Park Chan Hyuk, Park Jun Chul, Chung Hyunsoo, Shin Sung Kwan, Lee Sang Kil, Lee Yong Chan
Department of Internal Medicine, Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea.
Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
Surg Endosc. 2016 Oct;30(10):4193-9. doi: 10.1007/s00464-015-4728-2. Epub 2015 Dec 29.
The role of endoscopic ultrasonography (EUS) in gastric cardia cancer should be further evaluated because the accuracy of EUS depends on tumor location. We aimed to identify a specific role of EUS for therapeutic decision-making in patients with gastric cardia cancer.
Initial EUS examinations for treatment-naïve gastric cancer that were followed by endoscopic resection or surgery were included in the study. Lesions were classified as cardiac and non-cardiac cancer according to tumor location. The diagnostic performance of EUS in predicting invasion depth was compared between the two groups.
The overall accuracy of EUS in predicting invasion depth did not differ between the cardiac and non-cardiac cancer groups (44.4 vs. 52.3 %, P = 0.259). The underestimation rate was higher in the cardiac cancer group than in the non-cardiac cancer group (37.0 vs. 18.5 %, P = 0.001). When the depth of invasion was predicted to be deeper than the mucosa (submucosal or deeper) by EUS, the positive predictive value was 82.1 [95 % confidence interval (CI), 66.5-92.5 %] and 62.9 % (95 % CI, 60.5-66.9 %) in the cardiac and non-cardiac cancer groups, respectively (P = 0.015). In multivariable analysis, tumor location in the cardia was found to be an independent factor for the underestimation of invasion depth [odds ratio (95 % CI) = 2.242 (1.156-4.349)].
The underestimation rate in predicting invasion depth was significantly higher for cardiac cancers than for non-cardiac cancers. Therefore, selection of the treatment method for gastric cardia cancer via EUS should be done carefully.
由于超声内镜（EUS）的准确性取决于肿瘤位置，因此应进一步评估其在贲门癌中的作用。我们旨在确定EUS在贲门癌患者治疗决策中的特定作用。
本研究纳入了初治胃癌患者的初始EUS检查，这些患者随后接受了内镜切除或手术。根据肿瘤位置将病变分为贲门癌和非贲门癌。比较两组中EUS预测浸润深度的诊断性能。
贲门癌组和非贲门癌组中EUS预测浸润深度的总体准确性无差异（44.4%对52.3%，P = 0.259）。贲门癌组的低估率高于非贲门癌组（37.0%对18.5%，P = 0.001）。当EUS预测浸润深度超过黏膜（黏膜下层或更深）时，贲门癌组和非贲门癌组的阳性预测值分别为82.1 [95%置信区间（CI），66.5 - 92.5%]和62.9%（95% CI，60.5 - 66.9%）（P = 0.015）。在多变量分析中，发现肿瘤位于贲门是浸润深度低估的独立因素[比值比（95% CI）= 2.242（1.156 - 4.349）]。
贲门癌预测浸润深度的低估率显著高于非贲门癌。因此，通过EUS选择贲门癌的治疗方法应谨慎。
