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Ishihara R, Mizusawa J, Kushima R, Matsuura N, Yano T, Kataoka T, Fukuda H, Hanaoka N, Yoshio T, Abe S, Yamamoto Y, Nagata S, Ono H, Tamaoki M, Yoshida N, Takizawa K, Muto M. Assessment of the Diagnostic Performance of Endoscopic Ultrasonography After Conventional Endoscopy for the Evaluation of Esophageal Squamous Cell Carcinoma Invasion Depth. JAMA Netw Open 2021; 4:e2125317. [PMID: 34524432 PMCID: PMC8444025 DOI: 10.1001/jamanetworkopen.2021.25317] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Distinguishing between mucosal and submucosal cancers is important for selecting the optimal treatment for patients with esophageal squamous cell carcinoma (ESCC); however, standard procedures for diagnosing cancer invasion depth have not yet been determined. OBJECTIVE To evaluate the diagnostic performance of endoscopic ultrasonography (EUS) after conventional endoscopy for the evaluation of ESCC invasion depth. DESIGN, SETTING, AND PARTICIPANTS This prospective single-arm confirmatory diagnostic study comprising 372 patients with T1 esophageal cancer was conducted at 41 secondary or tertiary hospitals in Japan. Enrollment began on July 20, 2017; patients were enrolled in 2 steps, with the first registration occurring from August 4, 2017, to December 11, 2019, and the second from August 9, 2017, to December 11, 2019. After the completion of all first and second registration examinations, patients received treatment and were followed up for 30 days, with follow-up ending on February 14, 2020. Patients were eligible for inclusion if they had pathologically or endoscopically diagnosed esophageal cancer with T1 clinical depth of invasion. INTERVENTIONS In the first registration, nonmagnifying endoscopy (non-ME) and magnifying endoscopy (ME) were used to diagnose cancer invasion depth. In the second registration, patients from the first registration who had cancers invading the muscularis mucosa or submucosa were enrolled and received EUS. After completion of the protocol examinations, patients received treatment with endoscopic resection or esophagectomy. The pathological results of the resected specimens were used as the reference standard for evaluating cancer invasion depth. MAIN OUTCOMES AND MEASURES The primary end point was the proportion of overdiagnosis of submucosal cancer (defined as invasion depth >200 μm) after receipt of non-ME and ME, with or without the addition of EUS. The secondary end points were underdiagnosis, sensitivity, and specificity. RESULTS Among 372 patients enrolled in the first registration, 371 received non-ME and ME. Of those, 300 patients were enrolled in the second registration, and 293 patients received EUS. A total of 269 patients (217 men [80.7%]; median age, 69 years; interquartile range, 62-75 years) were included in the final analysis. The addition of EUS was associated with a 6.6% increase in the proportion of overdiagnosis (from 16 of 74 patients [21.6%; 95% CI, 12.9%-32.7%] after non-ME and ME to 29 of 103 patients [28.2%; 95% CI, 19.7%-37.9%] after the addition of EUS; 1-sided P = .93). All subgroup analyses found similar increases in overdiagnosis of submucosal cancer. The addition of EUS was associated with a 4.5% reduction in the proportion of underdiagnosis (from 57 of 195 patients [29.2%; 95% CI, 23.0%-36.2%] after non-ME and ME to 41 of 166 patients [24.7%; 95% CI, 18.3%-32.0%] after the addition of EUS). After non-ME and ME, diagnostic sensitivity was 50.4% (95% CI, 41.0%-59.9%), specificity was 89.6% (95% CI, 83.7%-93.9%), and accuracy was 72.9% (95% CI, 67.1%-78.1%). After the addition of EUS, diagnostic sensitivity was 64.3% (95% CI, 54.9%-73.1%), specificity was 81.2% (95% CI, 74.1%-87.0%), and accuracy was 74.0% (95% CI, 68.3%-79.1%). CONCLUSIONS AND RELEVANCE This study found that the addition of EUS was not associated with improvements in the diagnostic accuracy of cancer invasion depth. These findings do not support the routine use of EUS after conventional endoscopy for evaluating the invasion depth among patients with T1 ESCC.
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Affiliation(s)
- Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Ryoji Kushima
- Department of Clinical Laboratory Medicine (Diagnostic Pathology), Shiga University of Medical Science, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tomoko Kataoka
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Noboru Hanaoka
- Department of Gastroenterology, Osaka Red Cross Hospital, Osaka, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshinobu Yamamoto
- Department of Gastroenterological Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masashi Tamaoki
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naohiro Yoshida
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Liu C, Gao X. Determination of radiotherapy target volume for esophageal cancer. PRECISION RADIATION ONCOLOGY 2018. [DOI: 10.1002/pro6.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Chaoxing Liu
- First Hospital of shijiazhuang; Oncology; Shijiazhuang
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Luo LN, He LJ, Gao XY, Huang XX, Shan HB, Luo GY, Li Y, Lin SY, Wang GB, Zhang R, Xu GL, Li JJ. Endoscopic Ultrasound for Preoperative Esophageal Squamous Cell Carcinoma: a Meta-Analysis. PLoS One 2016; 11:e0158373. [PMID: 27387830 PMCID: PMC4936717 DOI: 10.1371/journal.pone.0158373] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/14/2016] [Indexed: 11/24/2022] Open
Abstract
Background Treatment options and prognosis of esophageal squamous cell carcinoma (ESCC) depend on the primary tumor depth (T-staging) and regional lymph node status (N-staging). Endoscopic ultrasound (EUS) has emerged as a useful staging tool, but studies regarding its benefits have been variable. The objective of this study was to evaluate the diagnostic accuracy of EUS for detecting preoperative ESCC. Methods We included in our meta-analysis studies involving EUS-based staging of preoperative ESCC compared with pathological staging. Using a random-effects model, we performed a meta-analysis of the accuracy of EUS by calculating pooled estimates of sensitivity, specificity and the diagnostic odds ratio. In addition, we created a summary receiver operating characteristic (SROC) curve. Results Forty-four studies (n = 2880) met the inclusion criteria. The pooled sensitivity and specificity of T1 were 77% (95%CI: 73 to 80) and 95% (95%CI: 94 to 96). Among the T1 patients, EUS had a pooled sensitivity in differentiating T1a and T1b of 84% (95%CI: 80 to 88) and 83% (95%CI: 80 to 86), and a specificity of 91% (95%CI: 88 to 94) and 89% (95%CI: 86 to 92). To stage T4, EUS had a pooled sensitivity of 84% (95%CI: 79 to 89) and a specificity of 96% (95%CI: 95 to 97). The overall accuracy of EUS for T-staging was 79% (95%CI: 77 to 80), and for N-staging, 71% (95%CI: 69 to 73). Conclusions EUS has good diagnostic accuracy for staging ESCC, which has better performance in T1 sub-staging (T1a and T1b) and advanced disease (T4).
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Affiliation(s)
- Lin-na Luo
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Long-jun He
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiao-yan Gao
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xin-xin Huang
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hong-bo Shan
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guang-yu Luo
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yin Li
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shi-yong Lin
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guo-bao Wang
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Rong Zhang
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guo-liang Xu
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- * E-mail: (GLX); (JJL)
| | - Jian-jun Li
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- * E-mail: (GLX); (JJL)
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Zhou SS, Yan S, Chen WC, Shi DT, Fu T. Accuracy of endoscopic ultrasound in preoperative staging of early esophageal cancer: A Meta-analysis. Shijie Huaren Xiaohua Zazhi 2014; 22:988-999. [DOI: 10.11569/wcjd.v22.i7.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) in the preoperative staging of early esophageal cancer.
