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Two types of endoscopic ultrasonography in preoperative staging of gastric carcinoma

2003; Elsevier BV; Volume: 29; Issue: 5 Linguagem: Inglês

10.1016/s0301-5629(03)00440-x

1879-291X

Naotake Akutsu, Tomoaki Karube, Shinichi Miyazaki, Taito Aoki, Kenji Nakajima, Takashi Akai, Masaya Uesato, Yoshihiro Ishikawa, Nobuo Hirayama, Fumihiko Miura, Hideaki Hayashi, Y Gunji, Takenori Ochiai,

Gastrointestinal Tumor Research and Treatment

Objective: Endoscopic ultrasonography (EUS) is thought to be a useful tool for accurate preoperative staging of patients with gastric carcinomas, especially essential for determining patient selection for potentially curative resection, curative endoscopic mucosal resection (EMR), or non-curative operation. In this presentation, we report our experience with two types of EUS (the rotating sector echoendoscope [RS] and the linear sector echoendoscope [LS]) and discuss the accuracy with these EUS. Methods: Two hundreds and sixty eight patients with prospectively and pathologically confirmed gastric adenocarcinoma during the last 12 years at Chiba University hospital were referred to EUS and classified by the TNM system. Seventy-two patients were examined with the RS (Fujinon SP-701; 12–20 MHz) and 196 patients were examined with the LS (Toshiba PEF-703FA; 7.5 MHz). Local tumor infiltration was determined according to the five-layer structure of the gastric wall and classified by the TNM system. The results of preoperative staging of EUS were compared with the definitive histopathological staging after the operation. Results: The overall accuracy of EUS for determination of the T stage was 62.2% (83.8%; RS, 54.3%; LS). The accuracy for the T1 and T2 stages was 77.0% (92%; RS, 65.1%; LS) and 43.0% (83.3%; RS, 35.8%; LS), respectively. The accuracy for T3 and T4 tumors was 65.5% (16.7%; RS, 71.5%; LS) and 14.3 % (LS), respectively. Conclusions: Our results about the accuracy of EUS staging were lower than those of other reports. One of the reasons would be that the RS (12–20 MHz) has good resolution for a shallower layer and poor resolution for a deeper layer; on the other hand, the LS (7.5 MHz) has the opposite feature in the resolution. The accuracy of the RS in T1 stage and that of the LS in T3 stage were thought to be sufficient for determinations of the following treatments, such as EMR, operation, and chemotherapy. However, EUS is the standard examination for local tumor infiltration of gastric carcinomas at the present time; therefore, progression of skill with EUS and proper application of each type of EUS should be essential to more exact staging of gastric carcinomas.