Tsujii Yoshiki, Hayashi Yoshito, Ishihara Ryu, Yamaguchi Shinjiro, Yamamoto Masashi, Inoue Takuya, Nagai Kengo, Ogiyama Hideharu, Yamada Takuya, Nakahara Masanori, Kizu Takashi, Kanesaka Takashi, Matsuura Noriko, Ohta Takashi, Nakamatsu Dai, Yoshii Shunsuke, Shinzaki Shinichiro, Nishida Tsutomu, Iijima Hideki, Takehara Tetsuo
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
Surg Endosc. 2023 Apr;37(4):3018-3028. doi: 10.1007/s00464-022-09778-7. Epub 2022 Dec 19.
Although the combination of conventional endoscopy (CE) and endoscopic ultrasonography (EUS) is useful for predicting the depth of early gastric cancer (EGC), the diagnostic value of EUS for submucosal (SM) invasive cancer has not been fully investigated.
We conducted a multicenter prospective study from May 2017 to January 2021 to evaluate the validity of a diagnostic strategy combining CE and EUS and to clarify the additional value of EUS for EGC suspected of SM invasion. In each case, the diagnosis was first made using CE, followed by EUS, and finally confirmed using a combination algorithm.
A total of 180 patients with EGC were enrolled from 10 institutions, of which 175 were analyzed. The histopathological depths were M, SM1, SM2, and ≥ MP in 72, 16, 64, and 23 lesions, respectively. Treatment included 92 endoscopic submucosal dissection cases and 83 surgical cases. The overall diagnostic accuracy classified by M-SM1 or SM2-MP was 58.3% for CE, 75.7% for EUS, and 78.9% for the combination of CE and EUS; the latter two were significantly higher than that of CE alone (P < 0.001). The CE, EUS, and combination accuracy rates in 108 differentiated-type lesions were 51.9%, 77.4%, and 79.6%, respectively; the latter two were significantly higher than CE alone (P < 0.001). A significant additive effect of EUS was observed in CE-SM2 low-confidence lesions but not in CE-M-SM1 lesions or in CE-SM2 high-confidence lesions. Among the nine CE findings, irregular surface, submucosal tumor-like elevation, and non-extension signs were significant independent markers of pSM2-MP. Poorly delineated EUS lesions were misdiagnosed.
EUS provides additional value for differentiated-type and CE-SM2 low-confidence EGCs in diagnosing invasion depth.
UMIN000025862.
尽管传统内镜检查（CE）与内镜超声检查（EUS）相结合有助于预测早期胃癌（EGC）的浸润深度，但EUS对黏膜下（SM）浸润癌的诊断价值尚未得到充分研究。
我们于2017年5月至2021年1月进行了一项多中心前瞻性研究，以评估CE与EUS联合诊断策略的有效性，并阐明EUS对疑似SM浸润的EGC的附加价值。在每个病例中，首先使用CE进行诊断，然后进行EUS检查，最后使用联合算法进行确诊。
共从10家机构招募了180例EGC患者，其中175例进行了分析。组织病理学浸润深度为M、SM1、SM2和≥MP的病变分别有72、16、64和23个。治疗包括92例内镜黏膜下剥离术和83例手术。按M-SM1或SM2-MP分类的总体诊断准确率，CE为58.3%，EUS为75.7%，CE与EUS联合为78.9%；后两者显著高于单独使用CE（P<0.001）。108例分化型病变中，CE、EUS及联合诊断准确率分别为51.9%、77.4%和79.6%；后两者显著高于单独使用CE（P<0.001）。在CE-SM2低置信度病变中观察到EUS有显著的附加效应，但在CE-M-SM1病变或CE-SM2高置信度病变中未观察到。在9项CE表现中,表面不规则、黏膜下肿瘤样隆起和无扩展征是pSM2-MP的重要独立指标。EUS病变边界不清会导致误诊。
EUS在诊断浸润深度方面，对分化型和CE-SM2低置信度的EGC具有附加价值。
UMIN000025862。