METHODS: We searched the Medline, PubMed, Web of Science, Embase, Cochrane Central Trials, Wanfang, CBM, CNKI and VIP databases for relevant studies published. Study selection, quality assessment and data extraction were performed by two reviewers independently. Meta-Disc (version1.4) software was used to perform the meta-analysis for sensitivity, specificity, positive likelihood ratio (LR), and negative LR. Pooling results were derived (by) using the fixed-effect model when significant heterogeneity was not present, and the random-effect model was applied otherwise. A summary receiver-operating characteristic (SROC) curve was constructed. Furthermore, to explore the potential sources of heterogeneity, we used meta-regression to estimate the effect of the characteristics of the studies on the diagnostic accuracy of EUS. In addition, the outliers were identified by the method described by Deville and a subgroup analysis was performed by excluding the outliers. We used Stata statistical software (version 10.0) to assess the publication bias using the Begg-Mazumdar indictor and Harbord-Egger indictor.
RESULTS: Twenty studies with a total of 1115 patients were included in this analysis. The pooled sensitivity, specificity, and positive and negative likelihood ratio of EUS for T1m staging were 0.85 (95%CI: 0.83-0.88), 0.86 (95%CI: 0.83-0.89), 5.34 (95%CI: 3.67-7.76), and 0.21 (95%CI: 0.15-0.29), respectively. For stage T1sm, these results were 0.87 (95%CI: 0.84-0.90), 0.85 (95%CI: 0.82-0.88), 4.64 (95%CI: 3.47-6.22), and 0.18 (95%CI: 0.13-0.25). For stage N, these results were 0.71 (95%CI: 0.61-0.80), 0.78 (95%CI: 0.71-0.84), 2.93 (95%CI: 1.49-5.79), and 0.46 (95%CI: 0.18-1.22). The percent of area under the curve was 92.1% for both stage T1m and stage T1sm, and 80% for stage N. No significant publication bias was found with either the Begg-Mazumdar indictor (P = 0.216) or the Harbord-Egger indictor (P = 0. 412).
CONCLUSION: EUS has excellent sensitivity and specificity in diagnosing the T1 stage of early esophageal cancer. However, the frequency of EUS probe and the experience of the endosonographers can affect the diagnostic accuracy of EUS. EUS plays an important role in clinical selection of surgical approaches and treatments.
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Fernández-Sordo JO, Konda VJA, Chennat J, Madrigal-Hoyos E, Posner MC, Ferguson MK, Waxman I. Is Endoscopic Ultrasound (EUS) necessary in the pre-therapeutic assessment of Barrett's esophagus with early neoplasia? J Gastrointest Oncol 2012. [PMID: 23205307 DOI: 10.3978/j.issn.2078-6891.2012.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Endoscopic ultrasound (EUS) is considered the most accurate tool for the TNM staging of esophageal cancer, but its role in early Barrett's neoplasia is still debatable. The aim was to evaluate the utility of EUS in Barrett's patients prior to therapy. Retrospective review of 109 patients enrolled in a treatment protocol for Barrett's neoplasia in our institution. EUS assessment was classified as suspicious for invasion in 19 patients; 84% of them had no evidence of invasion in final pathology. The assessment of depth of invasion of Barrett's neoplasia based solely on EUS findings leads to overstaging in most patients.
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Luna RA, Gilbert E, Hunter JG. High-grade dysplasia and intramucosal adenocarcinoma in Barrett's esophagus: the role of esophagectomy in the era of endoscopic eradication therapy. Curr Opin Gastroenterol 2012; 28:362-9. [PMID: 22517568 DOI: 10.1097/mog.0b013e328353e346] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to evaluate the role of esophagectomy for high-grade dysplasia (HGD) and intramucosal adenocarcinoma (IMC) in light of recent advances in endoscopic therapy for Barrett's esophagus. RECENT FINDINGS Radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR) are proven well tolerated and effective, at least in midterm follow-up. The application of these techniques has opened a new road for the local treatment of esophageal HGD and IMC. To safely employ these techniques, reliable and accurate staging of the esophageal neoplasm is essential. EMR has taken a central role, as it allows the pathologist to provide tumor-staging information necessary for an appropriate clinical management decision process. Unfortunately, both RFA and EMR have limitations that preclude their universal use in the treatment of early esophageal cancer. In some cases, esophagectomy still remains the best treatment option. The evolution of the minimally invasive approach to esophagectomy may improve outcomes of this major operation. SUMMARY A better understanding of the indications and limitations of endoscopic therapy for HGD and IMC permits a tailored approach to the management of patients with early esophageal adenocarcinoma. When indicated, the selection of a less morbid surgical technique has the potential to improve overall surgical and oncological outcomes.
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Affiliation(s)
- Renato A Luna
- Department of Surgery, Oregon Health and Science University, Portland, Oregon 97239-3098, USA
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Thosani N, Singh H, Kapadia A, Ochi N, Lee JH, Ajani J, Swisher SG, Hofstetter WL, Guha S, Bhutani MS. Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: a systematic review and meta-analysis. Gastrointest Endosc 2012; 75:242-53. [PMID: 22115605 DOI: 10.1016/j.gie.2011.09.016] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 09/06/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND The prognosis of esophageal cancer (EC) depends on the depth of tumor invasion and lymph node metastasis. EC limited to the mucosa (T1a) can be treated effectively with minimally invasive endoscopic therapy, whereas submucosal (T1b) EC carries relatively high risk of lymph node metastasis and requires surgical resection. OBJECTIVE To determine the diagnostic accuracy of EUS in differentiating T1a EC from T1b EC. DESIGN We performed a comprehensive search of MEDLINE, SCOPUS, Cochrane, and CINAHL Plus databases to identify studies in which results of EUS-based staging of EC were compared with the results of histopathology of EMR or surgically resected esophageal lesions. DerSimonian-Laird random-effects model was used to estimate the pooled sensitivity, specificity, and likelihood ratio, and a summary receiver operating characteristic (SROC) curve was created. SETTING Meta-analysis of 19 international studies. PATIENTS Total of 1019 patients with superficial EC (SEC). INTERVENTIONS EUS and EMR or surgical resection of SEC. MAIN OUTCOME MEASUREMENTS Sensitivity and specificity of EUS in accurately staging SEC. RESULTS The pooled sensitivity, specificity, and positive and negative likelihood ratio of EUS for T1a staging were 0.85 (95% CI, 0.82-0.88), 0.87 (95% CI, 0.84-0.90), 6.62 (95% CI, 3.61-12.12), and 0.20 (95% CI, 0.14-0.30), respectively. For T1b staging, these results were 0.86 (95% CI, 0.82-0.89), 0.86 (95% CI, 0.83-0.89), 5.13 (95% CI, 3.36-7.82), and 0.17 (95% CI, 0.09-0.30), respectively. The area under the curve was at least 0.93 for both mucosal and submucosal lesions. LIMITATIONS Heterogeneity was present among the studies. CONCLUSION Overall EUS has good accuracy (area under the curve ≥0.93) in staging SECs. Heterogeneity among the included studies suggests that multiple factors including the location and type of lesion, method and frequency of EUS probe, and the experience of the endosonographer can affect the diagnostic accuracy of EUS.
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Affiliation(s)
- Nirav Thosani
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas Medical School, Houston, Texas 77030, USA
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Kalaitzakis E, Meenan J. Controversies in the use of endoscopic ultrasound in esophageal cancer staging. Scand J Gastroenterol 2009; 44:133-44. [PMID: 18654933 DOI: 10.1080/00365520802273066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Evangelos Kalaitzakis
- Department of Gastroenterology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Abstract
The recent increase in the incidence of superficial esophageal cancer and promising developments in potentially curative endoscopic therapies have placed endoscopic ultrasound in a central position with regard to decision making. This is a review of the literature to determine the role of endoscopic ultrasound and high frequency probe ultrasonography in the assessment of superficial esophageal carcinomas.
