Endoscopy 2006; 39 - TH06
DOI: 10.1055/s-2006-947661

Diagnostic accuracy of endoscopic ultrasonography in preoperative assessment of early gastric cancer

BD Ye 1, SG Kim 1, JH Cheon 1, HJ Lee 2, JS Kim 1, HK Yang 2, JK Han 3, WH Kim 4, HC Jung 1, IS Song 1
  • 1Dept. of Internal Medicine and Liver Research Institute, Seoul National Univ. College of Med., Seoul, KR
  • 2Dept. of Surgery, Seoul National Univ. College of Med., Seoul, KR
  • 3Dept. of Radiology, Seoul National Univ. College of Med., Seoul, KR
  • 4Dept. of Pathology, Seoul National Univ. College of Med., Seoul, KR

Background and Aims: Recently, laparoscopy-assisted gastrectomy (LAG) has been more widely performed for early gastric cancer (EGC). Preoperative accurate evaluation for primary lesions regarding depth of invasion is important for LAG, but multidetector row computed tomography (MDCT) is not sufficient for evaluation of primary lesions in cases of EGC. This study was performed to evaluate the preoperative diagnostic role of endoscopic ultrasonography (EUS) for EGC.

Patients and Methods: We prospectively enrolled patients clinically diagnosed as EGC by upper gastrointestinal endoscopy with pathologic examination and EUS. They were evaluated by MDCT and planned to underwent LAG without evidence of distant metastasis. Diagnostic accuracies of EUS and MDCT for primary lesions were evaluated by comparing with pathologic examination of surgical specimens.

Results: A total of 55 patients (34 men and 21 women, mean age 57.4 years) was enrolled between August 2005 and February 2006. The pathologic examination of surgical specimens revealed 31 cases of EGC confined to mucosal layer (m-cancer), 19 cases of EGC confined to submucosal layer (sm-cancer) and 5 cases of AGC extended to proper muscle layer (pm-cancer). The sensitivity of EUS was 64.5% for m-cancer and 63.2% for sm-cancer, whereas MDCT could not distinguish m-cancer or sm-cancer in any cases. The T staging accuracy of EUS and MDCT between T1 and T2 was 90.9% and 94.5%, respectively (p=0.625). The N staging accuracy of EUS and MDCT between N0 and N1 was 92.7% and 85.5%, respectively (p=0.219).

Conclusions: EUS is useful for the more detailed preoperative evaluation of depth of invasion of EGC than MDCT. Further investigations with larger number of patients are needed to elucidate the role of EUS for making decisions on the method of curative treatment for EGC.