Role of Endosonography in the Surgical Management of Non-Hodgkin's Lymphoma of the Stomach

Abstract

Ten patients with primary gastric non-Hodgkin's lymphoma (NHL) were preoperatively assessed by endoscopic ultrasonography (EUS). Tumor infiltration depth and lymph node involvement were assessed using the TNM classification system. EUS was 80% accurate in determining the TL stage and 90% in detecting lymph node metastases (NL stage). Based on the longitudinal tumor extent (antrum to fundus), as assessed by preoperative (n = 10) and additionally, intraoperative EUS (n = 3), partial gastric resection was performed in nine patients and total gastrectomy in one. All resection specimens had tumor-free resection margins (R0 resection rate 100%). These results were compared to those in 23 patients with gastric NHL operated on prior to the introduction of EUS in the hospital who were comparable with respect to tumor location and extent. In comparison with the ten cases where treatment was guided by EUS, the rate of total gastrectomy was higher (65% versus 10%) and the R0 resection rate lower (72% versus 100%) in this group of 23 patients. These results show that EUS may play a crucial role in the pre-surgical staging of gastric NHL.

Endoscopic ultrasonography for assessment of medical treatment in patients with gastric mucosa‐associated lymphoid tissue lymphoma

“…Endoscopy alone is unsatisfactory in evaluating locoregional extension and is thus insufficient for assessing stage, determining prognosis and planning therapy 15,16 . Endoscopic ultrasonography appears to be effective in evaluating the depth of gastric wall invasion, infiltration into adjacent organs and lymph node involvement, 15–17 and it may be useful for initial staging and planning of non‐surgical therapy of the stomach because it permits visualization of the intramural area of the gastric wall. A previous report on non‐Hodgkin's lymphoma proposed that EUS evaluation of the gastric wall may overcome the problem of sampling error associated with histological specimens 18 .…”

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

“…However, EUS is extremely accurate in differentiating early invasion (T1 mucosal or submucosal, EI1 of Ann Arbor classification) from T2-T4 (EI2) or TxN1 (EII1) [21] . Diagnostic accuracy for T staging has ranged between 80% and 90% across the studies [22,23] , whereas for N stage, it ranges between 71% and 90% [22,24] . Accuracy is even higher when EUS is associated with FNA and FC being reported as high as 97% [25] .…”

Staging role of EUS

“…Endosonographic data on gastric lymphoma were, however, first based on few small series of patients [6,7]. In the era of surgical resection of gastric lymphoma EUS findings could be compared to the golden standard of the pathohistological stage of the resected material [8][9][10][11][12][13][14]. These studies revealed high diagnostic accuracies of EUS staging for both T-and N-stage (80-92% and 77-90%, respectively; Table 2).…”

“…Therefore, from a practical point of view and for costs regarding reasons EUS seems not to be a mandatory diagnostic tool in DLBCL. [9] 44 92% 77% Palazzo, 1993 [10] 24 91% 83% Schü der, 1993 [11] 10 8% 90% Suekane, 1993 [12] 15 Nc 83% Fischbach, 2002 [14] 70 59% 71%…”