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Affiliation(s)
- Tan Attila
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon 97239-3098, USA
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Waxman I, Raju GS, Critchlow J, Antonioli DA, Spechler SJ. High-frequency probe ultrasonography has limited accuracy for detecting invasive adenocarcinoma in patients with Barrett's esophagus and high-grade dysplasia or intramucosal carcinoma: a case series. Am J Gastroenterol 2006; 101:1773-9. [PMID: 16780561 DOI: 10.1111/j.1572-0241.2006.00617.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM To evaluate prospectively the accuracy of preoperative high-frequency (20 MHz) probe ultrasonography (HFPUS) for detecting invasive cancer in patients referred for esophagectomy because of an endoscopic biopsy diagnosis of high-grade dysplasia (HGD) or intramucosal carcinoma (ICA) in Barrett's esophagus (BE). PATIENTS AND METHODS Nine consecutive male patients (median age of 69 yr) who were referred for esophagectomy for HGD or ICA in BE agreed to participate. We performed conventional upper gastrointestinal endoscopy followed by HFPUS using a through-the-scope ultrasound probe (20 MHz), and we compared our preoperative findings with the pathologist's findings in the resected esophageal specimens. RESULTS There was complete agreement between the postoperative pathological findings and the preoperative HFPUS findings in only 4 of the 9 patients. HFPUS resulted in two false-negative diagnoses of esophageal cancer (both had T1 lesions in the resected specimens), one false-positive diagnosis of esophageal cancer, and two errors in tumor staging (1 understaged, 1 overstaged). CONCLUSIONS HFPUS has limited accuracy for identifying invasive cancer in patients found to have HGD or IMC in BE. Pending further refinements in technology, clinical management decisions in such patients should not be based solely on the results of HFPUS.
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Affiliation(s)
- Irving Waxman
- University Chicago Section of Endoscopy and Therapeutics and the Cancer Research Center, Chicago, Illinois 60637, USA
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Esaki M, Matsumoto T, Moriyama T, Hizawa K, Ohji Y, Nakamura S, Hirakawa K, Hirahashi M, Yao T, Iida M. Probe EUS for the diagnosis of invasion depth in superficial esophageal cancer: a comparison between a jelly-filled method and a water-filled balloon method. Gastrointest Endosc 2006; 63:389-95. [PMID: 16500385 DOI: 10.1016/j.gie.2005.10.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2004] [Accepted: 10/13/2005] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Diagnostic accuracy of probe EUS depends on the constant maintenance of luminal medium for acoustic coupling. This study compared the accuracy of probe EUS by a jelly-filled method (EUS-J) and by a water-filled balloon method (EUS-W) for the assessment of invasion depth in superficial esophageal cancer. DESIGN AND SETTING A prospective, single-center study. PATIENTS Forty superficial esophageal cancers in 38 patients. INTERVENTIONS Patients were alternately assigned to EUS-J or EUS-W. The depth of invasion was classified into epithelium or lamina propria mucosae (D1), muscularis mucosae or superficial layer of the submucosa (D2), and deep portion of the submucosa (D3). Depiction rate, interobserver variation between 2 observers, and accuracy for the determination of invasion depth were compared between EUS-J and EUS-W. MAIN OUTCOME MEASUREMENTS AND RESULTS Eighteen cancers were examined by EUS-J, and 22 cancers were examined by EUS-W. The actual depth of invasion was D1 in 21 cancers, D2 in 9 cancers, and D3 in 10 cancers. Depiction rate (94.4% vs 77.2%, P = .14) and interobserver agreement of EUS determination (82.3% vs 58.8%, P = .13) was higher in EUS-J than in EUS-W. The overall accuracy for the diagnosis of invasion depth was 77.8% in EUS-J and 59.1% in EUS-W (P = .18). The sensitivity for the diagnosis of D1 cancer was significantly higher in EUS-J than in EUS-W (100% vs 50%, P = .03), while the specificity was not different between the 2 procedures (81.8% vs 87.5%). CONCLUSIONS EUS-J is superior to EUS-W for the assessment of invasion depth in superficial esophageal cancer, especially for intramucosal cancer.
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Affiliation(s)
- Motohiro Esaki
- Department of Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Shimoyama S, Imamura K, Takeshita Y, Tatsutomi Y, Yoshikawa A, Fujishiro M, Yahagi N. The useful combination of a higher frequency miniprobe and endoscopic submucosal dissection for the treatment of T1 esophageal cancer. Surg Endosc 2006; 20:434-8. [PMID: 16437280 DOI: 10.1007/s00464-005-0144-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Accepted: 07/29/2005] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are few published data on the discrimination ability of endoscopic ultrasonography (EUS) among each subdivision of T1 cancer, and overdiagnosis is an unsolved problem that eventually causes overtreatment. The purpose of this study was to verify whether our treatment strategy incorporating EUS realizes a tailored patient management of T1 esophageal cancer. METHODS This study comprised 20 esophageal cancer patients undergoing 12- to 20-MHz miniprobes for T staging and a 7.5-MHz dedicated echoendoscope for N staging. Initial therapy constituted endoscopic submucosal dissection (ESD) for endosonographically node-negative, mucosal, or slight submucosal cancers and a primary esophagectomy with three-field lymphadenectomy for deeper cancers. If the ESD specimen revealed no cancer involvement of the muscularis mucosa, the patients entered a follow-up program; otherwise, they were advised to undergo a subsequent esophagectomy and three-field lymphadenectomy. RESULTS Perfect discrimination accuracy was achieved among T1, T2, and T3 cancers. Whether cancer depth was up to the slight submucosal layer or deeper was correctly differentiated in 12 of 14 T1 cancers (86%). EUS categorized all patients correctly into candidates for either ESD or surgery. The pathological cancer depth of the resected specimens revealed that no patients experienced unnecessary overtreatment. CONCLUSIONS A higher frequency miniprobe is useful for the detailed evaluation of cancer depth, contributing to decision making for treatment options of T1 esophageal cancer. A miniprobe and echoendoscope in combination with ESD provide an appropriately tailored management plan on an individual basis, avoiding unnecessary treatment or indicating radical surgery.
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Affiliation(s)
- S Shimoyama
- Department of Gastrointestinal Surgery, University of Tokyo, 7-3-1, Hongo, Tokyo 113-8655, Japan.
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Abstract
The endoscopic evaluation of patients with oesophageal adenocarcinoma does not only serve the purpose of diagnosing the lesion and obtaining biopsies for histological evaluation: a systematic description of advanced lesions is also required to guide further therapeutic decisions. New endoscopic imaging modalities hold the promise of better endoscopic detection of early cancer and its precursor lesions in Barrett's oesophagus. Video-autofluorescence and narrow band imaging are the most promising techniques in this respect. The former may be used as a 'red flag' technique, identifying lesions that remain occult with white light endoscopy; the latter may be used as a targeted imaging technique, allowing for detailed inspection of the mucosal and vascular patterns that may help to distinguish early neoplasia from non-dysplastic tissue. Currently, prototypes are under investigation that combine high-resolution endoscopy, narrow band imaging and video-autofluorescence in one endoscopy system. Endoscopic ultrasonography (EUS) is superior to any other imaging modality in the assessment of local tumour infiltration of oesophageal adenocarcinoma and locoregional lymph nodes status. EUS allows for the identification of patients with advanced disease who are unlikely to benefit from attempts at curative surgery and in whom a conservative palliative treatment is indicated. EUS may also play a role in the selection of patients for local endoscopic treatment of early oesophageal cancer. EUS guided fine needle aspiration (EUS-FNA) of locoregional lymph nodes is safe with a high sensitivity and an impeccable specificity for assessment of malignant involvement. The indications for EUS-FNA of lymph nodes, however, depend on local treatment protocols: caeliac nodes (M1a) and lymph nodes located at or above the subcarinal area are the most widely used indications. In addition, it may be important if the choice for specific treatment protocols (e.g. neoadjuvant chemoradiotherapy) depends on lymph node status.
