A Classification System of Echogenicity for Gastrointestinal Neoplasms

Abstract

Background and Aims: To confirm the utility of a newly-devised endoscopic ultrasonography (EUS) echogenicity classification system, which is based on the normal five-layer structure of the gastrointestinal wall, for the differential diagnosis of gastrointestinal neoplasms. Methods: A total of 275 patients with gastrointestinal disease detected by endoscopy, 53 with submucosal tumor (22 esophageal, 27 gastric, and 4 duodenal), 208 with cancer (58 esophageal, 150 gastric), and 14 with gastric malignant lymphoma, were examined. In each case, we performed standard EUS with 7.5, 12, or 20 MHz to evaluate the echogenicity of the lesion. Echogenicity was classified into seven levels that is based on the echogenicity of the normal five-layer structure of the gastrointestinal wall. The levels are stratified from anechoic (level 0) to hyperechoic (level 6), muscularis propria and deep mucosa being referred to as level 2 and level 4, respectively. Level 6 was equivalent to or higher than the echogenicity of submucosa. Results: EUS findings revealed several distinct echogenicities among the diseases. In submucosal tumor, levels 0, 2, and 6 were observed only in patients with cyst, myogenic tumor, and lipoma, respectively. In malignancies, levels 0, 5, and 6 were not observed in this study. The echo level of malignant lymphoma was markedly lower than that of epithelial cancer. Conclusion: Our classification system of echogenicity can be a useful method in the differential diagnosis of gastrointestinal neoplasms.

Duodenal duplication cyst: A rare cause of geriatric gastrointestinal bleeding

“…Smooth muscle neoplasm was favored regarding its muscularis origin, although heterotopic pancreas, lymphoma, carcinoid, granular cell tumor, cyst, and lipoma can also occur in rare situations. 11 The presence of intermediate to hypoechoic echogenicity on EUS further excluded the diagnosis of anechoic cyst, as well as hyperechoic granular cell tumor and lipoma. In addition, heterotopic pancreas, lymphoma, and carcinoids infrequently show regular margins on EUS.…”

Values of endoscopic ultrasonography for diagnosis and treatment of duodenal protruding lesions

“…In the present study, 12 cases were diagnosed as minor papilla by EUS, which seemed indefinite under conventional endoscope. In addition, diagnosed by EUS, we had 1 duodenal B-cell lymphoma that presented a hypoechoic mass, diffuse and obviously thickened wall with normal structure disappeared (Fig.1i), which was clinically important to the diagnosis of gastrointestinal lymphoma in future (Okanobu et al, 2005).…”

Technique of Endoscopic Biopsy of Islet Allografts Transplanted into the Gastric Submucosal Space in Pigs

“…EUS is the procedure of choice for evaluating subepithelial lesions of the gastrointestinal tract (11,17,20,25). Therefore, after initial identification by direct vision through an endoscope, EUS was used to confirm the location of the islet masses in the GSMS.…”

“…With regard to biopsy of islets transplanted into the GSMS, endoscopic ultrasonography (EUS) is able to accurately visualize the submucosa (11,17,20,25). EUS can indicate the difference between a tumor and normal healthy tissue.…”