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Endoscopic Ultrasonography Miniature Probe Performance for Depth Diagnosis of Early Gastric Cancer with Suspected Submucosal Invasion

Gut and Liver 2020년 14권 5호 p.581 ~ 588
Takamaru Hiroyuki, Yoshinaga Shigetaka, Takisawa Hajime, Oda Ichiro, Katai Hitoshi, Sekine Shigeki, Taniguchi Kazuhiro, Saito Yutaka,
소속 상세정보
 ( Takamaru Hiroyuki ) - National Cancer Center Hospital Division of Endoscopy
 ( Yoshinaga Shigetaka ) - National Cancer Center Hospital Division of Endoscopy
 ( Takisawa Hajime ) - National Cancer Center Hospital Division of Endoscopy
 ( Oda Ichiro ) - National Cancer Center Hospital Division of Endoscopy
 ( Katai Hitoshi ) - National Cancer Center Hospital Division of Gastric Surgery
 ( Sekine Shigeki ) - National Cancer Center Hospital Division of Pathology
 ( Taniguchi Kazuhiro ) - National Cancer Center Hospital Division of Pathology
 ( Saito Yutaka ) - National Cancer Center Hospital Division of Endoscopy

Abstract


Background/Aims: The accurate assessment of the depth of invasion of early gastric cancer (EGC) is critical to determine the most appropriate treatment option. However, it is difficult to distinguish shallow submucosal (SM1) invasion from deeper submucosal (SM2) invasion. We investigated the diagnostic performance of endoscopic ultrasonography (EUS) using a miniature probe for EGC with suspected SM invasion.

Methods: From April 2008 to June 2018, EGCs with suspected SM invasion were analyzed retrospectively. The EGCs examined by a 20 MHz high-frequency miniature probe was included in our study. Esophago-gastric junction cancers and patients treated by chemotherapy before resection were excluded. The sensitivity and specificity for the detection of SM2 invasion by EUS were compared with those of white light imaging (WLI). Additionally, factors related to depth underestimation or overestimation were investigated using multivariate analysis.

Results: A total of 278 EGCs in 259 patients were included in the final analysis. The sensitivity and specificity for SM2 or deeper by EUS were 73.7% (87/118) and 74.4% (119/160), respectively. The sensitivity and specificity by WLI were 47.5% (56/118) and 68.1% (109/160), respectively. The sensitivity of EUS was significantly superior to that of conventional endoscopy (p<0.01). Multivariate analysis revealed that an anterior location of the EGC was an independent risk factor for underestimation by EUS (odds ratio, 3.3; 95% confidence interval, 1.1 to 9.8; p=0.03).

Conclusions: The depth diagnostic performance for EGCs with suspected SM invasion using EUS was satisfactory and superior to that of conventional endoscopy. Additionally, it is important to recognize factors that may lead to misdiagnosis in those lesions.

키워드

Endosonography; Stomach neoplasms; Invasion depth

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