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Affiliation(s)
- Jacques J G H M Bergman
- Oesophageal Research Team, Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Portale G, Peters JH, Hsieh CC, Hagen JA, DeMeester SR, DeMeester TR. Can clinical and endoscopic findings accurately predict early-stage adenocarcinoma? Surg Endosc 2005; 20:294-7. [PMID: 16333557 DOI: 10.1007/s00464-004-8940-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Accepted: 01/26/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND The presentation and management of esophageal cancer are changing, as more patients are diagnosed at an earlier stage of the disease in which endoscopic treatment methods may be contemplated. Therefore, we conducted a study to determine whether symptomatic and endoscopic findings can accurately identify node-negative early-stage adenocarcinoma. METHODS A total of 213 consecutive patients (171 men and 42 women) with resectable esophageal adenocarcinoma seen from 1992 to 2002 were evaluated. None of these patients received neoadjuvant chemotherapy or radiation therapy. Using a multivariable model, model-based probabilities of early-stage disease (T1 im/sm N0) were calculated for each combination of the following three features: no dysphagia as main symptom at presentation, tumor length <or=2 cm, and noncircumferential lesion. RESULTS Eighty-two percent of the patients with all three characteristics presented with early-stage disease. Even in the setting of small, visible, noncircumferential tumors/nodules in patients without dysphagia, 14% of the patients harbored node metastasis. CONCLUSIONS Simple clinical and endoscopic findings predicted early-stage disease in 82% of cases, whereas a small but significant percentage had node metastasis. Because node metastasis predisposes to local failure in nonresectional treatment options such as endoscopic mucosal resection and photodynamic therapy, such findings should have a significant bearing on treatment decisions.
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Affiliation(s)
- G Portale
- Division of Thoracic and Foregut Surgery, University of Southern California, 1510 San Pablo Street, Los Angeles, CA 90033, USA
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15
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Lightdale CJ, Kulkarni KG. Role of endoscopic ultrasonography in the staging and follow-up of esophageal cancer. J Clin Oncol 2005; 23:4483-9. [PMID: 16002838 DOI: 10.1200/jco.2005.20.644] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To evaluate the role of endoscopic ultrasonography (EUS) in the initial staging and follow-up of esophageal cancer on the basis of a review of the published literature. METHODS Articles published from 1985 to 2005 were searched and reviewed using the following keywords: "esophageal cancer staging," "endoscopic ultrasound," and "endoscopic ultrasonography." RESULTS For initial anatomic staging, EUS results have consistently shown more than 80% accuracy compared with surgical pathology for depth of tumor invasion (T). Accuracy increased with higher stage, and was >90% for T3 cancer. EUS results have shown accuracy in the range of 75% for initial staging of regional lymph nodes (N). EUS has been invariably more accurate than computed tomography for T and N staging. EUS is limited for staging distant metastases (M), and therefore EUS is usually performed after a body imaging modality such as computed tomography or positron emission tomography. Pathologic staging can be achieved at EUS using fine-needle aspiration (FNA) to obtain cytology from suspect Ns. FNA has had greatest efficacy in confirming celiac axis lymph node metastases with more than 90% accuracy. EUS is inaccurate for staging after radiation and chemotherapy because of inability to distinguish inflammation and fibrosis from residual cancer, but a more than 50% decrease in tumor cross-sectional area or diameter has been found to correlate with treatment response. CONCLUSION EUS has a central role in the initial anatomic staging of esophageal cancer because of its high accuracy in determining the extent of locoregional disease. EUS is inaccurate for staging after radiation therapy and chemotherapy, but can be useful in assessing treatment response.
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Affiliation(s)
- Charles J Lightdale
- Columbia University Medical Center, 161 Fort Washington Ave, New York, NY 10032, USA.
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Giovannini M, Ries P. [Diagnosis and endoscopic treatments of superficial carcinomas of the esophagus]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2005; 29:540-5. [PMID: 15980747 DOI: 10.1016/s0399-8320(05)82125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Marc Giovannini
- Unité d'Endoscopie et des Tumeurs Digestives, Institut Paoli-Calmettes, Sainte-Marguerite, Marseille
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17
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Domagk D, Diallo R, Menzel J, Schleicher C, Bankfalvi A, Gabbert HE, Domschke W, Poremba C. Endosonographic and histopathological staging of extrahepatic bile duct cancer: time to leave the present TNM-classification? Am J Gastroenterol 2005; 100:594-600. [PMID: 15743357 DOI: 10.1111/j.1572-0241.2005.40663.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The discrepancy between high rates of sensitivity, specificity, and accuracy for intraductal ultrasonography (IDUS) in extrahepatic bile duct carcinoma and the failure to depict different wall layers as defined by the TNM classification have not yet been elucidated sufficiently. METHODS In a prospective study, endosonographic images were correlated with histomorphology including immunohistochemistry. Using IDUS, we examined fresh resection specimens of patients who had undergone pancreato-duodenectomy. For histological analysis, the formalin-fixed and paraffin-embedded specimens were stained by hematoxylin-eosin, elastica-van-Gieson, and immunohistochemically by smooth muscle-actin. To confirm our hypothesis, further cases from the archives were analyzed histopathologically and immunohistochemically. RESULTS The various wall layers of the extrahepatic bile duct as described by the International Union Against Cancer are neither histomorphologically nor immunohistochemically consistently demonstrable. Especially, a clear differentiation between tumor invasion beyond the wall of the bile duct (T2) and invasion of the pancreas (T3) by histopathological means is often not possible. Endosonographic images using high-resolution miniprobes similarly confirm the difficulty in imaging various layers in the bile duct wall. CONCLUSIONS Most adaptations made by the sixth edition of the TNM classification accommodate to the endosonographic and most of the histopathological findings as demonstrated in our study. In contrast to the new edition, however, our findings suggest to combine T2- and T3-staged tumors into one single class leading to clarification, and improved reproducibility of histopathological staging.
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Affiliation(s)
- D Domagk
- Department of Medicine B and General Surgery, Gerhard-Domagk-Institute of Pathology, University of Muenster, Muenster, Germany
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Soon MS, Soon A, Schembre DB, Lin OS. Prospective evaluation of a jelly-like conducting medium for catheter US probe imaging of esophageal and duodenal lesions. Gastrointest Endosc 2005; 61:133-9. [PMID: 15672076 DOI: 10.1016/s0016-5107(04)02446-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The catheter probe EUS(C-EUS) relies on luminal water for acoustic coupling. However, in tubular structures, such as the esophagus and the duodenum, instilled water drains away rapidly. The use of water-filled balloons is limited by air artifact and other problems. This study evaluated the image quality, the penetration depth, the tumor staging accuracy, and the safety of C-EUS by using carboxymethylcellulose, an edible, nontoxic, transparent jelly-like substance (JC-EUS). METHODS Forty patients with an esophageal or a duodenal submucosal lesion or an esophageal carcinoma were evaluated prospectively in a crossover study with both C-EUS and JC-EUS when using a 12-MHz US catheter probe. Based on still images, depth of US penetration and image quality (by using a predefined 1 to 5 scale) were assessed by a blinded, independent endosonographer. OBSERVATIONS JC-EUS was superior in image quality compared with C-EUS overall (mean score: 4.9 vs. 2.6; p <0.001), as well as in each subgroup (esophageal carcinoma, esophageal submucosal lesion, duodenal submucosal lesion). Penetration depth was not significantly different (2.5 cm). Staging was 100% accurate in 14 patients with esophageal cancer who underwent surgery. There was no procedure-related complication. CONCLUSIONS JC-EUS is safe, provides superior image quality to C-EUS, and is accurate for local staging of esophageal cancer.
