Ulcerous change decreases the accuracy of endoscopic ultrasonography diagnosis for the invasive depth of early gastric cancer

被引：61

作者：

Akashi K. ^{[1
]}

Yanai H. ^{[2
]}

Nishikawa J. ^{[1
]}

Satake M. ^{[1
]}

Fukagawa Y. ^{[1
]}

Okamoto T. ^{[1
]}

Sakaida I. ^{[1
]}

机构：

[1] Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505

[2] Department of Gastroenterology and Hepatology, National Hospital Organization Kanmon Medical Center, Shimonoseki, Yamaguchi 751-8501

来源：

Journal of Gastrointestinal Cancer | 2006年 / 37卷 / 4期

关键词：

Endoscopic mucosal resection (EMR); Endoscopic submucosal dissection (ESD); Endoscopic ultrasonography (EUS); Gastric cancer; Ulcerous change;

D O I：

10.1007/s12029-007-9004-9

中图分类号：

学科分类号：

摘要：

Background: With the development of endoscopic submucosal dissection, an expansion of the criteria for local treatment was suggested for lesions with ulcerous changes or undifferentiated-type adenocarcinoma. Aim of the Study: To determine the efficacy of endoscopic ultrasonography for such lesions, we retrospectively analyzed factors that influenced accurate diagnosis by endoscopic ultrasonography of the depth of tumor invasion. Methods: We investigated 267 gastric adenocarcinomas for which histopathological results were obtained by endoscopic mucosal resection or gastrectomy. The lesions were divided into four groups by histological type and the presence of ulcerous changes. Five clinicopathological factors were assessed for their possible associations with incorrect diagnosis. Results: The positive predictive value (PPV) for cancer limited within the mucosa (endoscopic ultrasonography, EUS-M) and cancer invaded into the submucosal layer (EUS-SM) were 88.0% (125 of 142 lesions) and 60.0% (30 of 50 lesions), respectively. The lesions diagnosed as EUS-M/SM borderline (37 lesions) included 19 lesions (51.4%) of M cancer and 17 lesions (45.9%) of SM cancer. In logistic analysis, ulcerous changes (p < 0.0001) and macroscopic classification (p = 0.0284) were factors that caused incorrect diagnosis by endoscopic ultrasonography. In the group having differentiated-type adenocarcinoma with ulcerous changes, the PPV of EUS-SM was 25% (3 of 12), and there was a significant difference (p < 0.05) between the EUS-SM of this group and that of the differentiated-type adenocarcinoma without ulcerous changes. Conclusion: The accuracy of endoscopic ultrasonography tumor staging was not sufficient for the lesions with ulcerous changes in our study. Therefore, we should be careful to perform endoscopic submucosal dissection for lesions with ulcerous changes. © 2007 Humana Press Inc.

引用

页码：133 / 138

页数：5

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