Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Daehangno 101, Jongno-gu, Seoul, 03080, Republic of Korea.
Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea.
Surg Endosc. 2018 Sep;32(9):3789-3797. doi: 10.1007/s00464-018-6104-5. Epub 2018 Feb 12.
Accurate preoperative tumor staging of gastric cancer is indispensable with expansion of indications for laparoscopic surgery and endoscopic resection. It is important to distinguish mucosal cancer (T1a) in smaller lesion and differentiate early gastric cancer (EGC) in larger lesion considering endoscopic resection indication and laparoscopic surgery indication. We evaluated the clinical outcomes of endoscopic ultrasonography (EUS) for the decision of treatment strategy of gastric cancer compared with pathological staging.
The patients who underwent EUS and surgical or endoscopic resection for gastric cancer were retrospectively reviewed between September 2005 and February 2016. The depth of tumor invasion (T staging) by EUS was compared with the pathological staging after endoscopic or surgical resection.
A total of 6084 patients were finally analyzed. The accuracy rates for T1a and EGC were 75.0 and 89.4%, respectively. The overall accuracy of T staging by EUS was 66.3% when divided by T1a, T1b, and over T2. The accuracy of EUS prior to endoscopic resection was 75.1% in absolute indication and 73.1% in expanded criteria, respectively. The accuracy rates for T1a with lesion ≤ 2 cm in miniprobe EUS and EGC with lesion > 2 cm in conventional EUS were 84.6 and 83.2%, respectively. In multivariate analysis, presence of ulcer, large tumor size, and radial EUS were associated with overestimation, and small tumor size and miniprobe were associated with underestimation in T staging.
EUS showed the high accuracy of 84.6% for T1a in lesion ≤ 2 cm in miniprobe EUS and 83.2% for EGC in lesion > 2 cm in conventional EUS, respectively. EUS can be a complementary diagnostic method to determine endoscopic or surgical treatment modality.
随着腹腔镜手术和内镜切除术适应证的扩大，准确的术前胃癌分期是必不可少的。对于较小病变的黏膜癌（T1a）和较大病变的早期胃癌（EGC），需要考虑内镜切除适应证和腹腔镜手术适应证，区分开来非常重要。我们评估了内镜超声（EUS）在决定胃癌治疗策略方面的临床结果，并与病理分期进行了比较。
回顾性分析了 2005 年 9 月至 2016 年 2 月间因胃癌接受 EUS 和手术或内镜切除术的患者。将 EUS 确定的肿瘤侵犯深度（T 分期）与内镜或手术切除后的病理分期进行比较。
共分析了 6084 例患者。EUS 对 T1a 和 EGC 的准确率分别为 75.0%和 89.4%。当按 T1a、T1b 和 T2 以上进行分组时，EUS 总体 T 分期的准确率为 66.3%。内镜切除的绝对适应证和扩展标准的 EUS 术前准确率分别为 75.1%和 73.1%。微探头 EUS 病变≤2cm 的 T1a 和常规 EUS 病变>2cm 的 EGC 的准确率分别为 84.6%和 83.2%。多因素分析显示，溃疡、肿瘤较大、EUS 呈放射状与 T 分期高估有关，肿瘤较小和微探头与 T 分期低估有关。
EUS 在微探头 EUS 病变≤2cm 的 T1a 和常规 EUS 病变>2cm 的 EGC 中分别具有 84.6%和 83.2%的高准确率。EUS 可以作为一种辅助诊断方法，用于确定内镜或手术治疗方式。
