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Juárez-Salcedo LM, Castillo JJ. Lymphoplasmacytic Lymphoma and Marginal Zone Lymphoma. Hematol Oncol Clin North Am 2019; 33:639-656. [DOI: 10.1016/j.hoc.2019.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Kim SY, Shim KN, Lee JH, Lim JY, Kim TO, Choe AR, Tae CH, Jung HK, Moon CM, Kim SE, Jung SA. Comparison of the Diagnostic Ability of Endoscopic Ultrasonography and Abdominopelvic Computed Tomography in the Diagnosis of Gastric Subepithelial Tumors. Clin Endosc 2019; 52:565-573. [PMID: 31311912 PMCID: PMC6900302 DOI: 10.5946/ce.2019.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/10/2019] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Endoscopic ultrasonography (EUS) is the most efficient imaging modality for gastric subepithelial tumors (SETs). However, abdominopelvic computed tomography (APCT) has other advantages in evaluating the characteristics, local extension, or invasion of SETs to adjacent organs. This study aimed to compare the diagnostic ability of EUS and APCT based on surgical histopathology results.
Methods We retrospectively reviewed data from 53 patients who underwent both EUS and APCT before laparoscopic wedge resection for gastric SETs from January 2010 to December 2017 at a single institution. On the basis of histopathology results, we assessed the diagnostic ability of the 2 tests.
Results The overall accuracy of EUS and APCT was 64.2% and 50.9%, respectively. In particular, the accuracy of EUS vs. APCT for the diagnosis of gastrointestinal stromal tumors (GISTs), leiomyomas, and ectopic pancreas was 83.9% vs. 74.2%, 37.5% vs. 0.0%, and 57.1% vs. 14.3%, respectively. Most of the incorrect diagnoses with EUS involved hypoechoic lesions originating in the fourth echolayer, with the most common misdiagnosed lesions being GISTs mistaken for leiomyomas and vice versa.
Conclusions APCT showed a lower overall accuracy than EUS; however, APCT remains a useful modality for malignant/potentially malignant gastric SETs.
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Affiliation(s)
- Sang Yoon Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Joo-Ho Lee
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Ji Young Lim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Tae Oh Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - A Reum Choe
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hye-Kyung Jung
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Chang Mo Moon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Seong-Eun Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Sung-Ae Jung
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
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Endoscopic ultrasound-guided fine-needle aspiration biopsy for diagnosis of gastric linitis plastica with negative malignant endoscopy biopsies. Oncol Lett 2018; 16:4915-4920. [PMID: 30250557 PMCID: PMC6144711 DOI: 10.3892/ol.2018.9258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 07/17/2018] [Indexed: 12/12/2022] Open
Abstract
The value of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy in the gastric linitis plastica (GLP) with negative malignant endoscopy biopsies was investigated. Forty-six patients with linitis plastica who had undergone EUS-FNA were retrospectively studied, and their clinicopathological data were examined. Among the 46 eligible patients, 38 cases were diagnosed clearly by EUS-FNA. There were 24 cases with lymph node metastasis in the 38 patients. Both the lymph nodes and gastric lesions were punctured by EUS-FNA in the 24 cases. We compared the diagnostic accuracy in different sites, and the results showed that the diagnostic accuracy in lymph nodes was significantly higher than that in gastric lesions (P<0.05). Among them, 16 patients underwent surgical resection, and the accuracy of the pathological diagnosis by EUS-FNA was 87.5% (14/16). The preoperative diagnostic accuracy of T and N staging by endoscopic ultrasound (EUS) were both 75%. Neither severe hemorrhage nor perforation occurred in any patient. In conclusion, EUS-FNA is a safe and effective procedure for the diagnosis of indefinite linitis plastica, and puncturing metastatic lymph nodes can improve the diagnostic accuracy.
