Clinicopathologic factors influence accurate endosonographic assessment for early gastric cancer

Kim, Joo Hang; Song, Kang Il; Youn, Young Hoon; Lee, Yong Chan; Cheon, Jae Hee; Song, Si Young; Chung, Jae Bock

doi:10.1016/j.gie.2007.06.012

Cited by 108 publications

(106 citation statements)

References 20 publications

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“…Endoscopic ultrasonography (EUS) can be considered the standard method for determining the depth of invasion by EGCs. However, even recent studies have reported widely varying diagnostic accuracies of 67-90 % when determining the depth of invasion using EUS, making it difficult to view the method as sufficiently reliable [9][10][11][12][13][14]. Furthermore, its diagnostic ability is similar to that of CE alone [15][16][17], and a number of studies have stated that EUS is unsuitable as a routine investigation for determining the depth of invasion by EGCs [15].…”

Section: Discussionmentioning

confidence: 99%

“…Reported limitations of EUS-which is widely used to diagnose depth of invasion by EGCs-include lesions with associated ulceration, lesions located in the upper stomach, and lesions with a large diameter [9][10][11][12][13][14]. To determine the limitations of diagnosis of the depth of invasion using the non-extension sign, we compared the clinicopathological characteristics of non-extension sign true-positive and false-negative groups of patients with lesions that were histologically confirmed as SM2.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic performance of conventional endoscopy in the identification of submucosal invasion by early gastric cancer: the “non-extension sign” as a simple diagnostic marker

et al. 2016

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Background and aim The ability to differentiate between mucosal (M) or microinvasive submucosal (SM1: depth of less than 500 lm) and invasive submucosal (SM2: depth of 500 lm or more) cancer is paramount when choosing the method of treatment for early gastric cancer (EGC). The ''non-extension sign'' relates to a localized increase in thickness and rigidity due to massive submucosal invasion by a cancer. The present study sought to assess the ability of conventional endoscopy (CE) to correctly identify SM2 cancer using only the non-extension sign. Methods This is a retrospective study based on a prospectively collected database. EGCs had been diagnosed according to invasion depth as M-SM1 or SM2. In terms of the endoscopic diagnostic criterion, lesions positive for the non-extension sign were classified as SM2 cancers, while those negative for the non-extension sign were classified as M-SM1 cancers. Histopathological findings were used as the gold standard. Results We examined a total of 863 lesions from 704 patients, comprising 104 true-positive, 733 true-negative, 9 false-positive, and 17 false-negative lesions. This yielded a sensitivity of 92.0 % (95 % confidence interval (CI), 87.0-97.0 %), a specificity of 97.7 % (95 % CI, 96.7-98.8 %), a positive predictive value of 85.9 % (95 % CI, 79.7-92.1 %), a negative predictive value of 98.8 % (95 % CI, 98.0-99.6 %), and a diagnostic accuracy of 96.9 % (95 % CI, 95.8-98.1 %). Conclusion The non-extension sign may be useful for accurately determining the suitability of minimally invasive endoscopic treatment. Nevertheless, considering the limitations of retrospective analysis, a further prospective study is warranted to confirm the diagnostic reliability of the non-extension sign.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of conventional endoscopy in the identification of submucosal invasion by early gastric cancer: the “non-extension sign” as a simple diagnostic marker

et al. 2016

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“…Kim et al [12] argued that EGC with poorly differentiated histology had a significantly higher probability of being UC undifferentiated component, SM1 submucosal invasion depth \500 lm from muscularis mucosa layer, SM2 or SM3 submucosal invasion depth C500 lm from muscularis mucosa layer understaged by endosonographic assessment compared to differentiated-type EGC. Kang et al [13] reported that lateral and vertical resection margin involvement rates after ESD were 23.3 % and 18.3 % for undifferentiated-type EGC and 8.8 % and 4.8 % for differentiated-type EGC, respectively.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of endoscopic submucosal dissection for differentiated-type early gastric cancer with histological heterogeneity

