Impact of miniprobes compared to conventional endosonography in the staging of low-grade gastric malt lymphoma.
OBJECTIVE
In patients with low-grade gastric MALT lymphoma, conventional endoscopic ultrasonography (EUS) is considered to be the most accurate modality for locoregional staging. The aim of this study was to evaluate the diagnostic role of ultrasonic miniprobes as part of routine clinical staging.


METHODS
A total of 39 patients who were histologically diagnosed with low-grade MALT lymphoma were reviewed retrospectively before treatment (n = 15) and during follow-up (n = 24). Assessment of tumor penetration into the gastric wall was based on the TNM system. Pathological lymph-node involvement was suggested by the presence of inhomogeneous hypoechoic echo patterns, with clearly demarcated borders. All examinations were carried out using a mechanical miniprobe (Olympus; diameter 2.4 mm, 12 MHz) introduced through the working channel of the endoscope. Ultrasonic miniprobe findings were compared with conventional EUS data and histology.


RESULTS
Using pretreatment endoscopic ultrasonography, gastric lymphomas presented endoscopically with an ulcer (in five of 15 patients) or a diffuse infiltrative pattern (ten of 15 patients). The ultrasonic miniprobe identified a T1 lesion in 53 % (T2, 33 %) and EUS in 60 % (T2, 20 %) of cases. Pathological lymph-node involvement in T1-T2 lesions was diagnosed with the ultrasonic miniprobe in 53 % of cases and with EUS in 60 %. Using endoscopic ultrasonography during the follow-up period, in patients with normal miniprobe ultrasonography (n = 15), the histological examination confirmed a complete remission in all patients. Hypoechoic thickening of the mucosa or submucosa, or both, was seen in nine patients. Endoscopic biopsies in four of these nine patients revealed recurrent lymphoma.


CONCLUSIONS
The ultrasonic miniprobe can be recommended as part of routine care in patients with gastric MALT lymphoma, both initially and during the follow-up period. The clinical significance of ultrasonic miniprobe examinations is that they can be performed as a single-step procedure during diagnostic endoscopy.
Lügering
N
N
Dept. of Medicine B, University of Münster, Münster, Germany. lugering@uni-muenster.de
Menzel
J
J
Kucharzik
T
T
Koch
P
P
Herbst
H
H
Tiemann
M
M
Domschke
W
W
D000328:Adult; D000368:Aged; D019160:Endosonography / Q000295:instrumentation*; D005260:Female; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging*