Mouri Ritsuo, Yoshida Shigeto, Tanaka Shinji, Oka Shiro, Yoshihara Masaharu, Chayama Kazuaki
Department of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University Hospital, Hiroshima, Japan.
J Clin Gastroenterol. 2009 Apr;43(4):318-22. doi: 10.1097/MCG.0b013e3181775966.
Endoscopic ultrasonography (EUS) is a useful method for visualizing features of gastric cancer. However, a previously reported classification system tended to result in overstaging. We investigated the usefulness of EUS for evaluation of the depth of gastric cancer invasion and indications for endoscopic treatment.
Accuracy of EUS for determining the depth of invasion and incidences of a positive basal margin were assessed in 235 patients who underwent endoscopic treatment or surgery for gastric cancer. The EUS-determined depth of invasion was classified as follows: EUS-M (lesion confined to sonographic layers 1 and 2); EUS-M/SM border (lesion with changes in sonographic layer 3 but no deeper than 1 mm); EUS-SM (lesion with changes in sonographic layer 3 deeper than 1 mm); or EUS-AD (lesion with changes in sonographic layer 4 or 5).
Accuracy of EUS for determining the depth of invasion was as follows: EUS-M, 99% were M and SM1 lesions; EUS-M/SM border, 87% were M and SM1 lesions; EUS-SM, 91% were SM2 lesions; EUS-AD, 100% were muscularis propria or deeper lesions. There was no EUS-M or EUS-M/SM border lesion for which endoscopic treatment resulted in a positive basal margin.
EUS is useful for accurately determining the depth of invasion of gastric cancer. When there are no endoscopically determined ulcerous changes, endoscopic treatment should be considered for EUS-M and EUS-M/SM border lesions, and EUS-SM lesions should be treated surgically.
内镜超声检查（EUS）是一种用于观察胃癌特征的有用方法。然而，先前报道的分类系统往往导致分期过高。我们研究了EUS在评估胃癌浸润深度及内镜治疗适应证方面的实用性。
对235例行胃癌内镜治疗或手术的患者评估EUS确定浸润深度的准确性及切缘阳性发生率。EUS确定的浸润深度分类如下：EUS-M（病变局限于超声第1和2层）；EUS-M/SM边界（病变在超声第3层有改变但不超过1mm深）；EUS-SM（病变在超声第3层的改变超过1mm深）；或EUS-AD（病变在超声第4或5层有改变）。
EUS确定浸润深度的准确性如下：EUS-M，99%为M和SM1病变；EUS-M/SM边界，87%为M和SM1病变；EUS-SM，91%为SM2病变；EUS-AD，100%为固有肌层或更深层病变。内镜治疗后切缘阳性的病变中没有EUS-M或EUS-M/SM边界病变。
EUS有助于准确确定胃癌的浸润深度。当内镜检查未发现溃疡改变时，对于EUS-M和EUS-M/SM边界病变应考虑内镜治疗，EUS-SM病变应行手术治疗。
