Abstract:
BACKGROUND:Although conventional endoscopy (CE) and EUS are considered useful for predicting the invasion depth (T-staging) in early gastric cancer (EGC), no effective diagnostic strategy has been established. OBJECTIVE:To produce simple CE criteria and to elucidate an efficient diagnostic method by combining CE and EUS for accurate T-staging. DESIGN:Single-center retrospective analysis. SETTING:Academic university hospital. PATIENTS:Consecutive patients with EGC from April 2007 to March 2012 who underwent CE and EUS before treatment. INTERVENTIONS:Recorded endoscopic images were independently reviewed by 3 observers. The CE criteria for massive invasion were defined, and their utility and the additional value of EUS were assessed. MAIN OUTCOME MEASUREMENTS:The accuracy of CE based on the criteria and the accuracy of EUS. RESULTS:Two hundred thirty patients were enrolled: 195 with mucosal cancer or cancer in the submucosa less than 500 μm from the muscularis mucosae and 35 with invasive cancers. Multivariate analysis of the CE findings by 1 observer revealed that an irregular surface and a submucosal tumor-like marginal elevation were significantly associated with massive invasion. The simple CE criteria, consisting of those 2 features, had an overall accuracy of 73% to 82% and no significant differences in the diagnostic yield compared with EUS in all observers. CE accurately revealed mucosal cancer, and EUS efficiently salvaged the lesions that were over-diagnosed by CE. With our strategy, which involved the CE criteria and the optimal use of EUS, the comprehensive accuracy exceeded 85% in each observer. LIMITATIONS:Retrospective, single-center study. CONCLUSIONS:We demonstrated a practical strategy for T-staging in EGC using simple CE criteria and EUS.
journal_name
Gastrointest Endoscjournal_title
Gastrointestinal endoscopyauthors
Tsujii Y,Kato M,Inoue T,Yoshii S,Nagai K,Fujinaga T,Maekawa A,Hayashi Y,Akasaka T,Shinzaki S,Watabe K,Nishida T,Iijima H,Tsujii M,Takehara Tdoi
10.1016/j.gie.2015.01.022subject
Has Abstractpub_date
2015-09-01 00:00:00pages
452-9issue
3eissn
0016-5107issn
1097-6779pii
S0016-5107(15)00024-3journal_volume
82pub_type
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