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Affiliation(s)
- Maw-Soan Soon
- Department of Gastroenterology, ChangHua Christian Medical Center, Seattle, WA 98101, USA
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19
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Affiliation(s)
- Gerard A Isenberg
- Division of Gastroenterology, University Hospitals of Cleveland, Case Western Reserve University, Ohio 44106-5066, USA
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20
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Yanai H, Harada T, Okamoto T, Hirano A, Takeo N, Yoshida T, Okita K, Kawano T. Prognostic value and interobserver agreement of endoscopic ultrasonography for superficial squamous cell carcinoma of the esophagus: a prospective study. INTERNATIONAL JOURNAL OF GASTROINTESTINAL CANCER 2004. [PMID: 15235130 DOI: 10.1385/ijgc: 34: 1: 01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND AIMS Submucosal invasion of superficial esophageal cancer (SEC) is related to the prognosis. We prospectively analyzed outcomes of SEC in patients staged by endoscopic ultrasonography (EUS). PATIENTS AND METHODS We staged 31 endoscopically diagnosed SEC cases using a 20/15-MHz thin probe. The EUS tumor stage was classified as EUSM (limited within mucosa), EUS-SM (with submucosal invasion), or EUS-MP over (invading the muscularis propria or deeper). Lymph node metastasis and 2-yr survival were analyzed according to the EUS tumor stage in 29 squamous cell carcinoma cases. Interobserver agreement of the EUS stage was tested between the examiner and a blind reviewer. RESULTS Lymph node metastasis was significantly frequent in the EUS-SM group (8 of 18 cases [44.4%]) compared with the EUS-M group (1 of 10 cases [10%]) (p = 0.03). Patient survival at 2 yr after initial therapy was 72.2% in the EUS-SM group and 90% in the EUS-M group. Death from cancer was noted only in the EUS-SM group (three cases). The accuracy rates of EUS tumor staging were 74.1% by the examiner and 66.7% by the blind reviewer, with moderate interobserver agreement (kappa = 0.46). CONCLUSIONS Thin-probe EUS can classify SEC into two groups: the EUS-M group with excellent outcome and the EUS-SM group with a significant risk of lymph node metastasis.
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Affiliation(s)
- Hideo Yanai
- Department of Gastroenterology and Hepatology, Yamaguchi University School of Medicine, Minamikogushi, Ube, Japan.
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21
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Hünerbein M, Handke T, Ulmer C, Schlag PM. Impact of miniprobe ultrasonography on planning of minimally invasive surgery for gastric and colonic tumors. Surg Endosc 2004; 18:601-5. [PMID: 14752658 DOI: 10.1007/s00464-003-8925-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2003] [Accepted: 10/16/2003] [Indexed: 12/11/2022]
Abstract
BACKGROUND The use of minimally invasive procedures for the management of gastrointestinal cancer is increasing. The aim of this study was to investigate the role of high-frequency miniprobe endoscopic ultrasound (EUS) for therapeutic decisions making in patients with gastric or colonic tumors. METHODS A total of 137 patients underwent EUS with a 12.5-MHz miniprobe for preoperative staging of tumors of the stomach ( n = 49) or colon ( n = 88). After resection, the surgical path was reviewed to analyze the role of preoperative staging with miniprobes. RESULTS Miniprobe EUS enabled accurate assessment of the infiltration depth of gastric and colonic tumors. The overall accuracy rates were 88% and 87%, respectively. The lymph node status was predicted correctly in 82% of the patients (sensitivity, 61%, specificity, 94%). Based on the results of miniprobe EUS, patients with gastric cancer were accurately selected to undergo endoscopic mucosal resection, laparoscopic resection, or open surgery in 100%, 91%, and 86% of the cases, respectively. In patients with colonic tumors, the treatment decision analysis showed that the stratification was correct in 90% of the patients. CONCLUSIONS Miniprobe EUS is a reliable method for validating treatment decisions for patients undergoing minimally invasive procedures for gastric and colonic tumors. This method is particularly valuable in the management of colon cancer, because endoscopic and laparoscopic resections can be offered to selected patients as an alternative to open surgery.
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Affiliation(s)
- M Hünerbein
- Department of Surgery and Surgical Oncology, Robert Rössle Hospital, Charité, Campus Buch, Helios Hospitals, University of Medicine, 13122, Berlin, Germany
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Tanioka Y, Yoshida T, Yagawa T, Saiki Y, Takeo S, Harada T, Okazawa T, Yanai H, Okita K. Matrix metalloproteinase-7 and matrix metalloproteinase-9 are associated with unfavourable prognosis in superficial oesophageal cancer. Br J Cancer 2004; 89:2116-21. [PMID: 14647147 PMCID: PMC2376843 DOI: 10.1038/sj.bjc.6601372] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
If oesophageal carcinoma is detected in the superficial stage, the prognosis is better than for advanced oesophageal carcinoma. But the factors which predict the prognosis and treatment policy remain unclear. Matrix metalloproteinase-7 (MMP-7) and matrix metalloproteinase-9 (MMP-9) have been reported to have close associations with tumour invasion and metastasis. In this study, we retrospectively studied the relations between MMP-7 and MMP-9 expression in immunohistochemistry, clinicopathologic factors, and prognosis in 55 superficial oesophageal carcinomas. MMP-7 and MMP-9 expression occurred in 23.6% and 47.3% of the patients, respectively. MMP-7 expression was significantly correlated with the presence of nodal metastasis (P=0.004). MMP-9 expression was significantly correlated with the depth of tumour invasion (P=0.004), lymphatic permeation (P=0.001), nodal metastasis (P=0.049), and pathologic differentiation grade (P=0.003). By the log-rank test, MMP-7 expression and MMP-9 expression on the invasive front were related to the prognosis. In multivariate analysis, MMP-9 expression on the invasive front was an independent prognostic indicator. The combined expression of MMP-7 and MMP-9 may be a good marker for the degree of malignancy of oesophageal cancer and for the presence of lymphatic metastasis.
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Affiliation(s)
- Y Tanioka
- Department of Gastroenterology and Hepatology, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - T Yoshida
- Department of Gastroenterology and Hepatology, Yamaguchi University School of Medicine, Yamaguchi, Japan
- Department of Gastroenterology and Hepatology, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505 Japan. E-mail:
| | - T Yagawa
- Department of Gastroenterology and Hepatology, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Y Saiki
- Department of Gastroenterology and Hepatology, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - S Takeo
- Department of Gastroenterology and Hepatology, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - T Harada
- Department of Gastroenterology and Hepatology, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - T Okazawa
- Department of Gastroenterology and Hepatology, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - H Yanai
- Department of Gastroenterology and Hepatology, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - K Okita
- Department of Gastroenterology and Hepatology, Yamaguchi University School of Medicine, Yamaguchi, Japan
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Wu LF, Wang BZ, Feng JL, Cheng WR, Liu GR, Xu XH, Zheng ZC. Preoperative TN staging of esophageal cancer: Comparison of miniprobe ultrasonography, spiral CT and MRI. World J Gastroenterol 2003; 9:219-24. [PMID: 12532435 PMCID: PMC4611315 DOI: 10.3748/wjg.v9.i2.219] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To evaluate the value of miniprobe sonography (MPS), spiral CT and MR imaging (MRI) in the tumor and regional lymph node staging of esophageal cancer.