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Cui X, Zhou T, Jiang D, Liu H, Wang J, Yuan S, Li H, Yan P, Gao Y. Clinical manifestations and endoscopic presentations of gastric lymphoma: a multicenter seven year retrospective survey. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:566-571. [DOI: 10.17235/reed.2017.4882/2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lim H, Lee GH, Na HK, Ahn JY, Lee JH, Choi KS, Kim DH, Choi KD, Song HJ, Jung HY, Kim JH, Kim D, Park YS. Use of Endoscopic Ultrasound to Evaluate Large Gastric Folds: Features Predictive of Malignancy. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2614-2620. [PMID: 26119461 DOI: 10.1016/j.ultrasmedbio.2015.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 05/20/2015] [Accepted: 05/22/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to investigate with endoscopic ultrasound (EUS) the features of the gastric wall that can be used to predict malignant disease in patients with large gastric folds. We retrospectively reviewed the EUS findings of 65 patients (26 with benign and 39 with malignant disease) with large gastric folds on endoscopy and EUS and analyzed the predictors of malignant disease (e.g., gastric wall thickness, preservation of five-layered structure, thickened layers). Gastric wall thickness (≥9.8 mm), thickened deep layer, thickened muscularis propria and non-preserved wall layer structures were significantly more prevalent in patients with malignant disease on EUS. Among them, gastric wall thickness (≥9.8 mm) (odds ratio = 6.72, 95% confidence interval = 1.23-36.73, p = 0.028) and thickened muscularis propria (odds ratio = 37.14, 95% confidence interval = 7.02-196.49, p < 0.001) were significantly associated with malignant disease. Our data indicate that EUS is a useful tool for assessing large gastric folds and that gastric wall thickness (≥9.8 mm) and thickened muscularis propria are significant features predictive of malignant disease on EUS.
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Affiliation(s)
- Hyun Lim
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, South Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, South Korea.
| | - Hee Kyong Na
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, South Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, South Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, South Korea
| | - Kwi-Sook Choi
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, South Korea
| | - Do Hoon Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, South Korea
| | - Kee Don Choi
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, South Korea
| | - Ho June Song
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, South Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, South Korea
| | - Jin-Ho Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, South Korea
| | - Dowhan Kim
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, South Korea
| | - Young Soo Park
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, South Korea
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Kim JS, Rou WS, Ahn BM, Moon HS, Kang SH, Sung JK, Jeong HY, Song KS. [Gastric perforation caused by primary gastric diffuse large B cell lymphoma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2015; 65:43-7. [PMID: 25603853 DOI: 10.4166/kjg.2015.65.1.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Spontaneous gastric perforation is a rare complication of gastric lymphoma that is potentially life threatening since it can progress to sepsis and multi-organ failure. Morbidity also increases due to prolonged hospitalization and delay in initiating chemotherapy. Therefore prompt diagnosis and appropriate treatment is critical to improve prognosis. A 64-year-old man presented to the emergency department with severe abdominal pain. Chest X-ray showed free air below the right diaphragm. Abdominal CT scan also demonstrated free air in the peritoneal cavity with large wall defect in the lesser curvature of gastric lower body. Therefore, the patient underwent emergency operation and primary closure was done. Pathologic specimen obtained during surgery was compatible to diffuse large B cell lymphoma. Fifteen days after primary closure, the patient received subtotal gastrectomy and chemotherapy was initiated after recovery. Patient is currently being followed-up at outpatient department without any particular complications. Herein, we report a rare case of gastric lymphoma that initially presented as peritonitis because of spontaneous gastric perforation.
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Affiliation(s)
- Ju Seok Kim
- Departments of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Woo Sun Rou
- Departments of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Byung Moo Ahn
- Departments of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hee Seok Moon
- Departments of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sun Hyung Kang
- Departments of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae Kyu Sung
- Departments of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyun Yong Jeong
- Departments of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kyu-Sang Song
- Departments of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
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Shan GD, Xu GQ, Li YM. Endoscopic ultrasonographic features of gastric linitis plastica in fifty-five Chinese patients. J Zhejiang Univ Sci B 2014; 14:844-8. [PMID: 24009205 DOI: 10.1631/jzus.b1200307] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The objective of this study was to investigate the endosonographic appearance of gastric linitis plastica (GLP) and to study the usefulness of endoscopic ultrasonography (EUS) for the T and N staging of GLP. EUS examinations of 55 patients with histologically proven GLP were retrospectively studied. In all patients, EUS showed that lesions involved at least one-third of the circumference of the stomach. Based on the findings of the EUS, the 55 patients were divided into two groups. There were 32 (58.2%) patients in the first group. EUS of this group showed that the five sonographic layers had disappeared and had been replaced by a hypoechogenic thickening of the gastric wall. There were 23 (41.8%) patients in the second group. EUS of this group showed that the first three sonographic layers were blurred and thickened, and the fourth layer was significantly thickened. The full thickness of the gastric wall was significantly thicker in first than in the second group of patients (P<0.01). The incidence of perigastric lesions was significantly higher in the first than in the second group of patients (P<0.01). Results for the 15 patients following preoperative EUS were compared postoperatively with histopathologic findings for T and N staging. The overall diagnostic accuracy of the T stage was 73.3% and of the N stage was 60.0%. In eight patients, we used EUS to assess a therapeutic response. No response was observed in five patients and a partial response in three. EUS images of GLP are characteristic. EUS is helpful in diagnosing GLP and for assessing the T and N stages.
