BACKGROUND AND STUDY AIMS: A recent challenge that is increasingly being faced in endoscopy is the use of endoscopic mucosal resection (EMR) to treat differentiated intramucosal gastric cancers smaller than 2 cm. The usefulness of pretherapeutic endoscopic ultrasonography (EUS) in assessing whether this form of treatment is possible remains controversial. PATIENTS AND METHODS: We retrospectively investigated the value of pretherapeutic EUS evaluation in 58 patients with macroscopically early gastric cancer that was histologically differentiated and less than 2 cm in diameter. The patients were classified as negative for endoscopic mucosal resection if EUS showed modifications of the third layer, and as positive if such modifications were not seen. All patients underwent radical surgery and the preoperative EUS findings were compared with the histological findings. RESULTS: The prevalence of metastatic adenopathy was 3% (two of 58). In the lymph-node staging, endosonography had a sensitivity of 0% (neither of two cases), and a specificity of 93% (52 of 56). In assessing the indication for EMR, EUS had a sensitivity of 93% (27 of 29), and a specificity of 86% (25 of 29). CONCLUSIONS: These results suggest that EUS is a promising method of evaluating the indication for endoscopic mucosal resection in early gastric cancer. EUS may improve pretherapeutic prediction of tumor curability by EMR, and may reduce the need for standard gastrectomy.
BACKGROUND AND STUDY AIMS: A recent challenge that is increasingly being faced in endoscopy is the use of endoscopic mucosal resection (EMR) to treat differentiated intramucosal gastric cancers smaller than 2 cm. The usefulness of pretherapeutic endoscopic ultrasonography (EUS) in assessing whether this form of treatment is possible remains controversial. PATIENTS AND METHODS: We retrospectively investigated the value of pretherapeutic EUS evaluation in 58 patients with macroscopically early gastric cancer that was histologically differentiated and less than 2 cm in diameter. The patients were classified as negative for endoscopic mucosal resection if EUS showed modifications of the third layer, and as positive if such modifications were not seen. All patients underwent radical surgery and the preoperative EUS findings were compared with the histological findings. RESULTS: The prevalence of metastatic adenopathy was 3% (two of 58). In the lymph-node staging, endosonography had a sensitivity of 0% (neither of two cases), and a specificity of 93% (52 of 56). In assessing the indication for EMR, EUS had a sensitivity of 93% (27 of 29), and a specificity of 86% (25 of 29). CONCLUSIONS: These results suggest that EUS is a promising method of evaluating the indication for endoscopic mucosal resection in early gastric cancer. EUS may improve pretherapeutic prediction of tumor curability by EMR, and may reduce the need for standard gastrectomy.