METHODS: Eight-six patients (56 men and 30 women; age range of 39-73 years, mean 62 years) with esophageal carcinoma were staged preoperatively with imaging modalities. Of them, 81 (94%) had squamous cell carcinoma, 4 (5%) adenocarcinoma, and 1 (1%) adenoacanthoma. Eleven patients (12%) had malignancy of the upper one third, 41 (48%) of the mid-esophagus and 34 (40%) of the distal one third. Forty-one were examined by spiral CT in whom 13 were co-examined by MPS, and forty-five by MRI in whom 18 were also co-examined by MPS. These imaging results were compared with the findings of the histopathologic examination for resected specimens.
RESULTS: In staging the depth of tumor growth, MPS was significantly more accurate (84%) than spiral CT and MRI (68% and 60%, respectively, P < 0.05). The specificity and sensitivity were 82% and 85% for MPS; 60% and 69% for spiral CT; and 40% and 63% for MRI, respectively. In staging regional lymph nodes, spiral CT was more accurate (78%) than MPS and MRI (71% and 64%, respectively), but the difference was not statistically significant. The specificity and sensitivity were 79% and 77% for spiral CT; 75% and 68% for MPS; and 68% and 62% for MRI, respectively.
CONCLUSION: MPS is superior to spiral CT or MRI for T staging, especially in early esophageal cancer. However, the three modalities have the similar accuracy in N staging. Spiral CT or MRI is helpful for the detection of far-distance metastasis in esophageal cancer.
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Affiliation(s)
- Ling-Fei Wu
- Department of Gastroenterology, Second Affiliated Hospital, Shantou University Medical College, Shantou 515041, Guangdong Province China.
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24
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Yeh HZ, Chen GH, Chang WD, Poon SK, Yang SS, Lien HC, Chang CS, Chou G. Long-term follow up of gastric low-grade mucosa-associated lymphoid tissue lymphoma by endosonography emphasizing the application of a miniature ultrasound probe. J Gastroenterol Hepatol 2003; 18:162-7. [PMID: 12542600 DOI: 10.1046/j.1440-1746.2003.02938.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Endoscopic ultrasonography (EUS) is a useful tool for the evaluation of gastric wall infiltration including gastric lymphoma. The aims of this study were to characterize gastric low-grade mucosa-associated lymphoid tissue (MALT) lymphoma according to EUS findings and to evaluate the role of a miniature ultrasound probe in the long-term follow up. METHODS From January 1994 to March 2002, 20 patients were proven to have gastric low-grade MALT lymphoma. Endoscopic ultrasonography was performed with a conventional echoprobe and/or a miniature ultrasound probe for initial staging and a miniature ultrasound probe was performed during follow up. All patients positive for Helicobacter pylori received a 2-week course of omeprazole, amoxicillin and clarithromycin. RESULTS Helicobacter pylori infection was found in 17 (85%) patients. In all patients, H. pylori was eradicated after treatment. Initial EUS showed significantly greater wall thickness (6.1 +/- 3.0 mm) in MALT lymphoma patients when compared with control (2.8 +/- 0.3 mm). The infiltrative patterns included wall thickening (3.5-14.1 mm) in 18 patients: stage E-I1 in 16 (mucosa and/or submucosa), stage E-I2 in one and stage E-II in one. Complete regression of MALT lymphoma following treatment for H. pylori was noted in 14 patients, with a mean duration of 11.3 +/- 9.1 months. Follow-up miniature ultrasound probe sonography showed comparative reduction in wall thickness (P < 0.05). CONCLUSIONS Endoscopic ultrasonography plays a valuable role in the initial staging and long-term follow up of gastric low-grade MALT lymphoma. The application of a miniature ultrasound probe enables adequate evaluation in the majority of these patients, with additional benefits.
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Affiliation(s)
- Hong-Zen Yeh
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, National Yang-Ming University, Taipei, Taiwan, China.
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Funakoshi K, Akiyama N, Kozakai I, Arai F, Motoyama H, Kato T, Ogoshi K, Ohta T. Successful endoscopic therapy of superficial esophageal cancer on varices in a patient with alcoholic liver cirrhosis. Dig Endosc 2002. [DOI: 10.1046/j.1443-1661.2001.00141.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
| | | | | | | | | | | | | | - Tamaki Ohta
- Pathology, Niigata Cancer Center Hospital, Niigata, Japan
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Bordas JM. [Gastrointestinal echoendoscopy: technical aspects and tools]. GASTROENTEROLOGIA Y HEPATOLOGIA 2002; 25:2-6. [PMID: 11835866 DOI: 10.1016/s0210-5705(02)70233-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J M Bordas
- Unidad de Endoscopia Digestiva. Institut de Malalties Digestives. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
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Waxman I, Saitoh Y, Raju GS, Watari J, Yokota K, Reeves AL, Kohgo Y. High-frequency probe EUS-assisted endoscopic mucosal resection: a therapeutic strategy for submucosal tumors of the GI tract. Gastrointest Endosc 2002; 55:44-9. [PMID: 11756913 DOI: 10.1067/mge.2002.119871] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy and safety of high-frequency probe EUS (HFPE)-assisted endoscopic mucosal resection in the management of submucosal tumors of the GI tract. METHODS HFPE-assisted endoscopic mucosal resection was attempted in 28 patients with submucosal tumors less than 2 cm in diameter. HFPE was performed with a 20-MHz "through-the-scope" probe. Saline solution was injected into the submucosa. After confirming detachment of the lesion from the muscularis propria by repeat HFPE, endoscopic mucosal resection was performed with a lift-and-cut or endoscopic mucosal resection cap technique. Follow-up endoscopy was performed in all patients. RESULTS Submucosal tumors from the following areas were included: esophagus 3, stomach 4, duodenum 3, and colon 18. The submucosal tumors were located in the upper third (n = 3), middle third (n = 18), and lower third (n = 7) of the submucosa. Twenty-one submucosal tumors were removed by the lift-and-cut technique and 6 by the cap method. One patient required surgical resection after unsuccessful endoscopic mucosal resection. The origin and depth of penetration of all lesions was accurately depicted by HFPE. Median tumor diameter was 9 mm (range 3-20 mm). Resection was successful and complete in 93% of the cases. There were no immediate postprocedure complications (exact 95% CI [0%, 12.3%]). During a median follow-up of 21.5 months (range 2-74 months) no recurrence was found. CONCLUSIONS HFPE-assisted endoscopic mucosal resection is safe and effective for the management of selected submucosal tumors of the GI tract. A management algorithm based on endoscopic and HFPE findings is proposed.
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Affiliation(s)
- Irving Waxman
- University of Texas Medical Branch at Galveston, Texas, USA
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28
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Wang KK, Buttar N, Lutzke L. Endoscopic mucosal resection. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2000. [DOI: 10.1053/tgie.2000.8945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Nesje LB, Svanes K, Viste A, Laerum OD, Odegaard S. Comparison of a linear miniature ultrasound probe and a radial-scanning echoendoscope in TN staging of esophageal cancer. Scand J Gastroenterol 2000; 35:997-1002. [PMID: 11063164 DOI: 10.1080/003655200750023101] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic ultrasonography is a precise method for TN staging of esophageal cancer. We explored the staging properties of a linear miniprobe as compared with a radial-scanning echoendoscope. METHODS Sixty-eight patients with esophageal cancer underwent preoperative TN staging using a 20-MHz linear miniprobe and a 7.5/12-MHz radial-scanning echoendoscope. Tumor stage was verified by surgery and/or histology. RESULTS T and N stages were verified in 53 and 54 patients, respectively. T-staging accuracy using the echoendoscope was 70%. The high-frequency miniprobe could not differentiate between T3 and T4 tumors, but both systems had an accuracy of 87% in discriminating between T1, T2, and T3/4 stages. With traversable tumors, the accuracy of N staging was significantly better with the echoendoscope than with the miniprobe (90% vs. 48%, P = 0.008). CONCLUSIONS The two endosonographic systems had similar accuracy for assessing transmural tumor growth, but the echoendoscope was superior in staging advanced transmural tumors and in predicting lymph node metastasis with traversable tumors.