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Affiliation(s)
- Guo-dong Shan
- Department of Gastroenterology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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Sotoudehmanesh R, Mirzaagha F, Kolahdoozan S. Role of Endoscopic Ultrasonography in Patients With Thickened Wall Stomach by CT Scan. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2013. [DOI: 10.1177/8756479312475088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The usefulness of endoscopic ultrasonography (EUS) in patients who have gastric wall thickening in computed tomography (CT) is not clear. All patients referred for EUS due to thickened gastric folds on CT were included in this study. Esophagogastroduodenoscopy (EGD) followed by EUS was performed on all patients. Twenty-eight patients were enrolled in the study. The mean ± SD age was 50.8 ± 15.9 years, and 60.7% were male. Most patients (78.6%) had symptoms, and 10 patients (35.7%) were ultimately diagnosed with a gastric neoplasm. In all patients with a normal EGD (11 patients), the EUS was normal. Accuracy, specificity, sensitivity, positive predictive value, and negative predictive value of EUS for detecting a lesion in thickened wall stomach on CT were 89.3%, 88.8%, 90.0%, 81.8%, and 94.1%, respectively. In patients with a thickened gastric wall by CT, upper gastrointestinal endoscopy should be done before endoscopic ultrasonography, with ultrasonography reserved for those patients with an abnormal EGD. Endoscopic ultrasonography has good sensitivity for lesion detection in cases with an abnormal endoscopy, and the presence of gastric symptoms increases the likelihood of abnormal EUS.
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Affiliation(s)
- Rasoul Sotoudehmanesh
- Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Foroozandeh Mirzaagha
- Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadi Kolahdoozan
- Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Gan SI, Rajan E, Adler DG, Baron TH, Anderson MA, Cash BD, Davila RE, Dominitz JA, Harrison ME, Ikenberry SO, Lichtenstein D, Qureshi W, Shen B, Zuckerman M, Fanelli RD, Lee KK, Van Guilder T. Role of EUS. Gastrointest Endosc 2007; 66:425-34. [PMID: 17643438 DOI: 10.1016/j.gie.2007.05.026] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Pellisé Urquiza M, Fernández-Esparrach G, Solé M, Colomo L, Castells A, Llach J, Mata A, Bordas JM, Piqué JM, Ginès A. Endoscopic ultrasound-guided fine needle aspiration: predictive factors of accurate diagnosis and cost-minimization analysis of on-site pathologist. GASTROENTEROLOGIA Y HEPATOLOGIA 2007; 30:319-24. [PMID: 17662213 DOI: 10.1157/13107565] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS To evaluate a) new diagnoses by endoscopic ultrasound guided real-time fine-needle aspiration (EUS-FNA) compared with EUS alone; b) the predictive factors for an accurate EUS-FNA diagnosis, and c) the cost-effectiveness of the presence of an on-site cytopathologist. PATIENTS AND METHODS Demographic data, ultrasonographic characteristics, technical information on EUS-FNA and cytological results were prospectively collected in 213 patients. The gold standard used was pathological examination or clinical follow-up. Operating characteristics of EUS-FNA, multivariate analysis, and a cost-minimization study of on-site evaluation were performed with these variables. RESULTS Samples were obtained from a total of 262 lesions: extramural masses (n = 115), lymph nodes (n = 96), cysts (n = 40) and intramural lesions (n = 11). The overall accuracy of EUS-FNA was 89% (234/262 lesions). The accuracy of EUS in discriminating between malignant and benign disease was 92% but 105 lesions (40% of the total) were classified as indeterminate. The addition of FNA to EUS allowed almost all lesions (89%) to be diagnosed with an accuracy of 90%. The only variable independently associated with an incorrect diagnosis was intramural location of the target lesion. The effectiveness of EUS-FNA in the complete series progressively increased, reaching a plateau in the fourth pass. The presence of an attendant cytopathologist was cost-effective. CONCLUSIONS EUS-FNA allows diagnosis of most lesions classified as indeterminate by EUS alone. The only factor independently associated with low accuracy is intramural location of the lesion. The availability of an on-site cytopathologist is cost-effective.
