Divisions of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.
Divisions of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan.
Gut Liver. 2020 Sep 15;14(5):581-588. doi: 10.5009/gnl19243.
BACKGROUND/AIMS: The accurate assessment of the depth of invasion of early gastric cancer (EGC) is critical to determine the most appropriate treatment option. However, it is difficult to distinguish shallow submucosal (SM1) invasion from deeper submucosal (SM2) invasion. We investigated the diagnostic performance of endoscopic ultrasonography (EUS) using a miniature probe for EGC with suspected SM invasion.
From April 2008 to June 2018, EGCs with suspected SM invasion were analyzed retrospectively. The EGCs examined by a 20 MHz high-frequency miniature probe was included in our study. Esophago-gastric junction cancers and patients treated by chemotherapy before resection were excluded. The sensitivity and specificity for the detection of SM2 invasion by EUS were compared with those of white light imaging (WLI). Additionally, factors related to depth underestimation or overestimation were investigated using multivariate analysis.
A total of 278 EGCs in 259 patients were included in the final analysis. The sensitivity and specificity for SM2 or deeper by EUS were 73.7% (87/118) and 74.4% (119/160), respectively. The sensitivity and specificity by WLI were 47.5% (56/118) and 68.1% (109/160), respectively. The sensitivity of EUS was significantly superior to that of conventional endoscopy (p<0.01). Multivariate analysis revealed that an anterior location of the EGC was an independent risk factor for underestimation by EUS (odds ratio, 3.3; 95% confidence interval, 1.1 to 9.8; p=0.03).
The depth diagnostic performance for EGCs with suspected SM invasion using EUS was satisfactory and superior to that of conventional endoscopy. Additionally, it is important to recognize factors that may lead to misdiagnosis in those lesions.
背景/目的：准确评估早期胃癌（EGC）的浸润深度对于确定最合适的治疗方案至关重要。然而，区分浅黏膜下（SM1）浸润和更深的黏膜下（SM2）浸润是困难的。我们研究了使用微型探头对怀疑有黏膜下侵犯的 EGC 进行内镜超声（EUS）检查的诊断性能。
回顾性分析 2008 年 4 月至 2018 年 6 月期间怀疑有 SM 侵犯的 EGC。包括使用 20MHz 高频微型探头检查的 EGC。排除食管胃交界处癌症和接受化疗治疗的患者。比较 EUS 对 SM2 侵犯的检出率与白光成像（WLI）的检出率。此外，使用多变量分析研究了与深度低估或高估相关的因素。
共有 259 例患者的 278 个 EGC 纳入最终分析。EUS 对 SM2 或更深的敏感性和特异性分别为 73.7%（87/118）和 74.4%（119/160）。WLI 的敏感性和特异性分别为 47.5%（56/118）和 68.1%（109/160）。EUS 的敏感性明显优于常规内镜（p<0.01）。多变量分析显示，EGC 的前位是 EUS 低估的独立危险因素（优势比，3.3；95%置信区间，1.1 至 9.8；p=0.03）。
使用 EUS 对怀疑有 SM 侵犯的 EGC 进行深度诊断的性能令人满意，优于常规内镜。此外，重要的是要认识到在这些病变中可能导致误诊的因素。
