operation and histological diagnosis after endoscopic submucosal dissection (ESD) or surgery were enrolled in this study. For the 403 cases, we analyzed the accuracies of depth by conventional endoscopy (CE) and EUS retrospectively. We evaluated the clinical survey items of CE and EUS which will be described later to compare the differences between “accuracy group” and “over-staging group”, and between “accuracy group” and “under-staging group”, retrospectively. Additionally, 78 EGC lesions which were confined to the submucosa and for which it was possible to measure accurate invasive distance from the muscularis mucosae were examined for the relationship between preoperative diagnosis of depth by CE and EUS and invasive distance retrospectively.

Results: The overall accuracies of both CE and EUS in predicting EGC invasion depth were 87.3%. For CE staging, histological classification was the factor which influenced over-staging. Gastric regions and tumor area were the factors which influenced under-staging of CE. For EUS staging, tumor area was the factor which influenced over-staging, and gastric regions were the factors which influenced under-staging. Both CE and EUS were not sufficient for predicting the lesions confined to < 500 µm from the muscularis mucosae because the accuracies of both in predicting depth were less than 50%. However, EUS has a higher accuracy than CE for the lesions confined to 500 - 2,000 µm.

Conclusions: The overall accuracies of both CE and EUS in predicting EGC invasion depth were equal, but the contributing factors for over/under-staging were different. Both CE and EUS are not sufficient at present to predict the lesions confined to < 500 µm from the muscularis mucosae. However, the accuracy of EUS in predicting them may increase if high-performance EUS systems are developed in the future.

J Clin Med Res. 2021;13(4):222-229
doi: https://doi.org/10.14740/jocmr4465


Early gastric cancer; Endoscopic ultrasonography; Endoscopy; Depth

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