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Di Raimondo F, Caruso L, Bonanno G, Naso P, Chiarenza A, Fiumara P, Bari A, Palumbo GA, Russo A, Giustolisi R. Is endoscopic ultrasound clinically useful for follow-up of gastric lymphoma? Ann Oncol 2006; 18:351-6. [PMID: 17065587 DOI: 10.1093/annonc/mdl378] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Endoscopic ultrasound (EUS) is considered the best technique for locoregional staging at diagnosis but its role in the follow-up of patients with gastric lymphoma after organ-conserving strategies has not been established. DESIGN AND METHODS We retrospectively evaluated 23 patients with primary gastric lymphoma treated with a stomach-conservative approach. Sixteen of them were affected by MALT lymphoma and seven by diffuse large-B-cell lymphoma (DLBCL). Five patients were treated with Helicobacter pylori (HP) eradication therapy alone (omeprazole + amoxicillin + clarithromycin); eight patients received a treatment including HP eradication and chemotherapy and the remaining 10 patients were treated with chemotherapy alone. RESULTS At the end of treatment, a complete remission was documented in 21 (91%) patients by endoscopy with biopsy (E-Bx) but in only seven (30%) patients by EUS. A total of 99 evaluations with both EUS and E-Bx were evaluated and we found concordance between the two methods in 33 occasions (33%) only. No significant difference on the percentage of concordance was recorded between MALT and DLBCL. After a median follow-up of 36.5 months we have not observed any relapse in 12 patients (six DLBCL and six MALT) with a persistent positive EUS but negative E-Bx. CONCLUSIONS Although the length of follow-up cannot exclude late relapse, we think that in restaging and follow-up of gastric lymphoma, EUS seems not to be a reliable tool if it is abnormal and E-Bx still remains the gold standard. Therefore, after conventional conservative treatment, persistence of EUS abnormality with a negative histology should not be considered as a clinically relevant persistence of disease and should not be a reason for further treatment.
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MESH Headings
- Adult
- Aged
- Anti-Bacterial Agents/therapeutic use
- Antineoplastic Agents/therapeutic use
- Drug Therapy, Combination
- Endosonography
- Female
- Helicobacter Infections/complications
- Helicobacter Infections/drug therapy
- Helicobacter pylori
- Humans
- Lymphoma, B-Cell, Marginal Zone/complications
- Lymphoma, B-Cell, Marginal Zone/diagnostic imaging
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Male
- Middle Aged
- Retrospective Studies
- Stomach Neoplasms/complications
- Stomach Neoplasms/diagnostic imaging
- Stomach Neoplasms/drug therapy
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Affiliation(s)
- F Di Raimondo
- Divisione Clinicizzata di Ematologia, Università di Catania, Ospedale Ferrarotto, Catania, Italy.