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Affiliation(s)
- L B Nesje
- Institutes of Internal Medicine and Surgery, Dept. of Pathology, Haukeland University Hospital, University of Bergen, Norway
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Iwase H, Kusugami K, Suzuki M, Nishio Y, Ando T, Ina K, Peek RM. Endoscopic resection of early-stage esophageal cancer accompanied by esophageal varices. Gastrointest Endosc 2000; 51:749-52. [PMID: 10840320 DOI: 10.1067/mge.2000.104006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- H Iwase
- Department of Gastroenterology, Nagoya National Hospital, Nagoya University School of Medicine, Japan
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31
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Lambert R. Endoscopic mucosectomy: an alternative treatment for superficial esophageal cancer. Recent Results Cancer Res 2000; 155:183-92. [PMID: 10693252 DOI: 10.1007/978-3-642-59600-1_19] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Recent trends in the management of superficial esophageal cancer consist of improved detection, pretherapeutic staging and reliable criteria for curative endoscopic therapy. The endoscopic treatment is legitimate when the cancer is at an early stage, intra-epithelial or microinvasive (m1 or m2) and N0. Submucosal cancer should not be treated with a curative intent by endotherapy. Concerning squamous cell cancer, the oriental and occidental pathologists include high-grade dysplasia in the same group as intramucosal cancer. The distinction is however maintained for adenocarcinoma in the Barrett's esophagus. Indications of endoscopic rather than surgical treatment rely on: (1) the small size of the tumor (not more than 2 cm in diameter); (2) the endoscopic morphology in the type 0 of the Japanese classification with the flat subtypes IIa and IIb rather than type IIc--there is high risk of submucosal invasion for the polypoid (type I) or ulcerated superficial cancer (type III); and (3) the endoscopic ultrasound staging, with confirmed integrity of the hyperechoic submucosal layer. The high-frequency (20 MHz) miniprobe is preferred to the standard (7.5 MHz) instrument. The elective procedure for tumor eradication is endoscopic mucosectomy. The technique is associated with a 6.8% risk of severe complications (hemorrhage or perforation) and a recurrence rate of 3%-7%. The 5-year survival rate is similar to that of surgery (over 80%). In the small group of patients with superficial esophageal cancer (less than 10% of the disease) endoscopic treatment may now be proposed in about 30% of cases, surgery is preferred for submucosal cancer and for neoplasia with a large surface. Areas of high-grade dysplasia in the Barrett's esophagus offer a new and increasing sector of indications. The concurrent endoscopic procedure of destruction--photodynamic therapy--is preferred for the destruction of lesions with poorly delineated limits.
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Affiliation(s)
- R Lambert
- Department of Digestive Diseases, Hospital Edouard Herriot, Lyon, France
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Abstract
Endoscopic ultrasonography (EUS) represents a major advance in endoscopic imaging. The usefulness and effectiveness of EUS have been established during the past few years. However, endosonography using dedicated echoendoscopes (7.5/12 MHz) has some serious drawbacks, as follows: 1) Combining endoscopy and ultrasonography in one instrument increases the diameter of such echoendoscopes (12-13 mm); 2) Because of the large diameter, complete passage of severe strictures is often not possible and, for examination of the pancreatobiliary duct system, is not feasible at all; 3) Image quality and resolution for small lesions is not always satisfactory; and 4) Conventional endosonography requires a second examination separate from the previous routine endoscopy. Recently developed ultrasonographic miniprobes (diameters about 2 mm; frequencies 12-20 MHz) can be passed through the working channel of standard endoscopes to provide high frequency ultrasound images. These miniprobes might overcome some of the above-mentioned drawbacks and contribute to patients' security and convenience. Moreover, in various diseases of the GI tract and the pancreatobiliary duct system, diagnostic accuracy of miniprobe ultrasonography has been shown to be even superior to that of EUS. In summary, miniprobe ultrasonography seems to be a promising tool in the armamentarium of gastroenterological diagnostics.
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Affiliation(s)
- J Menzel
- Department of Medicine B, University of Münster, Germany
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Fujimoto JG, Pitris C, Boppart SA, Brezinski ME. Optical coherence tomography: an emerging technology for biomedical imaging and optical biopsy. Neoplasia 2000; 2:9-25. [PMID: 10933065 PMCID: PMC1531864 DOI: 10.1038/sj.neo.7900071] [Citation(s) in RCA: 521] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Optical coherence tomography (OCT) is an emerging technology for performing high-resolution cross-sectional imaging. OCT is analogous to ultrasound imaging, except that it uses light instead of sound. OCT can provide cross-sectional images of tissue structure on the micron scale in situ and in real time. Using OCT in combination with catheters and endoscopes enables high-resolution intraluminal imaging of organ systems. OCT can function as a type of optical biopsy and is a powerful imaging technology for medical diagnostics because unlike conventional histopathology which requires removal of a tissue specimen and processing for microscopic examination, OCT can provide images of tissue in situ and in real time. OCT can be used where standard excisional biopsy is hazardous or impossible, to reduce sampling errors associated with excisional biopsy, and to guide interventional procedures. In this paper, we review OCT technology and describe its potential biomedical and clinical applications.
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Affiliation(s)
- J G Fujimoto
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge 02139, USA
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Bergman JJ, Fockens P. Endoscopic ultrasonography in patients with gastro-esophageal cancer. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 1999; 10:127-38. [PMID: 10586017 DOI: 10.1016/s0929-8266(99)00055-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
For patients with gastro-esophageal cancer ultrasonography (EUS) is superior to any other imaging modality in the assessment of local tumor infiltration and local lymph nodes status. EUS is especially important in the preoperative staging of patients with esophageal cancer and patients with proximal gastric cancer. Here it allows for the identification of those patients with advanced disease who are unlikely to benefit from surgery and in whom a conservative palliative treatment is indicated. In advanced gastric cancer the clinical implications of EUS less clear. Still preoperative EUS is indicated in every patient with cancer of the proximal stomach to assess tumor infiltration in the esophagus. Relatively new is the use of EUS in staging early cancers in order to select patients for local endoscopic treatment. High-frequency miniprobes are the instruments of choice for imaging these lesions. Strict criteria should be applied in the selection of patients for local endoscopic treatment of early gastro-esophageal cancers. EUS guided fine needle aspiration (EUS-FNA) is currently only indicated in patients with esophageal cancer and suspicious celiac lymph nodes. It may become more important if new treatment protocols demand more objective and reliable assessment of lymph node status.
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Affiliation(s)
- J J Bergman
- Department of Gastroenterology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Odegaard S. High-resolution endoluminal sonography in gastroenterology. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 1999; 10:85-91. [PMID: 10586013 DOI: 10.1016/s0929-8266(99)00058-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Endosonography is an imaging method where a high frequency ultrasound probe is inserted blindly or under endoscopic control into a lumen. Examination of the gastrointestinal tract is performed using dedicated echoendoscopes or transendoscopic miniprobes. The gastrointestinal wall, mediastinum, pancreas, bile ducts, retroperitoneum, and other structures surrounding the gastrointestinal tract are target organs for endosonography. A detailed image of pathological processes can thus be obtained. The method can be used both for primary diagnosis of lesions and in follow-up of gastrointestinal diseases. It is accurate in local staging of cancer and in detecting small lesions, which cannot be seen with other imaging modalities. There are some limitations for optimal examination like stenoses or other factors prohibiting a precise position of the ultrasound transducer. The clinical importance of endosonographic examinations must be continuously evaluated on the basis of new technical modalities and changes in therapeutic procedures.
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Affiliation(s)
- S Odegaard
- Institute of Internal Medicine, Haukeland University Hospital, University of Bergen, 5021, Bergen, Norway.
