The Japanese experience with endoscopic ultrasonography in the staging of gastric cancer.

The Japanese experience with endoscopic ultrasonography in the staging of gastric cancer is reviewed and compared with Western results. Various graphic classifications for prediction of the depth of transmural penetration characterize the Japanese approach. Differentiation of early gastric cancers from advanced cancers has been emphasized, with the concordance rate of the ultrasonographic interpretation and the pathology exceeding 90%. When pre-operative staging by the TNM system was attempted, results were similar to the reports from the West, with overall concordance rate for tumor depth of greater than 80%. The Japanese system of classification may be useful in differentiating advanced cancers from early gastric cancers with co-existing ulceration and fibrosis. The reliability of endoscopic ultrasonography in the pre-operative staging of gastric cancer in Japan is similar to that in the West.