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Ginès A, Pellise M, Fernández-Esparrach G, Soria MT, Mata A, Membrillo A, Martínez-Pallí G, Solé MM, Llach J, Bordas JM, Piqué JM. Endoscopic ultrasonography in patients with large gastric folds at endoscopy and biopsies negative for malignancy: predictors of malignant disease and clinical impact. Am J Gastroenterol 2006; 101:64-9. [PMID: 16405535 DOI: 10.1111/j.1572-0241.2005.00349.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aims of the study were to assess in patients with large gastric folds at endoscopy and endoscopic biopsies that tested negative for malignancy: (i) the predictive variables of malignancy in endoscopic ultrasonography (EUS), (ii) the impact of EUS. METHODS Patients with this condition evaluated with radial EUS (following the standard study protocol of our Unit in these patients) during a 5-yr period were included. Nine variables were evaluated as possible predictors of malignancy (chi2, t-test, and logistic regression procedure) using pathology results, or a minimum of 2 yr of follow-up as gold standard. Likelihood ratios (LR), pre-EUS, and post-EUS probabilities for the diagnosis of malignancy were used to assess the clinical impact of the technique. RESULTS Sixty-one patients were included (40 benign and 21 malignant). Predictive factors of malignancy were as follows: thickened gastric wall, thickened deep layers, impaired gastric distension, loss of the wall structure, and presence of ascites or lymph nodes, whereas the enlargement of superficial layers was a predictor of a benign condition. The enlargement of deep layers, as assessed by EUS was the only independent predictive factor for malignancy. When using this parameter, the pre-EUS probability of malignancy in our series (34%) increased up to 95% when EUS suggested malignancy (positive LR = 45), whereas it decreased to 4.7% when EUS precluded this diagnosis (negative LR = 0.102). CONCLUSIONS (i) The enlargement of deep layers is the only independent predictive factor for malignancy in patients with large gastric folds at endoscopy and biopsies testing negative for malignancy and (ii) EUS has a high clinical impact in these patients.
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Affiliation(s)
- Angels Ginès
- Endoscopy Unit, Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Centre de Diagnòstic Biomèdic Hospital Clínic, IDIBAPS, Barcelona, Spain
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Schmidt WP, Schmitz N, Sonnen R. Conservative management of gastric lymphoma: the treatment option of choice. Leuk Lymphoma 2005; 45:1847-52. [PMID: 15223645 DOI: 10.1080/1042819042000219476] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The study was initiated to assess the safety and effectiveness of primary chemotherapy (CHT) followed by radiotherapy (RT) compared to surgery prior to CHT and/or RT in the management of localized gastric lymphoma. Ninety-two patients treated between 1985 and 2000 were included in a retrospective analysis. Sixty patients received primary CHT followed by extended field or involved field RT. Thirty-two patients had undergone primary surgery prior to referral and were treated with curative or consolidative CHT and/or RT. CHT was carried out according to the CHOP or COP-Blam protocol. Median age was 60 years (29-85). Forty patients had tumor stage IE, 36 II1E and 16 II2E (Musshoff classification). MALT histology was present in 25, diffuse large-cell in 62, lymphoplasmocytic in 4 cases and follicular histology in 1 case. Five-year disease-specific survival was 93% both after primary CHT and after primary surgery (P = 0.8). Five-year relapse-free survival was 91% and 93%, respectively (P = 0.7). No patient experienced gastric perforation or bleeding during CHT. Primary CHT of localized gastric lymphoma is associated with a low risk of treatment-related complications. Survival was similar compared to patients initially treated with surgery. To avoid long-term sequelae after gastric resection, primary CHT is recommended as standard initial treatment in localized gastric lymphoma.
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Affiliation(s)
- Wolf-Peter Schmidt
- Department of Haematology, Allgemeines Krankenhaus St. Georg, Hamburg, Germany.
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Tamerisa R, Irisawa A, Bhutani MS. Endoscopic ultrasound in the diagnosis, staging, and management of gastrointestinal and adjacent malignancies. Med Clin North Am 2005; 89:139-58, viii. [PMID: 15527812 DOI: 10.1016/j.mcna.2004.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Endoscopic ultrasound (EUS) is a superior modality for local staging of gastrointestinal cancer. In interventional endosonography linear array echoendoscopes permit real-time EUS-guided puncture of target lesions for cytologic evaluation of such lesions. This article describes the basic principles of EUS, established indications pertaining to gastrointestinal cancer and other malignancies, and emerging indications for this minimally invasive technology.
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Affiliation(s)
- Radha Tamerisa
- Department of Medicine, University of Texas Medical Branch, 301 University Boulevard, Route 0764, Galveston, TX 77555-0764, USA
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Fukuda A, Kajiyama T, Kishimoto H, Someda H, Sakai M, Seno H, Chiba T. EOSINOPHILIC GASTROENTERITIS WITH PREDOMINANT MUSCULAR LAYER DISEASE: FEATURE OF ENDOSCOPIC ULTRASONOGRAPHY. Dig Endosc 2004. [DOI: 10.1111/j.1443-1661.2004.00416.x] [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: 02/16/2023]
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Abstract
AIM: The purpose of this review is to describe the various aspects of primary gastric lymphoma and the treatment options currently available.