et al. 2014

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Background Long-term clinical outcomes after endoscopic submucosal dissection (ESD) is unclear for differentiated-type-predominant early gastric cancer (EGC) mixed with undifferentiated component (MUC-EGC). Therefore, the role and appropriate indication of ESD for MUC-EGC remain to be evaluated. Methods Between 2007 and 2011, 1,577 differentiatedtype EGC lesions [1,408 pure differentiated-type (PuD)-EGCs and 169 MUC-EGCs] in 1,527 consecutive patients were treated by ESD. After ESD, MUC-EGC was managed in the same way as PuD-EGC. The clinicopathological features and long-term outcomes after ESD of MUC-EGC were compared with those of PuD-EGC. Results En bloc resection and en bloc with R0 resection rates in MUC-EGC cases were 94.1 % and 81.7 %, respectively. MUC-EGC was significantly associated with larger tumor size, more frequent submucosal invasion, and lymphovascular invasion compared to PuD-EGC. Despite these aggressive features of MUC-EGC, no lymph node metastasis or extragastric recurrence occurred during follow-up after ESD if MUC-EGC met the curative endoscopic resection (ER) criteria for tumors of absolute or expanded indications. Four MUC-EGC cases meeting the curative ER criteria underwent additional radical gastrectomy after ESD, and no case showed lymph node metastasis. During a median 48 months of follow-up, overall survival rates for MUC-EGC meeting the curative ER criteria for tumors of absolute or expanded indications (3-year survival rates, 100 % and 100 %) were comparable to those of PuD-EGC. Conclusions Long-term outcomes after ESD were favorable for MUC-EGCs meeting the curative ER criteria for tumors of absolute or expanded indications. Therefore, ESD may be used as a promising treatment option for these cases.

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“…To date, EUS imaging can be performed with echoendoscopes or with the use of ultrasound catheters or 'miniature probes' which are passed through standard endoscopes. These miniature probes can provide ultra-high-frequency imaging (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), compared to echoendoscopes (5-12 MHz). Higher frequency yields higher resolution of the tumor at the expense of depth of penetration, thus limiting nodal examination [1,2]; thus, a higher frequency probe may provide better evaluation of a T1/T2 cancer, while a lower frequency probe may be more accurate in predicting nodal involvement.…”

Section: Endoscopic Ultrasoundmentioning

confidence: 99%

“…Fifteen studies [7, 17, 19, 20, 22-24, 26, 29-32, 34-36] used combinations of frequencies of B12 MHz and six studies [18,25,27,28,33,37] used combinations of frequencies ranging from 5 to 20 MHz. It was not feasible to construct a 2 9 2 table to investigate transducer frequencies as source of heterogeneity.…”

Section: Eus Examinationmentioning

confidence: 99%

A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer

et al. 2012

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Background Accurate preoperative staging is important in determining the appropriate treatment of gastric cancer. Recently, endoscopic ultrasound (EUS) has been introduced as a staging modality. However, reported test characteristics for EUS in gastric cancer vary. Our purpose in this study was to identify, synthesize, and evaluate findings from all articles on the performance of EUS in the preoperative staging of gastric cancer. Methods Electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1 January 1998 to 1 December 2009. All search titles and abstracts were independently rated for relevance by a minimum of two reviewers. Metaanalysis for the performance of EUS was analyzed by calculating agreement (Kappa statistic), and pooled estimates of accuracy, sensitivity, and specificity for all EUS examinations, using histopathology as the reference standard. Subgroup analyses were also performed. Results Twenty-two articles met our inclusion criteria and were included in the review. EUS pooled accuracy for T staging was 75% with a moderate Kappa (0.52). EUS was most accurate for T3 disease, followed by T4, T1, and T2. EUS pooled accuracy for N staging was 64%, sensitivity was 74%, and specificity was 80%. There was significant heterogeneity between the included studies. Subgroup analyses found that annual EUS volume was not associated with EUS T and N staging accuracy (P = 0.836, 0.99, respectively). Conclusion EUS is a moderately accurate technique that seems to describe advanced T stage (T3 and T4) better than N or less advanced T stage. Stratifying by EUS annual volume did not affect EUS performance in staging gastric cancer.

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Clinicopathologic factors influence accurate endosonographic assessment for early gastric cancer

Cited by 108 publications

References 20 publications

Diagnostic performance of conventional endoscopy in the identification of submucosal invasion by early gastric cancer: the “non-extension sign” as a simple diagnostic marker

Diagnostic performance of conventional endoscopy in the identification of submucosal invasion by early gastric cancer: the “non-extension sign” as a simple diagnostic marker

Outcomes of endoscopic submucosal dissection for differentiated-type early gastric cancer with histological heterogeneity

A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer

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