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Comparaison de l'échoendoscopie avec les nouvelles méthodes d'imagerie médicale. ACTA ACUST UNITED AC 1999. [DOI: 10.1007/bf03020859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chak A, Soweid A, Hoffman B, Stevens P, Hawes RH, Lightdale CJ, Cooper GS, Canto MI, Sivak MV. Clinical implications of endoluminal ultrasonography using through-the-scope catheter probes. Gastrointest Endosc 1998; 48:485-90. [PMID: 9831836 DOI: 10.1016/s0016-5107(98)70089-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Ultrasound catheter probe-assisted endosonography is a relatively new technique. The aim of this prospective multicenter study was to determine its potential clinical impact by assessing changes in diagnostic and therapeutic management affected by catheter probes compared with ultrasound endoscopes. METHODS Endosonographers at three centers selected theoretic diagnostic and therapeutic plans that would be followed if neither catheter probes nor ultrasound endoscopes were available. Patients with suitable lesions underwent endosonography with catheter probes followed by an ultrasound endoscope. Diagnostic and therapeutic plans were noted after each examination. RESULTS Sixty-six patients, of whom 15 had a stenotic esophageal cancer, 39 had a mucosal or submucosal lesion, and 12 had a stricture of the pancreaticobiliary system or the gastrointestinal tract, were enrolled. If neither form of endosonography were available, invasive or surgical diagnostic procedures would have been performed on 23 (35%) patients and surgical therapy would have been planned in 31 (47%) patients. Catheter probe-assisted ultrasonography and endoscopic ultrasonography led to a less invasive diagnostic plan in 11 (16%) and 12 (18%) patients and a less invasive therapeutic plan in 10 (15%) and 14 (21%) patients, respectively (p > 0.1 for differences). CONCLUSIONS Catheter probe-assisted endosonography has a modest effect on diagnostic and therapeutic management, comparable with endoscopic ultrasonography in the same patients. The vast majority of effected changes are toward less invasive management.
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Affiliation(s)
- A Chak
- Division of Gastroenterology at University Hospitals of Cleveland, Ohio 44106, USA
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Hünerbein M, Ghadimi BM, Haensch W, Schlag PM. Transendoscopic ultrasound of esophageal and gastric cancer using miniaturized ultrasound catheter probes. Gastrointest Endosc 1998; 48:371-5. [PMID: 9786108 DOI: 10.1016/s0016-5107(98)70005-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The aim of this study was to investigate the value of miniaturized ultrasound catheter probes (miniprobes) for preoperative staging of esophageal and gastric cancer. METHODS Fifty-one patients with esophageal (n = 21) and gastric cancer (n = 30) underwent endoscopic ultrasound (EUS). All examinations were carried out using mechanical miniprobes (diameter 6F, 12.5 MHz) that were introduced through the instrument channel of the endoscope. RESULTS EUS with miniprobes was successfully performed in all patients, although stenotic tumors, which could not be traversed with the endoscope, were found in 6 of 21 patients (29%) with esophageal cancer. Miniprobe scanning provided high-resolution images of the gastrointestinal tract. The overall accuracy in the assessment of tumor infiltration depth for esophageal and gastric cancer was 90% and 82%, respectively. However, the value of miniprobe scanning in the assessment of advanced tumors was limited by the imaging depth of the probe (approximately 3 cm). Lymph node involvement was accurately diagnosed in 78% of the patients with esophageal cancer (sensitivity 75%, specificity 80%) and in 80% of the patients with gastric cancer (sensitivity 73%, specificity 89%). CONCLUSIONS EUS with miniprobes can be performed as single-step procedure during diagnostic endoscopy. The 12.5 MHz transducer provides high-resolution imaging and enables accurate staging of tumors with limited infiltration depth.
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Affiliation(s)
- M Hünerbein
- Röbert Rössle Hospital, Charité, Humboldt University, Berlin, Germany
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Fischbach W, Gross V, Schölmerich J, Ell C, Layer P, Fleig WE. [1997 gastroenterology update--II]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 1998; 93:146-64. [PMID: 9564162 DOI: 10.1007/bf03044832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- W Fischbach
- II. Medizinische Klinik, Klinikum Aschaffenburg
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Lévy M, Hammel P, Lamarque D, Marty O, Chaumette MT, Haioun C, Blazquez M, Delchier JC. Endoscopic ultrasonography for the initial staging and follow-up in patients with low-grade gastric lymphoma of mucosa-associated lymphoid tissue treated medically. Gastrointest Endosc 1997; 46:328-33. [PMID: 9351036 DOI: 10.1016/s0016-5107(97)70120-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Endoscopic ultrasonography is an appropriate procedure to assess the depth of tumoral infiltration in primary gastric lymphoma. The aims of the present study were to characterize the endoscopic ultrasonographic aspects of low-grade gastric lymphoma of mucosa-associated lymphoid tissue and to determine the value of this procedure in medical treatment assessment. METHODS Between 1991 and 1996, 15 patients with low-grade gastric lymphoma of mucosa-associated lymphoid tissue were treated with oral cyclophosphamide and/or anti-Helicobacter pylori treatment. Endoscopic ultrasonography was carried out at the time of the diagnosis in all patients, 8 of whom (4 in complete remission and 4 with a stable or progressive disease) had at least one endoscopic ultrasonography examination within the treatment period (median follow-up 17 months). RESULTS The initial procedure showed an increased gastric wall thickness from 6 to 12 mm in 8 patients, equal to 5 mm in 5 patients, and normal in 2 patients. The thickening was predominantly of the mucosa alone and/or the submucosa but never extended beyond the muscularis propria. No lymph node was found. Gastric wall thickness returned to normal in the 4 patients in complete remission and remained thick in 3 of the 4 patients with a stable or progressive disease. Of these 3 patients, at least one set of biopsy samples, carried out during follow-up, showed the absence of lymphoma, but histology performed subsequently found evidence of disease. CONCLUSIONS Endoscopic ultrasonography differentiates superficial from infiltrative types of gastric lymphoma of mucosa-associated lymphoid tissue, which may have a prognostic significance and confirms remission or persistence of the disease with medical treatment during follow-up. When the gastric wall remains thick, even if histology is negative, repeated biopsies should be performed to detect evolving disease or relapse.
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Affiliation(s)
- M Lévy
- Service de Gastroentérologie, Hôpital Henri Mondor, Créteil, France
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Nesje LB, Odegaard S, Kimmey MB. Transendoscopic ultrasonography during conventional upper gastrointestinal endoscopy. Clinical evaluation of a linear 20-MHz probe system. Scand J Gastroenterol 1997; 32:500-8. [PMID: 9175215 DOI: 10.3109/00365529709025089] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoluminal ultrasonography provides detailed images of the gastrointestinal wall and surrounding tissue. Miniature ultrasound probes can be applied during conventional endoscopy. METHODS The supplementary diagnostic information obtained during endoscopy with a linear 20-MHz ultrasound probe system was independently assessed by two observers applying a general rating system on 188 consecutive examinations in 173 patients. RESULTS On average, 70% of the examinations were found to contribute conclusive or important supplementary information that could potentially influence treatment or further patient evaluation (substantial diagnostic yield). Substantial diagnostic yield was most often obtained in patients with known malignancy (92%), stenoses (81%), or subepithelial masses (80%) and more often in patients with malignant (85%) than in those with benign (61%) conditions (P < 0.001). CONCLUSIONS Transendoscopic ultrasonography using a 20-MHz linear miniature ultrasound probe may provide substantial supplementary diagnostic information during upper gastrointestinal endoscopy, especially in patients with malignant disease and with stenotic or subepithelial lesions.
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Affiliation(s)
- L B Nesje
- Medical Dept. A, Haukeland University Hospital, Bergen, Norway
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