METHODS: After a systematic search of Pubmed, Medscape and MDconsult, we reviewed and retrieved literature regarding gastric lymphoma.
RESULTS: Primary gastric lymphoma is rare however, the incidence of this malignancy is increasing. Chronic gastritis secondary to Helicobacter pylori (H pylori) infection has been considered a major predisposing factor for MALT lymphoma. Immune histochemical marker studies and molecular biology utilizing polymerase chain reaction have facilitated appropriate diagnosis and abolished the need for diagnostic surgical resection. Advances in imaging techniques including Magnetic Resonance Imaging (MRI) and Endoscopic Ultrasonography (EUS) have helped evaluation of tumor extension and invasion. The clinical course and prognosis of this disease is dependent on histopathological sub-type and stage at the time of diagnosis. Controversy remains regarding the best treatment for early stages of this disease. Chemotherapy, surgery and combination have been studied and shared almost comparable results with survival rate of 70%-90%. However, chemotherapy possesses the advantage of preserving gastric anatomy. Radiotherapy alone has been tried and showed good results. Stage IIIE, IVE disease treatment is solely by chemotherapy and surgical resection has been a remote consideration.
CONCLUSION: We conclude that methods of diagnosis and staging of the primary gastric lymphoma have dramatically improved. The modalities of treatment are many and probably chemotherapy is superior because of high success rate, preservation of stomach and tolerable complications.
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Affiliation(s)
- Ahmad M Al-Akwaa
- Gastroenterology Division, Neelam Siddiqui Oncology Division, Department of Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
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Okanobu H, Hata J, Haruma K, Hara M, Nakamura K, Tanaka S, Chayama K. Giant gastric folds: differential diagnosis at US. Radiology 2003; 226:686-90. [PMID: 12601220 DOI: 10.1148/radiol.2263012080] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate ultrasonographic (US) features in the differential diagnosis of giant gastric folds. MATERIALS AND METHODS One hundred sixty-five patients with giant gastric folds at transabdominal US examination (five with Ménétrier disease, 24 with anisakiasis, 61 with acute gastric mucosal lesion [AGML], 13 with gastric lymphoma, and 62 with scirrhous carcinoma) were examined. With 3-6-MHz curved and 5-11-MHz linear-array transducers, the authors evaluated gastric wall thickness, wall stratification, main thickened layer, echogenicity, and compressibility of the lesion in each case. The Fisher protected least-significant-difference method was used to compare statistically the thickness of the gastric wall among diseases. RESULTS Wall thickness of AGML was significantly (P <.001) less than that of anisakiasis, gastric lymphoma, and scirrhous carcinoma. US findings revealed regular gastric wall thickening of the second or third layer, with preservation of wall stratification in all patients with benign conditions. The fourth layer was thickened only in patients with malignancy. The echogenicity of gastric lymphoma was markedly lower than that of any other condition. Compressibility of scirrhous carcinoma was absent, whereas it was well preserved in all benign conditions. CONCLUSION Transabdominal US can depict gastric wall stratification and is a useful noninvasive modality for differential diagnosis of giant gastric folds.
