Preoperative Endoscopic Diagnosis and Issues for Determining the Absolute Indication of EMR/ESD for Early Gastric Cancer:Diagnosis of Invasion Depth:EUS Yoshiki Tsujii 1 , Yoshito Hayashi 1 , Motohiko Kato 2 , Takuya Inoue 3 , Shunsuke Yoshii 1 , Akihiko Sakatani 1 , Takanori Inoue 1 , Ryotaro Uema 1 , Minoru Kato 1 , Hirotsugu Saiki 1 , Kentaro Nakagawa 1 , Eiji Kimura 1 , Shinichiro Shinzaki 1 , Hideki Iijima 1 , Tetsuo Takehara 1 1Department of Gastroenterology and Hepatology, Graduate School of Medicine, Osaka University, Suita, Japan 2Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 3Department of Gastroenterology, Osaka General Medical Center, Osaka, Japan Keyword: 早期胃癌 , 深達度診断 , EUS , 通常内視鏡 , 上乗せ効果 pp.31-40
Published Date 2021/1/25
DOI https://doi.org/10.11477/mf.1403202224
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 The additional value for using EUS to predict the invasion depth of early gastric cancer has not been fully clarified. Therefore, we retrospectively compared the diagnostic abilities of CE(conventional endoscopy)and EUS among 230 patients who underwent pretreatment examinations. The accuracy rate of CE was 73〜82%, which was based on the findings of irregular surface and submucosal tumor-like marginal elevation as the simple diagnostic criteria for deep invasion. The accuracy rate for mucosal cancer in CE was 93%, whereas that for submucosal invasive cancer was 65%. In EUS, 62% of mucosal cancers, which were over-estimated in CE, were diagnosed correctly.

 If EUS is applied and combined only for cases suspected of deep invasion on the basis of CE findings, the accuracy rate improves to 86〜90%, which is significantly higher than that for CE alone or EUS alone. Thus, an integrated strategy that diagnoses mucosal cancer only with CE and performs EUS for lesions suspected of submucosal deep invasion on the basis of CE findings may offer a more efficient and accurate diagnosis. The validity of the algorithm and the auxiliary effects of EUS are currently being assessed in a multicenter prospective study. Considering the limited value of EUS, it is necessary for us to understand its characteristics and perform it appropriately to receive more accurate diagnoses.

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