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Affiliation(s)
- Hideharu Okanobu
- Department of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Japan
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Caletti G, Zinzani PL, Fusaroli P, Buscarini E, Parente F, Federici T, Peyre S, De Angelis C, Bonanno G, Togliani T, Pileri S, Tura S. The importance of endoscopic ultrasonography in the management of low-grade gastric mucosa-associated lymphoid tissue lymphoma. Aliment Pharmacol Ther 2002; 16:1715-22. [PMID: 12269963 DOI: 10.1046/j.1365-2036.2002.01334.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Anti-Helicobacter pylori therapy has been reported to cause regression of low-grade gastric mucosa-associated lymphoid tissue lymphoma in a high percentage of patients. However, in some patients, these lesions persist despite antibiotic treatment. AIM To determine the various endosonographic findings that may predict the regression of low-grade gastric mucosa-associated lymphoid tissue lymphoma post-antibiotics. METHODS Seventy-six patients with Helicobacter pylori-positive gastric mucosa-associated lymphoid tissue lymphoma were studied. Follow-up data were available on 51 patients. All patients were treated with antibiotics. Participants underwent pre- and post-anti-Helicobacter pylori therapy endoscopy with gastric biopsies, followed by endoscopic ultrasonography examination of the stomach. RESULTS Helicobacter pylori was eradicated in 45 of 51 (88%) patients. At the 2-year follow-up, complete regression of mucosa-associated lymphoid tissue lymphoma was seen in 28 of 51 (55%) patients: 12 of 16 (75%) patients in stage T1m N0, 11 of 19 (58%) patients in stage T1sm N0, four of eight (50%) patients in stages T1m N1 and T1sm N1, and one of four (25%) patients in stage T2 N0. None of the stage T2 N1 patients achieved clinical regression. CONCLUSIONS Endoscopic ultrasonography evaluation of gastric mucosa-associated lymphoid tissue lymphoma plays a pivotal role in the initial staging and post-treatment follow-up evaluation of these lesions. Accurate staging is essential in the determination of the optimal treatment modality.
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Affiliation(s)
- G Caletti
- Department of Internal Medicine and Gastroenterology, University of Bologna, Italy.
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Fusaroli P, Buscarini E, Peyre S, Federici T, Parente F, De Angelis C, Bonanno G, Meroni E, Napolitano V, Pisani A, Sottili S, Togliani T, Caletti G. Interobserver agreement in staging gastric malt lymphoma by EUS. Gastrointest Endosc 2002; 55:662-8. [PMID: 11979247 DOI: 10.1067/mge.2002.123421] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND EUS is highly accurate for staging gastric lymphoma. Because stage correlates to outcome, interobserver agreement is mandatory. However, previous studies suggest that interobserver agreement might vary according to T-stage. A multicenter evaluation of observer agreement with respect to endosonographic staging of gastric mucosa-associated lymphoid tissue (MALT) lymphoma was therefore conducted. METHODS Fifty-four patients were studied; 42 were also evaluated after eradication of Helicobacter pylori infection. EUS was performed at different institutions by 10 experienced endosonographers who collected the best photographs for each examination. Interobserver agreement was estimated with kappa statistics. RESULTS Overall interobserver agreement for T-stage was fair, both before and after treatment (kappa = 0.38 and kappa = 0.37, respectively). Overall interobserver agreement for N-stage was substantial before treatment, but only fair after treatment (kappa = 0.63 and kappa = 0.34, respectively). The lowest values of agreement occurred with T1sm (submucosa) and T2 stage lesions. CONCLUSIONS Interobserver agreement for staging of gastric MALT lymphoma by EUS is suboptimal before as well as after treatment of H pylori infection. This evidence suggests that gastric EUS may be more difficult technically compared with EUS of other organs. Lack of agreement is crucial because it influences the choice of therapy and assessment of response to treatment. Good interobserver agreement would permit better communication concerning the clinical status of patients, comparison of the results of different studies, and stratification of patients within clinical trials.
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Affiliation(s)
- Pietro Fusaroli
- Department of Internal Medicine and Gastroenterology, University of Bologna, Italy
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Viana HL, Henrique RM, Ferreira ES, Correia AM, Silva RA, Dias LM, Viana RL. Endoscopic ultrasonography in multiple lymphomatous polyposis. J Clin Gastroenterol 2002; 34:150-4. [PMID: 11782610 DOI: 10.1097/00004836-200202000-00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Two cases of multiple lymphomatous polyposis (MLP) are presented, involving different segments of the gastrointestinal tract. Both cases display the characteristic clinical and pathologic features of MLP. In addition, we were able to document, for the first time, the endoscopic ultrasonographic findings in this disease. This new ancillary diagnostic technique was found to be very helpful in the evaluation of the structural changes of the wall of the gastrointestinal tract and in the detection of affected lymph nodes.
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Affiliation(s)
- Helena Lomba Viana
- Department of Gastroenterology, The Portuguese Cancer Institute, Oporto, Portugal
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